The Repair Mechanism in the Context of Patient-Initiated Physician-Repair Sequences in the Physician-Patient Communication in a Teaching Hospital in Taiwan

  • 洪 玉芳

Student thesis: Master's Thesis

Abstract

When conversation repair occurs in medical communication, it not only reflects the patient’s uncertainty, but also indicates the existence of communicational gaps between the physician and patient. According to a report from the Taipei City Government’s Department of Health (2007), most medical malpractice cases result from poor communication between physicians and patients. One of the reasons for the poor communication in this context is physicians’ unclear statements, which can lead to the patients’ incomprehension or misunderstanding of the prescribed medication or therapy. Aronsson and Sätterlund (1987) claimed that communicational blocks in medical encounters can increase medical care costs or worse medical care. The aim of conversational repair is to deal with communication blocks in order to improve communication between physician and patients, and thus the purpose of the present study is to investigate what communication problems occur in physician-patient communication, and how physicians resolve these communicational problems in order to carry out successful diagnoses and medical treatment plans. Two research questions are examined: (1) What are the patients’ discursive mechanisms in initiating physicians’ repair and what is the distribution of these mechanisms in response to physicians’ original utterances? (2) What discursive mechanisms are used by physicians to respond to patients’ initiations and what is the distribution of these mechanisms in response to patients’ repair initiations? To answer my two research questions, a total of 21 transcriptions from medical encounters in which 17 physicians, with an average age of 34 years old, and 21 patients, with an average age of 61 years old, were collected from the family medicine department of a teaching hospital in southern Taiwan. In the 21 cases, a total of 46 patient-initiated physician-repair sequences (hereafter ‘repair sequence’) are identified and analyzed in this study. Each repair sequence has three elements: (1) physician’s original utterance (hereafter ‘T1’), (2) patient’s repair initiation (hereafter ‘T2’), and (3) physician’s repair completion (hereafter ‘T3’). The results show that: (1) ‘unlocatable’ repair initiators such as ‘Hann?’ ‘Pardon?’ (69.57%) and ‘specified’ repair initiators such as ‘食啥物? /tsia̍h-siánn-mih?’ ‘eat-what-food?’ (30.43%) are the two main repair initiators used in response to physicians’ original utterances. (2) most physicians’ original utterances are questions (44 out of 46), and they are all situated in the information gathering stage of the medical encounters. (3) Four main patterns are presented in physicians’ discursive mechanisms corresponding to patients’ repair initiations: Pattern I ‘topic restoring’(25%), Pattern II ‘simplification(53.57%), which is further divided into ‘short reply to T2’ (35.71%) and ‘simplifying by partially repeating T1’ (17.86%), Pattern III ‘changing question type from closed to Wh-question’ (14.29%), and Pattern IV ‘the use of the second singular pronoun’ (7.14%). (4) Only the pattern ‘short reply to T2’ corresponds to specified repair initiators, while the other patterns correspond to unlocatable ones. Based on these findings, this study suggests that: (1) greater information accuracy with respect to the content of questions and ways of asking and answering is critical for successful information exchange in the information gathering stage of medical encounters. (2) Topic clarification during information exchange is crucial for successful communication between physician and patient, and this suggestion is based on the presence of a specified repair initiator is right before T1. (3) Physicians are encouraged to make their questions more clear, as this can help patients to understand them, and even if the topic of the current discussion has been indicated in prior turns, it is essential to present it again in subsequent utterances or questions. (4) Inviting for a wide range of patient responses’ about their diseases or concerns can be achieved by changing the question type from a closed ones to a relatively open Wh-questions. (5) Asking questions with a second singular pronoun such as ‘你/汝ni/li’ ‘you’ can draw patients’ attention to the current discussion. Based on these findings and suggestions, two main conclusions are derived from this study. One is that the accuracy of information exchange is vitally important in the information gathering stage of medical encounters, and this can be seen by the presence of topics in the physicians’ questions. Second, eliciting a wider range of patient responses can produce more effective physicians’ question, and this can be achieved by changing the question type. This study has some practical implications with regard to asking questions and responding in the information gathering stage of medical encounters, and thus can help physicians to improve their questioning techniques.
Date of Award2012
Original languageEnglish
SupervisorMei-Hui Tsai (Supervisor)

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