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Topic transitions in physician-patient interviews: Power, gender, and discourse change1

Published online by Cambridge University Press:  18 December 2008

Nancy Ainsworth-Vaughn
Nancy Ainsworth-Vaughn
Affiliation:
Department of English, Morrill Hall, Michigan State University, East Lansing, MI 48824-1036
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Abstract

This article examines the ways topic transitions are made in 12 physician-patient encounters between eight physicians (four men and four women) and eight patients, all women, in private practice settings. The data include visits by the same patient to more than one physician; these data are unique in the literature. I expand both the explicit theoretical frame in which topic transitions have been described and the types of these transitions that need consideration. The two major types of transitions are reciprocal and unilateral activities. Reciprocal topic-transition activities are assumed to share power between physician and patient; unilateral topic transitions are assumed to allocate power to the speaker. Ratios of reciprocal to unilateral activities differ widely by gender of the physician. Change in discourse norms for this event may be in progress, due to increasing numbers of women physicians. (Medical discourse, topic, power, gender, sociolinguistic change, English)

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Type
Articles
Information
Language in Society , Volume 21 , Issue 3 , September 1992 , pp. 409 - 426
Copyright
Copyright © Cambridge University Press 1992

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References

REFERENCES

Arnold, R. M., Martin, S. C., & Parker, R. M. (1988). Taking care of patients – does it matter whether the physician is a woman? Western Journal of Medicine 149:729–33.Google ScholarPubMed
Beckman, H. B., & Frankel, R. M. (1984). The effect of physician behavior on the collection of data. Annals of internal Medicine 101:692–96.CrossRefGoogle ScholarPubMed
Bonanno, M. (1982). Women's language in the medical interview. In DePietro, R. J. (ed.), Linguistics and the professions. Norwood, NJ: Ablex. 27–38.Google Scholar
Brody, D. S., Miller, S. M., Lerman, C. E., Smith, D. G., & Caputo, G. C. (1989). Patient perception of involvement in medical care: Relationship to illness, attitudes, and outcomes. Journal of General Internal Medicine 4:506–11.CrossRefGoogle ScholarPubMed
Brown, G., & Yule, G. (1983). Discourse analysis. (Cambridge Textbooks in Linguistics.) Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Button, G., & Casey, N. (1985). Topic nomination and topic pursuit. Human Studies 8:3–55.CrossRefGoogle Scholar
Crow, B. K. (1983). Topic shifts in couples' conversations. In Craig, R. T. & Tracy, K. (eds.), Conversational coherence: Form, structure, and strategy. Sage Series in Interpersonal Communication. Beverly Hills, CA: Sage Publications. 136–56.Google Scholar
Davis, K. (1988). Power under the microscope. Dordrecht: Foris.Google Scholar
Epps, R. P. (1991). Commencement address. Michigan State University College of Human Medicine, East Lansing.Google Scholar
Fisher, S. (1986). In the patient's best interest: Women and the politics of medical decisions. New Brunswick, NJ: Rutgers University Press.Google Scholar
Fisher, S., & Groce, S. B. (1990). Accounting practices in medical interviews. Language in Society 19:225–50.CrossRefGoogle Scholar
Fishman, P. M. (1983). Interaction: The work women do. In Thorne, B., Kramarae, C., & Henley, N. (eds.), Language, gender, and society. Rowley, MA: Newbury House. 89–102.Google Scholar
Goodwin, M. H. (1990). He said she said: Talk as social organization among black children. Bloomington: Indiana University Press.Google Scholar
Greenfield, S., Kaplan, S., & Ware, J. E. (1985). Expanding patients' involvement in care: Effects on patient outcomes. Annals of Internal Medicine 102:520–28.CrossRefGoogle ScholarPubMed
Have, P. ten. (1989). The consultation as genre. In Torode, B. (ed.), Text and talk as social practice. Dordrecht: Foris. 115–35.CrossRefGoogle Scholar
Hymes, D. (1972). Models of the interaction of language and social life. In Gumperz, J. J. & Hymes, D. (eds.), Directions in sociolinguistics: The ethnography of communication. New York: Holt, Rinehart & Winston. 35–71.Google Scholar
Kaplan, S. H., Greenfield, S. S., & Ware, J. E. (1989). Assessing effects of physician-patient interaction on outcomes of chronic disease. Medical Care 27:110–27.CrossRefGoogle ScholarPubMed
Lazarus, E. (1988). Theoretical considerations for the study of the doctor-patient relationship: Implications of a perinatal study. Medical Anthropology Quarterly 2:34–58.CrossRefGoogle Scholar
Linn, L. S., Cope, , & Leake, B. (1984). The effect of gender and training of residents on satisfaction ratings by patients. Journal of Medical Education 59:964–66.Google ScholarPubMed
Maltz, D. N., & Borker, R. A. (1982). A cultural approach to male-female miscommunication. In Gumperz, J. J. (ed.), Language and social identity. Cambridge: Cambridge University Press. 196–216.Google Scholar
Maynard, D. (1980). Placement of topic changes in conversation. Semiotica 30(3/4):263–90.CrossRefGoogle Scholar
Mishler, E. (1984). The discourse of medicine. Norwood, NJ: Ablex.Google Scholar
Moerman, M. (1988). Talking culture: Ethnography and conversation analysis. Philadelphia: University of Pennsylvania Press.CrossRefGoogle Scholar
Pizzini, F. (1991). Communication hierarchies in humor: Gender differences in the obstetrical gynaecological setting. Discourse and Society 2(4):477–88.CrossRefGoogle Scholar
Schiffrin, D. (1987). Discourse markers. Studies in Interactional Sociolinguistics, 5. Cambridge, UK: Cambridge University Press.CrossRefGoogle Scholar
Searle, J. R. (1969). Speech acts: An essay in the philosophy of language. Cambridge, UK: Cambridge University Press.CrossRefGoogle Scholar
Silverman, D. (1987). Communication and medical practice. London: Sage.Google Scholar
Starr, P. (1982). The social transformation of American medicine. New York: Basic.Google Scholar
Tannen, D. (1989). Talking voices: Repetition, dialogue, and imagery in conversational discourse. Studies in Interactional Sociolinguistics 6. Cambridge, UK: Cambridge University Press.Google Scholar
Tannen, D., & Wallat, C. (1983). Doctor/mother/child communication: Linguistic analysis of a pediatric interaction. In Fisher, S. & Todd, A. (eds.), The social organization of doctor-patient communication. Washington, DC: Center for Applied Linguistics. 203–20.Google Scholar
West, C. (1984). Routine complications: Troubles with talk between doctors and patients. Bloomington: Indiana University Press.Google Scholar
West, C. (1990). Not just doctor's orders: Directive-response sequences in patients' visits to women and men physicians. Discourse and Society 1(1):85–112.CrossRefGoogle Scholar
West, C., & Garcia, A. (1988). Conversational shift work: A study of topical transitions between women and men. Social Problems 35:551–73.CrossRefGoogle Scholar
Widdowson, H. (1979). Explorations in applied linguistics. London: Oxford University Press.Google Scholar