Negotiating last-minute concerns in closing Korean medical encounters: the use of gaze, body and talk

Communication in Primary Healthcare: A State-of-the-Art Literature Review of Conversation-Analytic Research

We report the first state-of-the-art review of conversation-analytic (CA) research on communication in primary healthcare. We conducted a systematic search across multiple bibliographic databases and specialist sources and employed backward and forward citation tracking. We included 177 empirical studies spanning four decades of research and 16 different countries/health systems, with data in 17 languages. The majority of studies originated in United States and United Kingdom and focused on medical visits between physicians and adult patients. We generated three broad research themes in order to synthesize the study findings: managing agendas, managing participation, and managing authority. We characterize the state-of-the-art for each theme, illustrating the progression of the work and making comparisons across different languages and health systems, where possible. We consider practical applications of the findings, reflect on the state of current knowledge, and suggest some directions for future research. Data reported are in multiple languages.

Modeling the Conversation with Digital Health Assistants in Adherence Apps: Some Considerations on the Similarities and Differences with Familiar Medical Encounters

Digital health assistants (DHAs) are conversational agents incorporated into health systems' interfaces, exploiting an intuitive interaction format appreciated by the users. At the same time, however, their conversational format can evoke interactional practices typical of health encounters with human doctors that might misguide the users. Awareness of the similarities and differences between novel mediated encounters and more familiar ones helps designers avoid unintended expectations and leverage suitable ones. Focusing on adherence apps, we analytically discuss the structure of DHA-patient encounters against the literature on physician-patient encounters and the specific affordances of DHAs. We synthesize our discussion into a design checklist and add some considerations about DHA with unconstrained natural language interfaces.

The Role of Empathy in Jordanian Medical Encounters

Patients' satisfaction with their clinical visits is a common indicator of the latter's success. Their satisfaction is then reflected in the outcomes of the visit as satisfied patients are more likely to accept their doctor's diagnosis, treatment suggestions, and advice, as well as trust their future arrangements. In addition, this satisfaction then provides doctors with insight into the effectiveness of empathizing with patients and in terms of dealing with them as humans rather than as an illness. Therefore, this study investigated the role of empathy in Jordanian clinical encounters. A conversation analysis approach was conducted to reveal the types and functional accomplishments of empathy. The findings reveal three types of empathy: acknowledgment, pursuit, and sharing experiences and feelings. This study also found that empathy contributes to the success of medical visits as it plays a helpful role in these medical encounters, such as motivating patients to take care of their health, allowing the doctor to claim knowledge of the patient's problem, and allowing the sharing of strong feelings. Moreover, the empathy sequences then lead into the suggestion sequences, which are likely to improve patients' satisfaction. These findings provide insight into the usefulness of deploying empathy in clinical visits, which can be boosted by designing training courses that aim to help raise doctors' awareness of the value of empathy in medical encounters.

Physician gaze shifts in patient-physician interactions: functions, accounts and responses

OBJECTIVES

Physician gaze towards patients is fundamental for medical consultations. Physicians' use of Electronic Health Records (EHR) affects their gaze towards patients, and may negatively influence this interaction. We aimed to study conversation patterns during gaze shifts of physicians from the patient towards the EHR.

METHODS

Outpatient consultations (N = 8) were eye-tracked. Interactions around physician gaze shifts towards the computer were transcribed.

RESULTS

We found that physician gaze shifts have different interactional functions, e.g., introducing a topic switch or entering data into the EHR. Furthermore, physicians differ in how they account for their gaze shifts, i.e., both implicitly and explicitly. Third, patients vary in treating the gaze shift as an indication to continue their turn or not.

CONCLUSIONS

Our results suggest that physician gaze shifts vary in function, in how physicians account for them, and in how they influence the conversation. Future research should take into account distinctions when relating gaze to patient outcomes.

PRACTICE IMPLICATIONS

Physicians may be aware of the interactional context of their gaze behaviour. Patients respond differently to various types of gaze shifts. How physicians handle gaze shifts can therefore have different consequences for the interaction.

Dietary advice in chronic care: Comparing traditional Chinese and western medicine practiced in mainland China

The study examines dietary advice-giving in regular consultations for patients with chronic conditions in two types of clinical practices: Traditional Chinese Medicine and Western Medicine practiced in mainland China. Dietary habits are unanimously considered relevant to the patient's health, particularly in chronic conditions. This article reports the differences in where and how dietary advice is occasioned and co-constructed by participants in two settings. One significant finding of this paper is that while Traditional Chinese Medicine doctors take dietary talk to instruct patients and put it into the treatment recommendation, WM doctors may treat it as incidental and only valuable for diagnostic assessment, leaving its treatment opaque and not discussed with the patient. Data are in Mandarin Chinese. Using Conversation Analysis, the article describes the interactional organisation of dietary advice delivery in different medical practices and ascribes their differences to clinical pathology.

Presentation of patients' problems during triage in emergency medicine

OBJECTIVE

To investigate different interactional patterns in presentation of patients' problems depending on whether the presentation is made by patients themselves, or by their accompanying persons.

METHODS

Routine provider-patient interactions during triage were video-recorded at an academic emergency department in Seoul, Korea. Using the method of conversation analysis, 242 recordings were transcribed and analyzed in terms of the extent of problem presentation and interactional practices used by the presenting party.

RESULTS

Problem presentation made by accompanying persons was significantly more extensive than that by patients, in terms of its length and the number of symptoms described. Patients tended to describe physical conditions they directly experience, such as pain, whereas accompanying persons tended to provide patients' conditions they observed as a third party, often with more objective information such as medical history.

CONCLUSION

Compared to patients who simply present their condition(s), accompanying persons may also communicate their reasonableness in seeking emergency care.

PRACTICE IMPLICATIONS

Providers may utilize more facilitative questioning practices to get a fuller array of concerns when interacting with patients. When accompanying persons present the complaint, providers may acknowledge legitimacy of the visit and ask patients directly to better assess the severity of conditions patients themselves experience.