Study On The Structure Of Doctor-Patient Conversation In Outpatient Departments

This article uses the macro overall structure and micro local structure of doctor-patient conversation as the object of study, particularly the former as the most important,The conversation analysis as the main research method, based on the establishment of a small corpus of doctor-patient discourse, through the empirical method,inductive method, comparative method and other methods to comprehensively study the structure of doctor-patient conversation. Finally we try to find the real process of different stages of doctor-patient communication and interaction in details, and through the analysis of the global and local structure try to understand the process, nature, characteristics and the rules of the doctor-patient conversations.And we would like to provide recommended measures to ease tensions in the doctor-patient relationship, and improve the quality of medical services. The main contents are:The first chapter is the introduction part, mainly introduced the doctor-patient’s conversation research status at home and abroad, the significance of this study, the theory and method applied, and the problems to be solved in this paper and the data collection and transcription.The second chapter is the begins and disease presentations stage of the overall structure of doctor-patient conversation. Firstly we analyzes the partitioning problem of overall structure of doctor-patient sessions, determine how to divide the overall structure. Then we discuss the way of the beginning conversation, it is the inquiry, body movements or no discourse. Then we explore the positioning and the characteristics of problem presentation stage, and the way of the patients’ presentation. Finally according to the completion condition of patients’ presentation, we advise that patients should master the discourse skills to expand their illness representations at this stage.The third chapter is the history-taking stage of overall structure of the doctor-patient conversation. A prominent characteristic of this phase is that there is much different types of questions designed by doctors. Through this questions doctors obtain informations of illness and collect data of patients and validate their deductions.This chapter first analyzes the characteristics of doctors question design, such as set agendas, embody presuppositions, convey epistemic stance and incorporate preferences. Then we explore the three principle of doctors’ problem design:principle of optimization, problem attentiveness and principle of recipient design. Finally we classify different types of doctor’s questions, and discusses the effect or restrictions on patient response it act in interactive practice, and advise doctors how to choose the question type, thus reduce the patients limits, and improve visitor satisfaction.The fourth chapter is the stage of diagnosis, treatment recommendations and end stage of the overall structure of the doctor-patient conversation. Emphasis on the interactive way of diagnosis stage, namely the doctors’ diagnostic statement way and patients’ responded way to the doctors’ diagnostic statement. And then we discusses the diagnosis style of Chinese doctors, and it is still doctor-centered style which is lack of explanation, discussion and cooperation. Then we analysis the interactive mode of the stage of treatment recommendations between patients and doctors, and then we explore the different performance of doctors’ authority and responsibility in the two stages. Finally we analysis the way of the over stage of doctor-patient conversation.The fifth chapter is the study of adjacent pairs and turn-taking of the microstructure of doctor-patient conversations. Firstly we discuss the main types of adjacent pairs of doctor-patient conversations, and then analysis the adjacent feature in different stages of the whole structure. And then we explore the turn-taking system of doctor-patient conversation, namely turn-construction component and the turn-taking way, finally we summarize the features of turn-taking of doctor-patient conversation.The sixth chapter is the conclusion part of this paper, mainly summarize the whole content:First, on the mode of communication, conversation between doctors and patients belongs to typical institutional talk. It has significant discourse characteristics and structure mode which is totally different from Courtroom Conversation, classroom sessions, police interrogation discourse,120emergency calls and other institutional session. This structure model has potential constraints, rules and repeatability. Both doctors and patients in the interactive practice perform their behaviors and according to the rules and patterns understand each other’s behaviors. The doctor-patient start with doctors’ questions, and end with the farewell after recommendation. The doctor-patient interactional process is not disorder, but there is a order. The doctor-patient conversation structure can reflect the interaction order and social structure, reflect their status and identity in the interaction.Second, the doctor-patient conversation has a potential whole structure, it can reflect the medical discourse unique features. In the whole structure, each stage has its characteristics, they appeared in different order in the process of interaction, the role of different, different of importance and status, different of deletion possibility, different proportion of time occupancy in the whole structure, different of the doctor authority of power, different of patient autonomy and actively participate degree are also different. In addition, the line between stages is not completely clear, there is often a transition phenomenon. The constitution of the overall structure are closely related the organization’s objectives and tasks. The doctor began to question is to give patients opportunity, and doctors can lock range, and do in-depth investigation. History is a collection of data, diagnosis of disease is to give a positive or negative conclusion, treatment recommendations are directed to the communicative goal.Third, about the medical patient relationship and interactive features, although the doctor-patient have common purpose, but both of them have cooperation,and also conflict and the two sides state is not ideal harmonious, is still in the doctor as the center, and appear asymmetry phenomenon. The doctor opened turn more often, with which patients is less; Turn-construction component of the doctors’ turn are more complex, with relatively patients are simple; The use of plenty of yes-no questions severely restrict patients agendas, and doctors often use interruption mode to grasp the turn; The diagnostic statements which doctors often uses simple are assertions, and they rarely explain and describe to it. In short, in doctor-patient interaction, doctors often control the communication process, and the act of patients are often passive response, the two sides did not reach an equal dialogue and consultation.Fourth, about advice, patients should be actively involved in the interaction process, master the communication skills of different stages, and change from passive to active, break the doctor restrictions, as much as possible to express their opinions. At the same time, we suggest that doctors cannot excessive pursuit of their own technology and efficiency in the diagnosis process, and should pay more attention to patients’ experiences and feelings, in the language of less using restrictive questions, and give patients more expression opportunities, and improve the visitors’ satisfaction.This paper just focuses on the overall structure and made a preliminary preparatory work, there are still many problems to be solved. At the same time, the analysis of doctor-patient’s conversation, and description is more description than explanation, induction than deduction, the depth of the theory of writing is not high enough, to be next to continue mining.