A Conversation Analytic Study Of Companion Participation In Chinese Outpatient Clinical Interctions

Patients regularly attend medical consultations with their companions in Chinese outpatient clinics.Companions are reported to play crucial roles in medical consultations.However,little attention has been paid to companion participation and contributions in Chinese medical consultations.Only few studies have been conducted on companion participation in consultations by adopting conversation analysis(CA)as the research method.Specifically,few CA studies have examined how the interactional work of companion participation is accomplished and responded to by patients and clinicians in different activities of medical consultations,including the activity of medical information gathering,diagnosis delivery,and treatment recommendations.Additionally,there is a dearth of CA studies that investigate how the identities of companions are constructed,negotiated,and oriented by clinicians,patients,and companions through social actions accomplished by mobilizing verbal and non-verbal resources observed in video recordings of three-party interactions among clinicians,patients,and companions.Adopting CA as the research method and employing 79 video recordings of naturally occurring interactions among clinicians,patients,and their companions in the Chinese orthopedic outpatient clinic as the data,the present study investigated the interactional process of companion participation,actions accomplished by companions,and companions’ identities constructed in and through social actions in different activities of medical consultations in three-party interactions among clinicians,patients,and companions in the Chinese orthopedic outpatient clinic.The data was collected by way of video recording and fieldwork after obtaining consent from all participants(clinicians,patients,and their companions).The researcher of this dissertation then transcribed and analyzed the data according to the rules and principles of CA.This study was principally based on the empirical exploration and qualitative analysis of the data and provided a detailed and in-depth examination of companion participation and social actions performed by companions in medical encounters,aiming to investigate how companion participation was constructed to accomplish interactional projects and achieve institutional goals in different activities of consultations.Specifically,the present study aimed:(1)to explore when companion participation occurred,how it interactionally unfolded,and what it accomplished,(2)to examine what social actions were performed by companions in the activities of medical information gathering,diagnosis delivery,and treatment recommendations,and what interactional resources were mobilized by companions to perform these actions,and(3)to investigate the types of identities of companions and how these identities were interactionally constructed,negotiated,and oriented to by clinicians,patients,and companions in and through social actions in outpatient consultations.With regard to the forms of companion participation,the present study revealed two primary ways:solicited companion participation and voluntary companion participation,regarding how companions participated in the consultations and took their turns by taking into consideration the division of labor in medical consultations.In terms of solicited companion participation,clinicians and patients mobilized verbal resources(e.g.,questions and specific address terms)and embodied resources(e.g.,gaze)to direct their talk to companions and select companions as the addressees and next speakers,thus inviting companions to participate in the activities of medical information gathering,diagnosis delivery,and treatment recommendations in consultations.Patients could also recruit companions to participate in consultations by requesting them to do particular activities and seeking their assistance to answer clinicians’ questions.On the other hand,companions volunteered to participate in consultations in the absence of explicit verbal or embodied invitations from clinicians and patients in three sequential contexts in consultations:participating after patients’responses,responding to clinicians’ questions on behalf of patients,and initiating new actions.Furthermore,the findings showed that companions’ self-selections were interactionally and sequentially sensitive,and were context-shaped and co-constructed by clinicians,patients,and companions in particular contextual environments in different activities of outpatient consultations.When it comes to the actions performed by companions,this study revealed that the actions performed by companions were not pre-determined.Instead,they were accomplished and negotiated in different interactional contexts.First,this study identified the overall three-part sequential pattern of companion participation in the activity of medical information gathering:Part I:clinicians asked questions to solicit medically relevant information.Part Ⅱ:patients answered questions.Part III:companions confirmed,endorsed,corrected,and repaired patients’ responses.This study further demonstrated how companions claimed entitlement and encroached on the patients’ epistemic rights.Furthermore,this study also explored the conflicting knowledge claims and corrections made by patients and companions.Second,in the activity of diagnosis delivery,companions could initiate the activity of diagnosis delivery and provide minimal verbal responses,embodied responses,and extended responses to clinicians’ diagnostic statements and explanations.Companions coordinated the diagnostic activity by managing the asymmetries in the clinicians’epistemic domain of expertise and the patients’ and companions’ epistemic domain of experience.Furthermore,companions managed not only the asymmetry in knowledge between clinicians and patients but also the relationship among clinicians,patients,and companions.Third,in the activity of treatment recommendations,companions mainly employed two ways to initiate the activity of treatment recommendations,namely,inquiring about the treatment and proposing candidate treatment.Furthermore,this study investigated companions’ responses to treatment recommendations and identified three categories of companions’ responses:acceptance,passive resistance,and active resistance.Fourth,by examining the social actions performed by companions,this study further revealed that the identities of companions were not pre-determined.Instead,they were constructed through the moment-by-moment accomplishment of social actions with turns-at-talk in interactions and oriented to and co-constructed by clinicians and patients in consultations.It was found that the companions’ identities mainly consisted of the information supporter,the understanding broker,the decisionmaker,the practical supporter,and the emotional supporter in the activities of medical information gathering,diagnosis delivery,and treatment recommendations of outpatient consultations.In terms of the implications of companion participation in clinician-patient interactions in medical settings,this study argued that companion participation was based on companions’ territory of knowledge and deontic authority.Companions displayed and negotiated their asymmetric access to knowledge and their epistemic and deontic authority to participate in and contribute to the interactions in the activities of medical information gathering,diagnosis delivery,and treatment recommendations,thus acting as an informational and interactional resource for clinicians and patients in medical consultations.Therefore,companion participation was not insignificant nor did companions act as the passive third party in Chinese outpatient medical consultations.Instead,they played active,dynamic,and crucial roles in the activities of medical information gathering,diagnosis delivery,and treatment recommendations in medical consultations,such as providing informational and emotional support,facilitating information exchange,brokering mutual understanding,and participating in decisionmaking.Therefore,this study provided an overview of companion participation and contributions in medical consultations,shed some light on the three-party interaction among clinicians,patients,and companions in Chinese outpatient clinics,and had implications for clinician-patient interactions and the relationship between clinicians and patients in medical consultations.