A Conversation Analytical Study Of Recommendations In Doctor-Patient Interaction In Emergency Departments

Recommendations in the interaction between doctors and patients refer to the proposed diagnostic or treatment measures put forward by either party,which are crucial to the success of the doctor-patient communication and lay the foundation for the overall structure of the conversation.The research on treatment recommendations commenced earlier overseas.In China,scholars have focused on analyzing doctors’ treatment recommendations from the standpoint of conversation analysis.Nevertheless,there has been comparatively limited research done on treatment recommendations exchanged between doctors and patients in emergency departments.The emergency department is characterized by a significant flow of individuals and quick access,which results in unique recommendations from both doctors and patients.Based on them,this thesis examines the recommendations of both parties in emergency departments,with the ultimate objective of facilitating interaction between doctors and patients and bolstering the doctor-patient relationship.This thesis adopts the framework of Spencer-Oatey’s Rapport Management(2000).A corpus with 50 cases of real-life emergency departments doctor-patient conversations is used to discuss the recommendations of doctors and patients in emergency departments.In this thesis,conversation analysis is utilized as the research methodology while the research subject undergoes qualitative analysis along with a supplementary quantitative analysis.This thesis intends to address three research questions:(1)What are the features of sequential position and sequential organization of recommendation sequences in emergency departments?(2)How do doctors and patients construct and respond to each other’s recommendations?(3)In what ways can doctors’ and patients’ recommendations in emergency departments be interpreted from the perspective of Rapport Management Theory?Through analysis,the study found that:(1)The position of the recommendation sequences issued by the doctor are usually located after diagnosis,after examination and after the disease-presentation.The position of the recommendation sequences issued by the patient are mainly located after history-taking,after doctor’s recommendation and in beginning stage of the conversation.The recommendation sequences initiated by the doctor mostly contain only the root sequence,reflecting the direct and efficient nature of the recommendation given by the doctor,while the recommendation sequences initiated by the patient contain more insert-expansion sequences and post-expansion sequences,reflecting the patient’s lack of knowledge and other reasons to communicate proactively with the doctor.(2)In terms of constructing recommendations,emergency doctors are used to constructing them by inquiring and stating,and patients are more inclined to inquire and request,and sometimes refer to the treatment experiences of others.Both parties’ responses are divided into acceptance and refusal,with the doctor’s responses of acceptance mainly consisting of minimal acknowledgement and refusal mainly in the form of explanation and interruption.The patient’s acceptance of doctor’s recommendations is mainly minimal approval and repetition,and refusal is mostly expressed in the form of an alternative recommendation or silence.(3)A rapport oriented analysis of the doctor-patient recommendation from face perspective and sociality right perspective is made.Among the types of recommendations,the doctor could basically answer patiently to the patient’s insert-expansion and post-expansion sequences,showing a rapport-reinforcement or maintenance orientation.In most cases,patients give full respect to the doctor in the recommendation construction and response,maintaining the rapport orientation.However,sometimes the doctors still interrupt and refuse to explain when responding to the patients’ recommendations,violating the patients’ right to equality in terms of social rights perspective and violating the rapport orientation,which is due to the difference in authority status and the degree of mastery of medical knowledge between the two parties,but there are few doctors’ violations of the rapport orientation.Therefore,it also reflects to a certain extent the increased awareness of service among doctors,which is also a reflection of social progress.Providing recommendations constitutes a crucial aspect of the interaction between doctors and patients.This thesis utilizes the methodology of conversation analysis to investigate the recommendations provided by doctors and patients in emergency departments.Specifically,this research focuses on analyzing recommendations on a subtle linguistic level in terms of their sequential positions,types and the ways in constructing and responding recommendations,aiming at furnishing guidance for medical practice,putting new ideas into comprehending doctor-patient dynamics and enhancing doctor-patient rapport.