Small talk, high stakes: Interactional disattentiveness in the context of prosocial doctor-patient interaction

Abstract

The literature on “small talk” has not described the way in which this talk, even as it “oils the social wheels of work talk” (Holmes 2000), enables disattending to the instrumental tasks in which one or both participants may be engaged. Small talk in simultaneity can disattend to the movements, bodily invasions, and recording activities functional for the instrumental tasks of medicine. Small talk in sequence occurs in sensitive sequential environments. Surgeons may use small talk to focus away from psychosocial or other concerns of patients that may focus off the central complaint or treatment recommendation related to that complaint. Patients may use small talk to disattend to physician recommendations regarding disfavored therapies (such as exercise). Overall, small talk often may be used to ignore, mask, or efface certain kinds of agonistic relations in which doctor and patient are otherwise engaged. We explore implications of this research for the conversation analytic literature on doctor–patient interaction and the broader sociolinguistic literature on small talk.

Delivering patient choice in clinical practice: a conversation analytic study of communication practices used in neurology clinics to involve patients in decision-making

“…For example, patients may answer 'more than the question' during comprehensive history-taking, 36 make inexplicit requests for a diagnostic test, 37,38 self-initiate problem presentations during prenatal check-ups 39 and resist a doctor's diagnosis 23,40 or treatment recommendation. [41][42][43] In addition, as we discussed in the previous section, there is a handful of studies that have demonstrated how the turn designs selected by doctors can be more or less conducive to subsequent patient participation. 9,[22][23][24] However, CA studies of decision-making in clinical practice have rarely investigated the ways in which doctors might actively invite patients to participate.…”

“…For instance, a study in Finnish primary care 41 showed that -even when doctors produce a recommendation in a manner that appears to expect no responsepatients sometimes go on to introduce their own views in ways that succeed in initiating negotiation and subsequent shaping of the final decision delivery by the doctor. Maynard and Hudak 42 have shown how orthopaedic surgeons (in the USA) pursue acceptance of their recommendations and, like Stivers' 45 paediatricians, do not always succeed. By introducing small talk, patients can produce a topic shift away from the recommendation-relevant talk, avoiding the sought-after acceptance.…”

“…This is also true of our deviant case: having been prescribed a range of AEDs over an extended period of time (see lines 2-5), this patient has -the neurologist tells her -few (viable) options left to try (lines 1, 2 and 6-9). [41][42][43][44][45][46]. Thus, the choice, despite being constructed using all the elements of full form option-listing, is sandwiched between two announcements that alternative treatments are unlikely to be any better at controlling the patient's seizures than the drug she is already taking.…”

‘What Brings Him Here Today?’: Medical Problem Presentation Involving Children with Autism Spectrum Disorders and Typically Developing Children

“…Research on gaze, body movement, spatial alignments and medical instrumentation has elaborated CA into a multi-modal approach and has extended its reach into fields such as surgery (Mondada 2011), anesthesiology (Hindmarsh and Pilnick 2007), dentistry (Hindmarsh et al 2011), and the uses of imaging technologies (Nishizaka 2013). CA methods have also been applied to medical specialties such as cancer (Beach and Anderson 2003), autoimmune deficiency syndrome (Peräkylä and Bor 1990), orthopedics (Hudak and Maynard 2011; Maynard and Hudak 2008), pediatric pain management (Clemente 2009), and a variety of aspects of childbirth (Kitzinger 2011). CA has also been used in studies of sensitive medical care topics such as future illness progression and end of life (Parry et al 2014).…”

English for the Workplace: Doing Patient-Centred Care in Medical Communication

“…In contrast, all the NESs successfully employed small talk to achieve a number of relational and medical goals (see Coupland, Robinson, & Coupland, 1994;Maynard & Hudak, 2008), although Nina, who was less experienced than the others, made only one social statement. Casual small talk help to give medical encounters a more relaxed conversational tone (Ragan, 2000), and comments about Aaron's parents, for example, aided participants in determining the social circumstance of the patient.…”