Trust, talk and the dictaphone: Tracing the discursive accomplishment of trust in a surgical consultation

Abstract

Using discourse analytical methods, this article examines the interactional accomplishment of trust. Focusing on a case study drawn from a corpus of 28 surgical consultations collected in a gastro-intestinal clinic, it traces the trust-building process in a specific, communicatively challenging encounter where the patient is seeking a second opinion following an operation that she deems unsuccessful. Discourse analytical findings make visible the doctor’s strategic interactional work to build interpersonal trust with the patient and to regain her trust in the surgical profession. This work extends beyond interaction with the patient to include dictation of a letter to the referring doctor in the patient’s presence. Close analysis of the encounter reveals how this co-constructed consultation letter is deployed to strengthen the fragile patient–doctor trust engendered thus far. The article therefore provides insights into the discursive processes of trust building that could potentially be of considerable practical relevance to the medical profession.

Tracing the discursive development of rapport in intercultural nurse–patient interactions

“…Building rapport is a core ingredient in developing a therapeutic relationship between nurses and patients, and research examining social aspects of nurse–patient interactions found that small talk and humour is skilfully integrated with the clinical aspects of patient care by effective nurses (Holmes & Major, ). O'Grady et al (: 9) also found that small talk was ‘purposeful and closely intertwined with the pursuit of clinical goals’. Similarly, the RNs who participated in this research used humour and small talk in the interactions with their patients.…”

“…Good communication skills form a platform for building good nurse–patient relationships, with rapport being a core tenet that underpins effective and compassionate nursing care (Candlin, ; SmithBattle, Leander, Westhus, Freed, & McLaughlin, ). Rapport is defined as the interpersonal experience of harmony, warmth and ‘feeling comfortable with one another’ (Belcher & Jones, , p. 146; O'Grady, Dahm, Roger, & Yates, ). It is distinct from trust which is ‘confidence that the other party will act in one's best interests’ (O'Grady et al, , p. 9), although the two terms are often used interchangeably.…”

“…Rapport is defined as the interpersonal experience of harmony, warmth and ‘feeling comfortable with one another’ (Belcher & Jones, , p. 146; O'Grady, Dahm, Roger, & Yates, ). It is distinct from trust which is ‘confidence that the other party will act in one's best interests’ (O'Grady et al, , p. 9), although the two terms are often used interchangeably. O'Grady et al () suggest that once rapport has been accomplished, a trusting and cooperative therapeutic relationship between patient and health professional is more likely to be achieved.…”

“…It is distinct from trust which is ‘confidence that the other party will act in one's best interests’ (O'Grady et al, , p. 9), although the two terms are often used interchangeably. O'Grady et al () suggest that once rapport has been accomplished, a trusting and cooperative therapeutic relationship between patient and health professional is more likely to be achieved. However if a nurse is having difficulty communicating with a patient, then rapport building and the development of a therapeutic relationship is undermined, potentially resulting in poorer health outcomes (Hamilton & Woodward‐Kron, ).…”

“…Rapport, and subsequently trust, are developed through a co‐constructed, dynamic and interactive process that emerges out of mutual understanding and regard, where the clinician respects the patient's needs and concerns (O'Grady et al, ). O'Grady et al (: 15) also found that rapport and therefore trust are never an absolute accomplishment but rather a ‘gradual, iterative and delicate process that is often diverted by patient wariness and dissent’. Belcher and Jones () found that rapport was built by nurses primarily through active listening and having social conversations with the patients.…”