Referral Recognition Sequences in Surgeon-Patient Consultations
| Author: | White, Sarah |
| Abstract: | |
| How a consultation begins has implications for the overall structure of the interaction & for the medical outcomes of the visit(1), such as diagnosis, treatment options & patient satisfaction. A key sequence that occurs at the beginning of New Zealand surgeon-patient consultations is the Referral Recognition Sequence (RRS). RRSs involve an implicit or explicit reference to the referring doctor &/or letter. Alignment between patients & surgeons regarding the referral must occur before the consultation is moved on to the next phase. The RRS sets the agenda of the consultation & as such has implications for the overall structure of the consultation. The acceptance or non-acceptance of the referral frames the trajectory for the interaction and initially restricts both the patient & the physician to the agenda set by it. This research shows how the opening phases of surgeon-patient interactions differ from those in primary care; that is, there is a sequence that deals with referrals. It also demonstrates how patient agency is limited through modified or deleted problem presentations & how patients attempt to regain their place to tell their story in surgeon-patient consultations. Conversation Analysis has been successfully used in the analysis of primary care research(2). I have used what is known about the “generic orders of organization”(3) of conversation to analyze the turn-taking, sequence organization & turn design of 35 video-recorded consultations (collected between 2004 & 2006). The data is part of a larger data corpus & includes consultations from general surgery, vascular surgery, breast cancer surgery, & cardiothoracic surgery. |
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