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Tma 03

The doctor and patient had different interpretations of their medical encounter due to constraints on time and communication. Close analysis of language from the consultation shows the doctor spoke for most of the time, interrupting the patient and focusing questions on symptoms rather than underlying issues. While the doctor felt he addressed the problem effectively, the patient was unsure her actual concerns were treated due to the brief interaction. More in-depth analysis could examine non-verbal cues and perspectives from both parties to better understand the disparity in experience.

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Paul Fanning
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49 views

Tma 03

The doctor and patient had different interpretations of their medical encounter due to constraints on time and communication. Close analysis of language from the consultation shows the doctor spoke for most of the time, interrupting the patient and focusing questions on symptoms rather than underlying issues. While the doctor felt he addressed the problem effectively, the patient was unsure her actual concerns were treated due to the brief interaction. More in-depth analysis could examine non-verbal cues and perspectives from both parties to better understand the disparity in experience.

Uploaded by

Paul Fanning
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Why do you think the doctor and the patient have different interpretations about the success of the

encounter?

Drawing on the range of approaches to language analysis that you have come across in Section 3 of the
module materials, demonstrate how close analysis of language can provide evidence for your answer.
Include in your discussion a reflection on:

Why you have chosen particular approaches to language analysis, why they are appropriate for this task, and
how they complement each other.
The limitations of the data you have drawn on, and what additional information or types of data you might
have used to do a more in-depth analysis.

Social context:

In the UK, when someone has a medical problem, the first point of call is their general practitioner (GP), a
local generalist doctor that people tend to be registered with. On average, a GP will see 180 patients a week
and consultations last about 13 minutes (the National Health Service target is 10 minutes per consultation)
and in 90% of cases GPs do not refer people for further tests or specialist consultations, i.e. they deal with
patient problems themselves. Patients sometimes complain that they don’t feel that their GP really listened to
them or gave them a chance to fully explain what the problem was. GPs do say that they wish they had more
time with their patients, but they generally feel that they are able to get at the actual problem in the vast
majority of cases.

(Adapted from Harvey and Koteyko, 2013)

Field notes: on-site observation

Large central London GP surgery: currently with 9 GPs (5 male, 4 female), 2 nurse-practitioners (specialist
nurses: 1 male, 1 female), 2 female nurses and 1 female nutritionist. Waiting room with 5–8 patients waiting
at any one time on day of observation. Patients are generally sitting quietly. Most patients are looking at or
tapping their mobile phones. The walls are painted bright yellow and green, and on them hang several
noticeboards filled with patient information, posters and leaflets. There is a fish tank in one corner, and a
children’s play area in another. The atmosphere is nevertheless busy, with people moving in and out of the
reception area two or three times every two minutes. The main sound in the surgery is the almost constant
ringing of the surgery phone, answered loudly by the receptionists. Receptionists are also heard talking to
patients who arrive throughout the day, as they report to reception. GPs and nurses fetch patients from the
waiting room. Doctor S (GP) under observation stands in doorway of waiting room and loudly calls out
patient names.

Patient C’s appointment is at 10.35 am. At 11.05 am Doctor S collects her from reception and briskly leads
the way into the consultation room. Doctor enters consultation room first. By the time patient arrives at the
door of the consultation room, doctor is already sitting behind his desk typing something into the computer.
Patient hesitates briefly at the door. Doctor asks patient to enter and sit down across the desk from where he
is sat. The doctor's computer screen is not visible to patient. When patient is seated, doctor looks up, smiles
briefly, and greets her with ‘Good morning’. Without pause, doctors asks: ‘What can I do for you today?’
Patient begins to explain problems with stomach. Doctor listens briefly (for approx. 20 secs?), then
interrupts and begins to ask specific questions (as recorded in Extract 1). At end of consultation, patient is
given advice to reduce drinking. Patient gets up to leave, as doctor turns to computer and begins typing.
Patient hesitates at door, turns back. Doctor doesn’t seem to notice. Patient says goodbye again and leaves
consultation room.

Information elicited from brief patient post-consultation questionnaire

Patient C: Female, white, mid-thirties, has university-level education, works as a train manager, Polish
origin. Has lived and worked in the UK for 10 years. Patient’s questionnaire responses indicate that she feels
that, although they have had a pleasant interaction, she isn’t quite sure that the doctor has addressed her
actual problem.

Information elicited from interview with the doctor

Doctor S: Male, white, early fifties, has a medical degree from a prestigious UK university, has been
working as a GP for 20 years, originally from Nottingham, UK, has lived and worked in five locations in
England and Scotland. In his consultation with Patient C, the doctor feels that he deals with the patient
professionally and effectively. However, he is aware that the morning surgery was running behind and says
this may have influenced how he dealt with patients towards the end of the morning.

References

Harvey, K. and Koteyko, N. (2013) Exploring Health Communication: Language in Action, London and
New York, Routledge.

Mishler, E. (1984) The Discourse of Medicine: Dialectics of Medical Interviews, Norwood, NJ, Ablex.

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