Christian Heath
King's College London

Animating bodies: revealing symptoms in the medical consultation


Pain and suffering are an important feature of many of the difficulties with which patients seek professional medical help. During the consultation patients adopt an analytic standpoint towards their difficulties and yet on occasions they attempt to reveal the very suffering they have incurred. Drawing on field observation and video recordings of general practice consultations, this paper explores the ways in which patients attempt to express their suffering through bodily conduct and talk. In particular, it addresses how patients transpose 'inner feelings' to the body and provide momentary revelations of their personal experience. It also considers how practitioners respond to these revelations and the ways in which they come to inform the diagnosis and management of the complaint.

During clinical investigations, the body becomes an important referential domain, serving to provide both patient and doctor with the signs and symptoms of injury and illness. The body, and its operation, is constituted with regard to the practicalities of diagnosis and management, and is brought to fore, in and through, the action and interaction of the participants. For patients however, who, at least in general practice, have to legitimise their presence in the surgery by disclosing their illness, the revelation of symptoms, may prove problematic. They can describe their difficulties, and yet in many cases, the problem may not be visible to the practitioner, even during the physical examination.

Over the past 20 years great strides have been made in research on the discourse of medical encounters. The Index Medicus lists upwards of 10,000 articles on the topic. A growing number rely on linguistic theory, methods and practice. This "linguistic turn," I will argue, is a welcome development and has actually helped create an evidence base for interaction research that links specific elements of communication and outcomes of care.

According to George Engel (1989) the Interview is, "...the most powerful, encompassing and versatile instrument available to the physician." It is also the most frequently employed medical procedure as the average American physician conducts between 120,000-160,000 interviews in a practice lifetime. Despite this fact the medical interview has been under-research and under-taught in medical training and practice.

My presentation will focus first on a review of the methods and approaches that have been used to study the doctor patient relationship in the modern era. I will then review the evidence that links talk and social interaction to health care outcomes. I will next illustrate how specific elements of language process -- agenda setting, empathy, and delivery of diagnostic information affect both process and outcome in the health care encounter. I will end with a short discussion of the contribution language studies have made to medicine and offer some potential directions for the future.

In the literature on medical consultations, there are two contrasting ways of thinking about the relation between doctors and patients. One emphasizes the asymmetric aspects of this relation, and the other, often programmatically, emphasizes the symmetry between the two parties. Writers who emphasize asymmetry (e.g. Parsons, Freidson and Abbott) point out that the doctor occupies an authoritative position in relation to the patient: he possesses technical and scientific knowledge that enable him to diagnose illnesses, and society has warranted him with the license to decide about and perform treatments. Writers who emphasize symmetry (e.g. Kleinman, Helman and Tuckett) maintain that the doctor-patient relation is or at least should be a more symmetric one. These writers point out that both the doctor and the patient have ideas about the nature, the origin and the possible remedies of the patient's ailment. The consultation could and should be an encounter between two equally resourceful agents where they negotiate diagnosis and treatment. In an ideal case, the parties' views will merge.

In the first part of the presentation, the basic arguments of each these views will be laid out. In the second part of the presentation, data from diagnostic sequences (delivery and reception of diagnosis) from Finnish primary health care will be discussed in this light. It will be shown that the diagnostic sequences accommodate the doctor's authority and his accountability for the diagnostic conclusion, as well as the patient's relative knowledge ability about his or her condition.

Medical Technology and Routines as Resources for Communicative Projects


Medical technologies and routines have their self-envident roles in doctors´ and nurses´ medical tasks of checking up the health status of patients. But they are also used as resources in the conversations between patients and health care professionals.

Using a few examples from different health care settings, I will discuss this additional role of examination and check-up routines and medical tests, and try to shed light on some of the relations between medical tasks and conversational projects.