Kristin Bührig, Latif Durlanik, Bernd Meyer (Hamburg): Multilingual doctor-patient-communication in monolingual hospitals.

Beth Elverdam (Denmark): Personal narratives in general practice - patients' and doctors'.

Yoshimitsu Fujimori, Nozomi Ikeya, Mitsuhiro Okada (Japan): Medical Case Conference as Educational Setting. 

Mark Hartswood, Rob Procter, Mark Rouncefield, Michael Sharpe (Scotland): "I'm happy to sedate him if you want me to": Some Everyday Issues in Patient Disposal.

Mark Hartswood, Rob Procter, Mark Rouncefield, Roger Slack (Scotland): Interactional Practices in Breast Screening Work: A Case Study of Accountability and Professional Vision

Jesper Herman (Denmark): Understanding and Meanings between Patients and Doctors - Ð empirical findings.

Eveliina Korpela (Finland): The work patients do with their answers: providing more than a minimal answer

Camilla Lindholm (Finland): Multi-Unit Question Turns in Doctor-Patient Interaction

Bernd Meyer (Germany): Towards the influence of interpreting on the course of interaction in doctor-patient-communication

Lorenza Mondada (Basel): Interaction at work: how do surgeons operate together through videoconference.

Inger Moos (Denmark): Narrative, identity and interaction in conversation in between caregivers and persons with Alzheimer’s Dementia

Fabian Overlach (Germany): Discursive and Linguistic Patterns in Communication between Dentists and Patients with Chronic Orofacial Pain - Preliminary Results

Johanna Ruusuvuori (Finland): Uses of Interruptions in Finnish Doctor-Partient Communication

Ilana Rischin (Australia): "What else can I say, apart from "It must be very hard for you"? The experiences of overseas born students in interviewing patients".

Berthel Sutter (Sweden): A representational artifact at work in coronary diagnostics.

Hans Tap (Sweden): "Do you mean here?" Analysis of nurse-patient interaction in a video-mediated setting and some implications for design

Kiek Tates, Ludwien Meeuwesen (Utrecht University ): Participation framework in doctor-parent-child-communication

Akiko Yamazaki, Keiichi Yamazaki, Hideaki Kuzuoka, Tetsuo Yukioka (Japan): Co-constructing situation: Conversation analysis of dispatcher-bystander interaction.

Abstracts

Bührig ,Kristin; Durlanik, Latif; Meyer, Bernd (University of Hamburg)

E-mail: kristin.buehrig@talknet.de

Multilingual doctor-patient-communication in monolingual hospitals

The study of multilingual doctor-patient-communication arises out of the fact that over the last decades Germany has gradually become a multilingual country. This has led to a growing need to overcome language barriers in all social institutions. In our research we investigate one specific way to bridge the language barrier in a specific institutional setting: interpreting in hospitals. Interpreting in hospitals is an everyday practise in urban areas in Germany, although it is not officially acknowledged as a professional service. The interpreters are bilingual staff members or relatives of the patient with little or no experience in interpreting. They get drafted ad hoc and receive no payment. Doctor-patient-communication is perceived here as a special type of institutional discourse with specific requirements for both expert and lay person. In this mutual exchange, the various forms of speech actions each have their specific function. The overall question is, how a thirdparticipant, the interpreter, influences the exchange of knowledge between expert and lay person, as well as the entire process of interaction. The analysis is based on transcriptions of authentic tape recordings of briefings for informed consent (GermanÇPortuguese). After a general introduction, the institutional requirements of these briefings will be discussed, as to enable the comparison of propositional and illocutinary dimensions of discourse in source and target language. Moreover, it will be shown how the course of interaction is influenced by the specific needs of the interpreting task.

Elverdam, Beth (University of Southern Denmark)

E-mail: pattac@image.dk, BElverdam@health.sdu.dk

Personal narratives in general practice - patients' and doctors'.

Most common in studies on narratives within medical anthropology are studies of illness narratives. But there are other forms of narratives and theoretical inspiration to be found outside anthropology in related fields as for instance folklore.

Personal narratives are narratives which take off from a specific experience that the narrator has had. They have a common structure: a fluent form, a beginning - a body - and an end. They are at same time an individual presentation and demonstrate cultural norms and attitudes. They may be understood without reference to a context, and they contain a message which tells something important about the narrator as a person.

In anthropological research personal narratives may be found in interviews and through participant observation. In anthropological research in general practice it is possible to distinguish between narratives of the patient and of the doctor, and narratives used in the communication. When analyzed they are similar in form but also have differences.

In my presentation I will show how the structure known from personal narratives may be recognized in narratives from and in general practice. How patients' and doctors' narratives may be analyzed as narratives that adhere to a common structure but that there are significant differences. In a communication perspective, i.e. in the consultations in general practice, narratives may be crucial in discovering the main reason as to why the patient has come to see the doctor. Furthermore the structure of the narrative uses a structure of telling that is unconciously recognized by both patient and doctor. In this capacity the narrative greatly influences the power relation between doctor and patient.

Fujimori, Yoshimitsu (Meiji Gakuin University ); Ikeya, Nozomi (Tokyo University); Okada, Mitsuhiro (Tokyo International Christian University)

E-mail: fujimori@soc.meijigakuin.ac.jp, nozomi@hakusrv.tokyo.ac.jp, bzg00446@nifty.ne.jp

Medical Case Conference as Educational Setting

We have been conducting an ethnographic research at an advanced emergency care centre located west side of Metropolitan Tokyo area. At this Advanced Trauma and Critical Center, which is a part of a large teaching hospital, the case conference is held every weekday morning where the junior doctors report all the previous day cases to the senior administrative doctors.

The primary purpose of this conference, according to one of the senior doctors at an interview, is to manage ICU beds; which means to monitor who’s brought into ICU, who’s currently in, and who is released or transferred from there to somewhere else. In order to achieve this task, it is important for these senior doctors to monitor if the diagnosis and treatment doctors made are correct and appropriate, in addition, since this institution is also a part of a teaching hospital, assessments of these junior doctors by the senior doctors for medical instructional/educational purpose are also important task.

Although we have found that several other tasks were achieved at this conference through our research, we will focus our analysis on educational aspect of it in this presentation. By analysing video-taped data of these conferences from ethnomethodological point of view, we would like to explicate how the participants establish and manage this medical conference as educational setting. We’ll also argue that this task is enabled through participants’ concerted activities.

Hartswood, Mark; Rouncefield, Mark; Procter, Rob (University of Edinburgh); Slack, Roger

E-mail: rnp@dai.ed.ac.uk

’I'm happy to sedate him if you want me to": Some Everyday

Issues in Patient Disposal

 This paper reports on an ethnographic study of the Deliberate Self-Harm (DSH) unit within a large Edinburgh hospital. The main function of the DSH unit is to provide necessary medical treatment and determine the need for further psychiatric and social care, referring patients on as appropriate. Because of its referral role -- in effect negotiating the transfer of patients to other care providers -- the function it performs is commonly known as a ‘liaison service’. Treatment of self-harm incidents may involve complex care pathways that call upon the services of acute medicine, DSH clinicians, GPs, social services and community healthcare agencies. Yet, a number of inquiries have concluded that communications with, and between organisations involved in the provision of mental health care, are often very poor.

The paper explicates features of everyday work and interaction in the DSH unit, typically involving various forms of ‘categorisation’ work requiring the production, utilisation and display of various categorization devices as practical ongoing accomplishments. The identification of ‘relevance’ in the varied activities associated with working with DSH patients, assessing them and ‘disposing’ of them to other care providers, requires the use of members’ knowledge of acts, actors and their contexts, organised as membership categories and category predicates. This involves knowledge of the rights, expectations, obligations, knowledge, attributes and competencies that are expectably and properly done by various persons and organizations. The sorts of practical negotiation undertaken between DSH members and the care providers to which they refer their patients is a matter of arriving at some shared sense of the significance of the matter under discussion and a shared sense of its implicativeness for future courses of action. It is about arriving at shared understandings. The paper presents several instances of the kind of work, mundane interactional competencies, involved in coming to shared understandings about DSH incidents. These categorizations demonstrate the practical accomplishment of various kinds of liaison work, in particular the role of the DSH staff as intermediaries with responsibility for receiving from, and disposing to, the various care provider organisations. From the DSH consultant’s point of view, the practical accomplishment of the work requires learning and knowing how to use, the information, artefacts, files, etc., relevant to the work, and how DSH work meshes with the work of healthcare workers within other organisations. What this identifies are the subtle but essential competencies involved in developing mutual intelligibility, a competence essential to a whole range informalities involved in performing work activities, including ‘knowing how others do their work’, ‘understanding shortcuts’, ‘knowing who to rely upon to get things done’, and so on.

Hartswood, Mark; Rouncefield, Mark; Procter, Rob (University of Edinburgh); Slack, Roger

E-mail: rnp@dai.ed.ac.uk

Interactional Practices in Breast Screening Work: A Case Study of Accountability and Professional Vision

 The goal of screening is to achieve a reliable and controlled cancer detection rate. Two performance parameters are particularly important: specificity and sensitivity. A high specificity (high true positive rate) means that few women will be recalled for further tests unnecessarily; a high sensitivity (low false negative rate) means that few cancers will not be found. Achieving high specificity and high sensitivity is difficult and errors do occur. Current practice in the UK National Health Service Breast Screening Programme (NHSBSP) involves each mammogram being ‘double read’ (examined independently by two radiologists) which has been shown to improve performance compared with single reading (examination by one radiologist only).

As part of a wider programme of research (Hartswood et al, 1998; Hartswood and Procter, 2000a; Hartswood and Procter, 2000b), we have carried out an ethnographic study of work practices at six NHSBSP centres. In this paper, we focus on some of the interactional practices that radiologists take part in so as to make the work they perform as individuals observable-reportable to their peers. These findings raise important questions for the design and use of new technologies, such as computer-aided detection tools, in the NHSBSP, and in medical work more generally.

Our findings show how radiologists reflexively adapt their working practices in order to build and sustain their ‘professional vision’ (Goodwin, 1994), of what constitutes ‘normal’ and what constitutes ‘abnormal’ for mammograms. This, in turn, contributes to the management of performance, both for individual readers and for the group. Of particular interest is the way that radiologists, through the public character of the screening reporting form and the annotations that they add to it, exploit double reading to make their work observable-reportable. In this way, radiologists are able to make some of the practices that are important for the management of their performance inseparable from the actual doing of reading work. To paraphrase Dourish and Button (1998), to do reading work is not simply to engage in rational decision-making behaviour, but is also a way to be seen by others to be so engaged. We conclude that radiologists use annotations as a way of making their work accountable so as to sustain (and sometimes contest) their professional vision.

References

Dourish, P. and Button, G. (1998). On "Technomethodology": Foundational Relationships Between Ethnomethodology and Systems Desig. Human-Computer Interaction, 13, p. 395-432.

Goodwin, C. (1994). ‘Professional Vision’. American Anthropologist. 96; 606-633.

Hartswood, M., Procter, R. and Williams, L. (1998). Prompting in practice: How can we ensure radiologists make best use of Computer-Aided Detection Systems? In Karssemeijer, N. et al. (Eds.) Proceedings of the Fourth International Workshop on Digital Mammography, Nijmegen, Netherlands, June 7th-10th. Kluwer Academic Publishers.

Hartswood, M., Procter, R., (2000a). Computer-aided Mammography: A Case Study of Error Management in a Skilled Decision-Making Task. Topics in Health Information Management, Vol. 20(4), p. 38-54.

Hartswood, M. and Procter, R. (2000b). Designing for Breakdowns and Repairs in Collaborative Work Settings. In Fields, B. and Wright, P. (Eds.) Special issue on

Understanding Work and Designing Artefacts, the International Journal of Human Computer Studies, Vol. 53(May). Academic Press.

Herman, Jesper (University of Copenhagen)

E-mail: J.Hermann@cphling.dk

Understanding and Meanings between Patients and Doctors - Ð empirical findings

Communications between doctors and their patients have recently been scrutinized from many perspectives and in many countries. Several different traditional approaches have been applied, some more sociolinguistically and some more clinically slanted being the most prominent angles. The paper deals with these institutional talks from the vantage point of an integrated psychology of language, e.g. how are the understandings of the participants showing themselves during the ongoing dialogues? How do the speakers show each other that they have both understood "what this is about?" Prior to commenting on samples of these mutual meanings, a few necessary, theoretical notions are discussed, i. e. the mutual and reciprocal relationship between meanings and understandings; and how their respectively intersubjective and private character work together in producing individual outcomes of the clinical communications. I have heard utterances where it is evident for a third party listening in, that they are indeed understanding each other in this context. What it is in their way of talking that, however, makes us think so? I have noticed where the paticipants explicitly discuss the understandings of some specific item by using words like "do you understand what I mean?" or "what do you mean by heart-flickering?" These traces of empirical understandings are employed to highlight some new methodological consequences for investigating language integrated in use.

Korpela, Eveliina (University of Helsinki)

E-mail: karevaar@cc.helsinki.fi

The work patients do with their answers: providing more than a minimal answer

Questions are put to multiple uses in conversation. They can be requests for information or topic openers that offer a space for the co-participant to tell a story or to go on with one. Also invitations, offers and other first pair-parts may be constructed by using the interrogative form. Answers are put to many uses as well, they do not just offer a complying minimal answer to the preceding question.

In my presentation I’m focusing on patients’ sentence-formatted answers to yes-no questions, that is, on cases in which the patient responds with more than just yes or no. Furthermore, I will concentrate on cases in which there is actually no yes or no &emdash; word in the answer at all. Unlike the particles yes and no , sentences do not necessarily have any linguistic element that would allow us to recognize them as answers.

Yes/no questions do not make relevant any report in the development of the problem in their design, a plain confirmation or denial may serve as a sufficient answer to them. That is why the textbooks tell doctors to use open questions (e.g. what’s the matter) during the verbal examination: doctors must not control the patients’ answers. However, it seems that patients answer closed-ended questions often with a full sentence answer. In their answer, they can expand the focus suggested by the doctor or even correct. Using a few examples I’ll consider the function of patients’ full sentence answers, the kinds of work they do in interaction. My data come from the corpus of doctor-patient-conversation in Finnish primary health care.

Lindholm. Camilla (University of Helsinki)

E-mail: cclindho@cc.helsinki.fi

Multi-Unit Question Turns in Doctor-Patient Interaction

Previous studies have shed light on the use of questions in doctor- patient interaction. Researchers such as West (1983) and Frankel (1990) have shown that the interactional pattern to a large extent consists of doctors’ questions and patients’ responses, while the patients only pose few questions. The patients’ questions are often constructed as dispreferred, e.g. by the use of perturbations (West 1983) or presequences, which defer the introduction of the question (Frankel 1990). However, previous research has focused mainly on topic construction and on how questions are related to dominance and interactional control. Therefore, there is a need of complementary studies in order to give further knowledge of the use of questions in doctor- patient interaction.

This paper discusses the doctors’ and patients’ use of multi-unit question turns in Finland Swedish doctor- patient interaction. A multi-unit question turn is a turn, which includes two or more turn construction units, at least one of which has the form or the function of a question. Multi-unit question turns have been examined in previous studies on news interviews (Heritage & Roth 1995, Nylund 2000) and interaction in focus groups (Puchta & Potter 1999). There is no extensive study of the use of multi-unit questions in doctor- patient interaction, even if this subject is touched upon in a paper concerning patients’ initiatives in check-up talks (Sandén et al. 1999).

In my paper, I will first give a brief account of the different types of multi-unit question turns occurring in my data. One type of multi-unit question turns, turns consisting of two or more interrogative turn constructional units, is analyzed in more detail. I will focus on: a) the turn design of these turns consisting of several interrogative TCUs and b) how these turns are responded to. My data consists of 20 videotaped medical consulations (approximately 11,5 hours of talk), which were collected within the project Interaktion i en institutionell kontext (Interaction in an Institutional Context).

References:

Frankel, R. M., 1990: Talking in interviews: dispreference for patient-initiated questions in physician- patient encounters. I: Psathas, G. (ed.), Interaction competence. Lanham MD. S. 231- 262.

Heritage, J. & Roth, A., 1995: Grammar and institution: Questions and questioning in the broadcast news interview. I: Research on Language and Social Interaction 28. S. 1- 60.

Nylund, M., 2000: Iscensatt interaktion. Strukturer och strategier i politiska mediesamtal. [Enacted interaction: structures and strategies in political broadcast discourse.] Skrifter utgivna av Svenska Litteratursällskapet i Finland nr 622. Svenska Litteratursällskapet i

Finland. Helsingfors.

Puchta, C. & Potter, J., 1999: Asking elaborate questions: Focus groups and the management of spontaneity. I: Journal of Sociolinguistics 3 (3). S. 314- 335.

Sandén, I., Sätterlund Larsson, U., Eriksson, C. & Linell, P., 1999: Patients’ initiatives in check-up talks after surgery for testicular cancer. Tema K. Linköping. Ms.

West, C., 1983: ªAsk me no questions...ª. An analysis of queries and replies in physician-patient dialogues. I: Fisher, S. & Todd, A. (ed.), The social organization of doctor-patient communication. Centre for Applied Linguistic, Washington DC. S. 75- 105.

Bernd Meyer (University of Hamburg )

Towards the influence of interpreting on the course of interaction in doctor-patient-communication

Although some work already has been done on interpreted doctor-patient-communication during the last 15 years (Pauwels 1995, Prince 1986, Wadensjö 1998), we still know little about the effect of interpreting on medical interactions as a whole.

This paper investigates the impact of interpreting on the course of briefings for informed consent. Such briefings are obligatory by law before certain types of operations are carried out. They also play an important role for preparing the cooperation between doctor and patient. I will argue that such interactions constitute a specific, pre-organised type of institutional discourse between a medical expert (doctor) and a lay person (patient), which is characterised by different phases (see Biel 1983, Mann 1984, or Meyer 2000 for further discussion and data). The participation of a third person (usually a bilingual relative or staff member) leads to a different course of interaction as the interpretation task allows and sometimes even requires additional activities of "the man (or the woman) in the middle".

References

Biel, M. (1983) Vertrauen durch Aufklärung. Analyse von Gesprächsstrategien in der Aufklärung über die freiwillige Sterilisation von Frauen in einer Klinik. Frankfurt/M. usw.: Lang

Knapp, K. & Knapp-Potthoff, A. (1987) The man (or the woman) in the middle: Discoursal aspects of non-professional interpreting. In: W. Enninger, K. Knapp & A. Knapp-Potthoff (eds.): Analyzing Intercultural Communication. Berlin: Mouton de Gruyter, 181-211

Mann, F. (1984) Aufklärung in der Medizin. Theorie - Empirische Ergebnisse - Praktische Anleitung Stuttgart, New York: Schattauer

Meyer, Bernd (2000) Medizinische Aufklärungsgespräche. Struktur und Zwecksetzung aus dis-kursanalytischer Sicht. In: Arbeiten zur Mehrsprachigkeit (Folge B) Nr. 8 Universität Hamburg: SFB Mehrsprachigkeit (forthcoming)

Pauwels, Anne (1995) Cross-Cultural Communication in the Health Sciences. Communicating with Migrant Patients. Melbourne: Macmillan

Prince, Cynthia D. (1986) Hablando con el Doctor. Communication Problems between Doctors and their spanish-speaking Patients. Ann Arbour: UMI

Wadensjö, C. (1998/2) Interpreting as Interaction. London etc.: Longman

Mondada, Lorenza (University of Basel)

E-mail: lorenza.mondada@unibas.ch

Interaction at work: how do surgeons operate together through videoconference

Interaction at work is becoming a central issue within ethnomethodological and conversational studies. Since the last decade, recorded data from several professional and institutional domains have been scrutinized, in order to describe the detailed ways in which activities and talk-in-interaction are orderly embedded in the collective accomplishment of professional tasks.

In the field of medecine, doctor-patient encounters were first priviledged, but a number of studies are beginning to address issues in communication between experts, within teams, between young doctors and seniors, etc., often taking into account highly technological environments. In this latter framework, my paper aims at describing how the task of performing a surgical operation is interactively accomplished .

In order to do that, I will analyze some particular data, where interaction plays a specific role. They concern a series of operations within the field of laparoscopic morbid obesity surgery; these operations are transmitted on-line through a videoconferencing device to an audience, composed by advanced trainees and a board of experts, who can interact with the chief surgeon during the operation. This device was adopted for didactical purposes but also for experimenting expert advice in real time during the operation, within a more general telemedicine project.

In this paper, I will focus on the interactions between the operating surgeon and an expert, in order to describe how a surgical operation can be interactively performed by the surgeon and his team in the operating rooom and by the expert outside the operating room. In this particular setting, interaction and its sequential organization are constitutive of the task performed. Topics of analysis will be the collective actions where surgeons and experts are performing the task together; the way in which a complex participation space is shaped by different modes of interaction and recipient design; sequences initiated by the surgeon &emdash; for instance by asking for confirmations or advices &emdash; and sequences initiated by the expert &emdash; for instance by challenging the choices made by the surgeon.

Moos, Inger (Aarhus University)

E-mail: schreiber-moos@mail.tele.dk

Narrative, identity and interaction in conversation in between caregivers and persons with Alzheimer’s Dementia

Telling others about your life and experiences is a common way of expressing identity. The assumption of the project is that dementia sufferers in spite of their deteriorating ability to communicate in varying degrees are able to &emdash; and will try to &emdash; express their identity this way. It is essential to caregiving that their hesitating and fragmented narratives are heard.

How the life stories or narratives told by sufferers from Alzheimer’s Dementia express identity in conversation with caregivers, and how the reception of the narratives influences the interaction has not been investigated in Scandinavian Nursing Science. One aim of the project was to create a theoretical frame for analysing this field; another aim &emdash; to be pursued in the autumn 2000 &emdash; is to use the frame in an empirical investigation.

The dysphasia of dementia sufferers and their increasing difficulty in understanding, processing and forming utterances necessitate a theoretical frame that makes it possible to investigate conversational structure and interaction as well as content in naturally occuring conversations.

The Russian literary theorist Mikhail Bakhtins concepts, chronotope and speech genre, can be further developed and used to identify and analyse the narratives of dementia sufferers. Chronotope is the organising matrix of literary, and &emdash; argues the linguist Michael Holquist &emdash; of everyday stories: in the chronotope time and place blend with the value ascribed to the time and the place by the author of the narrative and by the reader or listener in their common culture into an inseparable whole. Speech genres are norms for language use in different situations and can be seen as linguistic contextualisation cues, signals to hint at or identify a context, in the perspective of this project, a narrative. Other contexualisation cures are, according to the sociallinguist John Gumperz, paralinguistic and non-linguistic traits of the conversation that can be used not only to infer, what is being talked about, but also to analyse interaction between conversationalist.

The field of interest being so little investigated makes it difficult, however, once and for all to determine, what constitutes a narrative and a chronotope, and how contextualisation cues are used in the speech of dementia suffers. So the concepts and the theoretical frame must be developed together with and alongside the empirical findings.

Overlach Fabian (University of Freiburg)

E-mail: overlach@unifreiburg.de 

Discursive and Linguistic Patterns in Communication between Dentists and Patients with Chronic Orofacial Pain - Preliminary Results

Chronic orofacial pain is considered to be induced and influenced by a wide range of possible causes. As a consequence, the diagnostic procedure of orofacial pain is a challenging task. Patients’ histories have proved to be indispensable for diagnostic purposes. Nonetheless, little is known about the way in which patients refer to pain in their oral accounts, and how an analysis of their descriptions can be used to differentiate, diagnose, and manage their pain condition. Therefore, it appears to be useful to follow a combined linguistic and medical approach. In doing so, this paper analyzes narratives by ten female patients, who were seeking care for chronic orofacial pain at the Section of Orofacial Pain, Department of Prosthodontics, Dental School, University of Freiburg (Germany).

Three types of data will be used:

1. recordings of the initial appointment with a dentist;
2. recordings of a biographical semi-structured interview with a medical layman;
3. a catalogue of standardized medical questionnaires in written form.

The aim of the project is to show differences between doctor-patient talk and informal interviews with regard to discourse behavior and to linguistic characteristics in patients’ descriptions of chronic pain. The study tries to find possible shortcomings in the initial appointment with the doctor which might in part be due to institutional requirements (such as time limitations), but perhaps also to inadequate diagnostic procedures.

The paper will present data samples from the doctor-patient conversation and preliminary results of the linguistic analysis of these data. From the first type of data, we will distinguish linguistic patterns (such as special lexical and syntactical use) in the description of pain which could be specific to patients with chronic pain in the institutional setting of the initial appointment. In addition, we will show how categories for the description of chronic pain are negotiated between patient and dentist. In a further step, these findings will be compared with linguistic patterns used by patients during the biographical interviews in which the patients describe their pain and its impact on daily activities and social life.

Rischin, Ilana (University of Melbourne)

E-mail: i.rischin@medicine.unimelb.edu.au

What else can I say, apart from "It must be very hard for you"? The experiences of overseas born students in interviewing patients.

Interviewing simulated and real patients is a central part of the undergraduate curriculum at the University of Melbourne. At this university a significant proportion of the student population is overseas born, originating from up to 90 different countries. In my role as a language/cultural support lecturer, I observe students in their tutorials and assessment tasks, as well as offering communication sessions to address their needs. This paper reports on these observations of how overseas born students interact with patients.

Examples will be given of how the inappropriate transfer of cultural knowledge can adversely affect the interview. At times student expectations about the content and style of an interview differ dramatically from the model suggested. This is exemplified in the domain of expressing empathy.

Ruusuvuori Johanna

Uses of Interruptions in Finnish Doctor-Patient Interactions

In both medical and social scientific literature, interrupting the patient has been a major focus of research when evaluating the fluency of medical interaction and the style of consultation of the doctors. Interrupting the patient has been considered as particularly harmful when occurring during the patientís problem presentation at the beginning of the consultation: interruption inhibits the patient from continuing his/her narration of the reason for the visit, and thereby, potentially valuable information of the patientís problem may get lost. This presentation will study interruption in the context of giving and receiving the reason for the visit, drawing upon a data of 84 Finnish general practice consultations. Interruptions are defined in conversation analytical terms, as taking the turn of talk somewhere else within the present speakerís (the patientís) ongoing turn than at or around its possible completion. It will be observed that 1) interrupting is relatively uncommon in the Finnish data, 2) the doctors treat interruption as an accountable act, 3) although mostly the doctors interrupt the patient by starting the verbal examination, this way rushing the agenda, in some consultations interruptions may work in the opposite direction: delaying the shift forward in consultation. It seems that interruption cannot simply and straightforwardly be hooked to one particular outcome in doctor-patient interaction. This finding addresses the importance of taking into consideration both the immediate and the larger activity-contexts in studying interruption.

Sutter, Berthel (University of Karlskrona)

E-mail: berthel.sutter@iar.hk-r.se

A representational artifact at work in coronary diagnostics

In a study of coronary diagnostic work, conducted by two sub-teams 200 kilometers apart via a conference system, I have become interested in the use of a certain artifact, that seems central in coronary work activity. Up to now I have had, in a concrete sense, my point of view from a studio in one of the hospitals, the home site for one of the sub-team. From there I have video-documented the work of the distributed coronary diagnostic meeting, called the heart conference.

The aim of the paper is to give an account of the construction and uses of a representational artifact at coronary diagnostic work. The artifact is the "angiography," an x-ray technology-based visualization of the coronaries after injection of a radiopaque substance. The angiography has turned out to be a central artifact in current coronary diagnostics, not the least in the so called heart conferences, where patient cases are discussed, diagnoses are made, and treatment decided. My research methodology is to focus on one angio patient case, and record its history and transformations.

Therefore, I have in this study gone beyond the borders outlined by the heart conference and expand my observations to the whole cycle of the patient angiography, from its production and uses until the patient, at least temporary, is considered to have got a fair (final) diagnosis and treatment.

The study shows that the representational artifact is not just constructed once and for all. It is first constructed as a digital computer-based representation, but then it is reconstructed, added on, transformed into paper format, used as a shared representation, and also used as a representation for individual uses due to division of labor between professionals. The patient angio is constructed in the angiolab, being prepared for and is used in the heart conference as a tool for diagnoses and as an object of work to investigate and transform. Further, it is used as a guide for the treatment, and is finally used as a summing up documentation of the history of the angio patient.

The results are discussed in terms of 1) mutual co-coaching in collaborative work activity, and 2) the role of the angio representations as an instructive artifact oriented at the object of the work.

Tap, Hans (University of Karlskrona)

E-mail: hans.tap@iar.hk-r.se

"Do you mean here?" Analysis of nurse-patient interaction in a video-mediated setting and some implications for design

In a joint project between a hospital, a medical company and the University of Karlskrona/Ronneby, the aim is to develop new design ideas for existing and future hemodialysis equipment and systems, based on detailed studies of work practices. One goal is to increase the possibilities for patients to conduct hemodialysis without the immediate presence of (skilled) personnel &emdash; for instance in their own homes or in local dialysis centres. One of the main reasons is the rapidly growing number of patients who need to be treated within the framework of a decreasing budget.

In this paper, I present an analysis of an experimental setting where one nurse is guiding a patient in resolving a specific problem through a video conferencing system. Further I discuss how the nurse goes about diagnosing the situation and helping the patient to practically solve a problem. The differences in how the nurse and patient refer to the setting are the main focus of the discussion in the paper. An interesting phenomena is how the patient is able to use deictic expressions together with body movement in a similar way as in face to face interaction when referring to his local setting (e.g. "here?" while pointing to a button), while the nurse needs to refer to the patient’s environment by naming the object and/or by direction. These differences will be discussed and used as a base for design considerations of a future system.

The interaction analysis presented is based on a video taped sequence in the patient’s environment together with field notes and an audio recording from the nurse’s work place. The analysis is inspired by an ethnomethodological perspective, although the conclusions attempt to go beyond the interaction mechanisms as such, and relate the observations to design considerations.

Tates, Kiek; Meeuwesen, Ludwien (Utrecht University )

E-mail: H.Tates@fss.uu.nl, l.meeuwesen@fss.uu.nl

Participation framework in doctor-parent-child-communication

In line with a relationship-centered medical paradigm, it is increasingly acknowledged that children themselves should be involved in decisions about their own health care. This paper explores the interaction in the doctor-parent-child triad at the General Practitioner's Surgery and focusses on the participants'roles and identities as discursively produced.

Videotaped observations of 106 medical interviews involving a doctor-parent-child triad have been analysed (Tates & Meeuwesen, 2000). A sequential analysis of the turn-taking characteristics by means of the Turn Allocation System (Aronsson & Rundström, 1988), and an analysis of the participant's affective and instrumental behaviour (Roter, 1989) reveal that the interaction in the triad is dominated by both adult participants, and that the child's contribution to the medical encounter is rather limited. An important finding is the difference in the way the GP and the parent accommodate their interactional style to the age of the child. Whereas GPs are obviously encouraging older childeren to participate actively in the medical interview, parents seem to restrict child participation, irrespective of the child's age. In addition, a qualitative analysis focusses more extensively on the participation frameworks and the way in which participants orient themselves to their institutional roles and identities. Based on this analysis a typology of triadic medical interviews is being developed, which tries to give a description of the different roles the GP, parent and child may play in medical interaction. This typology will be presented and discussed in terms of roles and identities of the three participants.

Tates, K., & Meeuwesen, L. (2000). Let mum have her say: Turntaking in doctor-parent-child communication. Patient Education and Counseling, 40, 151-162.

Yamazaki, Akiko (University Hakodate); Yamazaki, Keiichi (Saitama University)

Kuzuoka, Hideaki (University of Tsukuba); Yukioka,Tetsuo (Tokyo Medical University)

E-mail: rxu04370@nifty.ne.jp

Co-constructing situation: Conversation analysis of dispatcher-bystander interaction

In this paper, we discuss how dispatchers (professionals at medical institutions) and bystanders (laypersons), co-construct situation and space using their bodies and talk through instructing cardiopulmonary resuscitation (CPR) at a distance.

We conducted research on using telephones for instruction of CPR. One of the crucial procedures of remote CPR instruction is to share indexicality and understanding toward the patient’s body. For medical professionals, the deictic center is always the patient’s body, but for bystanders, it is not fixed: sometimes, the patient’s body and sometimes, the bystander’s body.

In our data, when dispatcher1 asked "Which side of the patient are you on?" Caller1 answered "on the right" with a less confident high pitch, and while turning to look from his (the caller’s, not the patient’s) right. Caller1’s deictic center was his own body, but dispatcher1 questioned him again to confirm it. Then, caller1, while touching the patient’s body, said "Oh, on the left maybe". The Dispatcher’s question for the bystander’s understanding of institution indexicality. Then the dispatcher displayed his understanding for the bystander’s understanding of institutional indexicality and co-constructiong the situtation.

We found three points from interaction between dispatcher and bystander.

For further research, based on these analysis, realizing technical innovations we want to use HMD (Head Mounted Display) instead of telephone for CPR. HMD is now use for medical area and enables people to share their views. It facilitates people to share medical indexicality, understanding and ombodiment.