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Conversation Analysis

4. CA and the Medical Encounter

Levels of Analysis

CA approaches the medical visit at several levels of analysis, which can easily be seen in the acute primary care visit.

  1. Overall phase structure
  2. Sequence Organization
  3. Turn Design
  4. Lexical Choice

Overall Phase Structure

At the broadest level is the overall structure of the visit. This has been institutionalized in American medicine since the 1880s and taught in medical school, and has been learned inductively by patients ever since. An ideal model of this structure, recognizable to clinicians and patients alike is represented below.

Figure 1

Phase Structure of the Acute Care Primary Visit (Based on: Byrne and Long, 1976)

Figure of the Phase Structure of the Acute Care Primary Visit as described in the text.

As Byrne and Long (1976) note, this structure is idealized: many visits embody departures from this organization (Robinson, 2003). However its value does not lie in its capacity for exact representation of the events of the medical consultation, but rather in the ways it supplies the participants with a normative road-map or schema of how medical visits normally run. With the use of this schema, the participants can orient themselves to:

  • Recognizable landmarks in the visit;
  • The relevancies that come into play during particular phases;
  • Appropriate and expectable conduct given a particular phase; and
  • What may be expected to happen next.

This orientation is highly visible at phase boundaries, where phase transition is imminent or contested (Robinson and Heritage, 2005; Robinson and Stivers, 2001).

Byrne P.S., Long B.E.L. (1976). Doctors talking to patients: A study of the verbal behaviours of doctors in the consultation. London: Her Majesty's Stationary Office.
Byrne P.S., Long B.E.L. (1976). Doctors talking to patients: A study of the verbal behaviours of doctors in the consultation. London: Her Majesty's Stationary Office.
Robinson J. D., Stivers T. (2001). Achieving activity transitions in primary-care encounters: From history taking to physical examination. Human Communication Research 27(2): 253-298.