Doctor-patient interaction at a Jordanian university hospital: A conversation Analysis study

This dissertation is concerned with analysing medical talk from a CA point of view. The data consists of a collection of consultations recorded in a Jordanian hospital. The thesis identifies fundamental patterns that underpin these medical consultations in terms of the overall structure of the interactions and the turns that make up each segment. Attention is paid to those parts where the participants orient to the medical agenda and where they depart from it (referred to as ‘side talk’ (ST)). ST is recurrent in the data and was found to affect the way sequences are opened and closed, the sequences themselves and the turns that constitute them. ST affects the delivering of diagnosis and treatment decisions and making the consultation smoother. Medical talk has been studied in the context of different countries, such as England, Korea, Taiwan and US but not in Jordan. Investigating the sequences and turn- taking in Jordanian medical talk is important in order to discover the culturally specific features of Jordanian consultations and similarities with consultations in other countries. Thus, analysis focused on how doctors open the consultations, how they elicit the necessary information, how diagnosis and treatment are managed and how the interaction is closed. A lack of studies analysing the medical talk in Arab countries in general and in the Jordanian culture in particular is another reason to provide information about the medical interaction from a CA point of view.

The data was collected from a university hospital and the health centre that is affiliated to it in Jordan. A total of 20 audio recorded consultations for 20 patients and eight doctors and residents from the internal clinic were analysed. Ethical consent was obtained from University of Huddersfield, the administration of the hospital and patients and doctors. The data was analysed according to a CA framework in which audio recording was conducted in the doctors’ consultation room, in order to collect the necessary data for the analysis. A quantitative approach was also used to count the frequency of the occurrence of features in the Jordanian consultations, such as the use of the religious greeting ‘peace upon you’ in the opening phase and the use of ‘invocations’ in the closing phase. A transcription to English, including a word by word translation and a functional translation for the utterance as a whole, was performed before starting the analysis procedure. To investigate the overall structure of the medical talk, the findings of Have (2002) and Heritage and Maynard (2006) on the overall structure of doctor-patient interactions was used to inform the current investigation. Analysis revealed that the Jordanian consultations followed the same patterns as identified by these authors based on data drawn from medical interactions in different countries.

The findings show that the medical phases (opening, presenting the complaint, history-taking, diagnosis, treatment and closing) occur in most of the consultations. Each one of these phases had elements that characterise medical talk; some of these features are specific to Jordanian medical talk, such as religious expressions and invocations. Religious expressions and invocations were used to open consultations or to close certain topics before shifting to new ones or to close the consultation as a whole. However, a point of departure from consultations analysed in previous research is the amount of talk that involves moving away from orienting to the medical agenda. Side talk occurred in all the phases of the medical interaction with a higher frequency in the middle of the consultations (presenting the complaint, history- taking, diagnosis and treatment phases) than at the margins (opening and closing). ST was found to play an important role in the organisation of the consultations. It also makes the communication process smoother because it takes participants away from formality of conversation and helps patients to provide doctors with the required information in relaxed context. However, ST was used not just to facilitate the transition from one phase to another. This contrasts with Holmes’ (2000) findings that demonstrated the occurrence of it at the boundaries of social encounters or at transition points within an interaction. The occurrence of ST in different forms, such as joking and compliment shows how it positively affects the consultations; it plays a role convincing patients of diagnosis and treatment decisions.

The overall structure for the Jordanian doctor-patient interaction was found to be in many ways similar to that in other countries. However, certain elements that constructed those medical phases were restricted to the Jordanian Arabic medical talk. These findings provide a compelling resource for King Abdullah University Hospital (KAUH) and other hospitals to help improve doctors’ communication skills. The use of CA provides hospitals with naturalistic and empirical data in addition to a detailed description of how the effective communication occurs in the medical consultations.