title: Engagement of patients with psychosis in the consultation: conversation analytic study.
abstract: OBJECTIVE
  To investigate how doctors engage with patients with psychotic illness in routine consultations.
  
  
  METHODS
  Conversation analysis of 32 consultations between psychiatrists and patients with schizophrenia or schizoaffective disorder.
  
  
  METHODS
  Two psychiatric outpatient clinics in east London and south west London.
  
  
  METHODS
  7 psychiatrists and 32 patients with schizophrenia or schizoaffective disorder.
  
  
  METHODS
  Mutual engagement in communication during the consultation.
  
  
  RESULTS
  Patients actively attempted to talk about the content of their psychotic symptoms in consultations by asking direct questions, repeating their questions and utterances, and producing these utterances in the concluding part of the consultation. In response, doctors hesitated, responded with a question rather than with an answer, and smiled or laughed (when informal carers were present), indicating that they were reluctant to engage with patients' concerns about their psychotic symptoms.
  
  
  CONCLUSIONS
  Patients repeatedly attempted to talk about the content of their psychotic symptoms, which was a source of noticeable interactional tension and difficulty. Addressing patients' concerns about their illness may lead to a more satisfactory outcome of the consultation and improve engagement of such patients in the health services.
authors.affiliation: Unit for Social and Community Psychiatry, Barts and the London School of Medicine, Newham Centre for Mental Health, London E13 8SP, UK. r.mccabe@qmul.ac.uk
authors.forename: Rosemarie
authors.initials: R
authors.lastname: McCabe
authors.forename: Christian
authors.initials: C
authors.lastname: Heath
authors.forename: Tom
authors.initials: T
authors.lastname: Burns
authors.forename: Stefan
authors.initials: S
authors.lastname: Priebe
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D017028:Caregivers; D003142:Communication; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011618:Psychotic Disorders / Q000628:therapy*; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology