Sequential analysis of the phasing of the medical interview.
OBJECTIVE
To study an analytical approach towards sequential analysis of the medical interview. An interview phase constitutes the analytical unit. Generally accepted phases of the medical interview are 1) medical history, 2) physical examination and 3) the conclusion segment. While descriptive and prescriptive studies claim that the sequence of the phasing is standard, it is hypothesised that in natural medical conversation the sequencing of the interview is more complex. For the doctor, the sequencing pattern is a powerful device to structure the interview and to manage the interactions within a limited time span. For the patient, especially the conclusion segment will contain more self-selection than other segments. Key concepts are turn taking, topic shift, topic flow, conversational coherence and responsiveness.


METHODS
The data consisted of 800 verbatim transcript pages of 85 medical interviews obtained from general practice. Interplay of theoretical notions and data-driven observations produced a reliable analytical method described in the article. The method enables to study processes of (a)symmetry in medical communication and the ways to deal with problems of misunderstanding.


RESULTS
Results confirmed 1) the asymmetrical character of the interview, 2) the complexity of the phasing, and 3) the existence of several types of interviews.


CONCLUSIONS
The method can be applied for a broad range of research questions.
Meeuwesen
Ludwien
L
Department of General Social Sciences, Utrecht University, PO Box 80.140, 3508 TC Utrecht, The Netherlands. l.meeuwesen@fss.uu.nl
D003142:Communication; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D010817:Physician-Patient Relations