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Last Updated: Nov 18, 2006 - 1:55:25 PM

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Dissecting Doctor Patient Dialogue
Aug 9, 2006 - 3:12:00 PM, Reviewed by: Dr. Himanshu Tyagi

"This is the first time there has been a book that anatomizes the primary-care interview from start to finish"

An international group of conversation analysts has put together a new anthology of studies that explore communication between primary-care doctors and their patients.

Douglas Maynard, a professor of sociology at the University of Wisconsin-Madison, co-edited the new book titled "Communication in Medical Care: Interaction Between Primary Care Physicians and Patients."

"This is the first time there has been a book that anatomizes the primary-care interview from start to finish," says Maynard, who has dissected conversations in various arenas for more than 25 years.

Thinking about doctor-patient interaction is crucial at a time when medical schools are increasingly aware of the need for fruitful interactions between primary caregivers and their patients. Several schools now require students to pass an exam evaluating interaction skills. Meanwhile, medical residency programs are beginning to recruit residents with at least some communication training.

The book targets sociologists, communication experts and medical professionals, and ultimately aims to understand the social organization of medical talk while helping to improve doctor-patient relationships, Maynard says. The sociologist co-edited the anthology with John Heritage, a professor of sociology at the University of California, Los Angeles.

Eighteen researchers from the United States, the United Kingdom and Finland contributed chapters to the book, each analyzing different aspects of the doctor-patient interview. One chapter examines how physicians record patient medical histories, for example, while another analyzes discussions between a doctor and patient about treatment options.

Another chapter, co-authored by Maynard, examines conversations in which physicians announce both bad and good news. Maynard says that is a departure from earlier studies in which researchers primarily focused on doctors delivering bad news, such as a terminal diagnosis or the announcement of a patient's death to family members. Yet, good news can also be problematic in some cases, such as when a patient continues to experience symptoms, even though the doctor has detected no sign of disease.

The book's contributors gleaned insights about communication in the doctor's office through video clips and audio recordings - and the help of very detailed transcripts. Conversation analysts are trained to pick up telling clues from even the tiniest nuance in a verbal exchange. And sometimes, what is not said is almost as important as what is. "Silences in conversations are extremely important," Maynard says. "We actually time them, in tenths of a second."

"Communication in Medical Care" does not mark the first time researchers have thought about doctor-patient interactions, but it is the first time experts have studied in detail the behaviors of both the doctor and the patient, and how the two interrelate.

"Previous work on doctor-patient relationships focused much more on the physicians and what they should or should not do," says Maynard. "But our book is among the first to study how the physician and the patient together contribute to an interaction."

- Published earlier this year by Cambridge University Press, the volume will be on view during the 101st annual meeting of the American Sociological Association in Montreal, to be held Friday-Monday, Aug. 11-14.


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