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Conversation Analysis of Doctor and Patient

2732 words (11 pages) Essay in Psychology

04/04/18 Psychology Reference this

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Conversation Analysis

Overview

To conduct the conversation analysis, the research had to analyze the short recording to the discussion in detail and analyze it from different perspectives like therapeutic, legal, business, health, family, or social context. There are different things in the conversation of people which researcher has analyzed like pause between the conversation and sentences, short and long pause, increase and decrease in the pitch of people, interruptions in conversation and the precise words and phrases used by the people in the conversation. The basic purpose was to identify that how individuals fulfill their goals and how the sense of order is maintained (Maynard, 1997). The conversation which is being analyzed in this researcher paper is institutional talk between doctor and patient.

Methodology

Transcription

A transcription of the conversation is written below. At first the researcher recorded a conversation either in audio or video. Secondly the researcher used the nomenclature, described by Jefferson, to recode the conversation(Woodruff, Szymanski, Grinter & Aoki, 2009). The purpose of nomenclature was to explain the words that are expressed in the conversation and many other verbal features such as the intonation, timing, and other vocal characteristics. During the conversation analysis, the researcher had to listen to conversation repeatedly to identify certain vocal features. Sometimes the help of another researcher was taken to identify whether the transcription used is accurate or not.

Dr: Come’n sit down, (.) Missiz Sampson,=

Pt: =Yes

Dr: Ah

(0.3)

Dr: ¨t¨hhhh |^I |vdon’t think we’ve |^met before |^h’v we

(1.0)

Pt: Well I’ve had this: u-sore throat on’n off, for weeks no:w.=

Dr: =|^Oo dear.

Pt: En I’ve got a cough- writs- it’s- I’ve been you know choking

you know’n I’m[coughin]g- I’m getting no relief from=

Dr: [Mm|^hm,]

Pt: coughing it’s just taw- choking that (.) [( ) back]of=

Dr: [¨h h h h h h ]

Pt: =my[( )

Dr: [Do you bring any |vphlegm up when you |vcough

(0.7)

Pt: Well- (0.2) e-yesterday I managed to be sick’n I di:d you

know,? but normally: i[t-

Dr: [But you: vomited then,

Pt: Ye:s u[h huh

Dr: [Mm.

The conversation nomenclature has been explained in the table below. For example, the (.) explains the a complete but short pause in the conversation. The number written in the brackets would explain the duration of pause in the conversation. Wherever was possible the Para-verbal features to explain and interpret the speech. Moreover, the motive and emotions expressed in conversation are not included in this explanation of conservation.

(.) Just noticeable pause

(0.3) pause of 0.3 seconds, for example

?word Detectable, obvious rise in pitch

?word Detectable, obvious fall in pitch.

words [words… ]

[words… ] Square brackets across adjacent lines implies to individuals are speaking simultaneously

.hh Inhalation

hh Exhalation

wo(h)rd Implies laughter while speaking the corresponding word

hehehe Laughter that is separate from the speech

wor- A sharp termination of the word while speaking

wo:rd Implies the sound that precedes the colon has been elongated

(words) Words in brackets are conjectures when the sound or pronunciation is unclear

( ) Unclear talk. Each set of brackets represents one syllable of unclear speech

word=

=word Implies no pause between two consecutive speakers

word Louder than usual speech

WORD Appreciably louder than usual speech

?word? Quieter than usual speech

>word word< Faster than usual speech

Slower than usual speech

((description)) Double brackets represent descriptions of some verbal behavior that is difficult to write phonetically, such as ((sobbing)) or ((clears throat))

In the explanation of conversation and transcription formation sometimes the precise pronunciation is also presented for example in the transcription “dunno” is preferred over don’t know” if found applicable. To capture the speech styles, the researcher has diverged from the conventional spelling of the words. But when the divergence is in the excess then reader would have struggled to follow the exchange of communication. However, while transcribing the conversation styles and other things like physical movements, manners of the people, their gestures and the cheek scratching to hold the gaze are not included in it. These physical movements cannot be transcribed the vocal and para-vocal features. Moreover, the nuances of these physical movements cannot be presented well.

Interpretation

At the third stage researcher had interpreted the conversation by the transcription made and by replaying the recording. As the first step of interpretation the intuitive interpretation of the action of every person are explained. Secondly the each response has been considered in more detail to uncover the mechanism and devices which has been used in the conversation to maintain the understanding of conversation and fulfill the goals behind conversation.

the first step of this conversation analysis is to analyze the aim of doctor. Clinic of the doctor is the institution which is involved in this conversation analysis. Thus, this particular conversation is example of institutional conversation as describe by Silverman (1997). The basic purpose of the person from the institution(doctor) is to analyze the situation in which patient finds himself at the same time avoiding saying any such word which could make his situation worse.

Another immediate observation which comes from this conversation is that patient is the only and important person who holds the information and is very critical for doctor. This is proximal context of conversation. Researcher can establish this point that it creates a powerful relationship between doctor and patient because of limited to immediate context of interaction between them. This type of conversation is represented by the particular way of conversation management devices are used by both protagonists. By using different conversation methods like sequencing, adjacency pairs along with preferred and dis-preferred responses, patient has made easy for the doctor to analyze the seriousness of his situation. After doctor realizes the seriousness of situation then patients provides packages of information and limited amount of information to doctor when he moves towards the most delicate matter.

Observing this conversation one can observe that from line 6 onwards conversation goes from normal sequential structure to more turbulent one once the topic of conversation turns into more delicate one. More precisely, on line one the doctor greets the patient and after her sitting he tries to identify what is the matter by asking her whether he knows the patient and patient has ever visited him before. After a short pause the patient gives him desired response by telling that she keeps visiting him because of her sore throat. This precision is particularly important to note and could also be dismissed as irrelevant in this analysis if the adjacency pair had not been appeared in the further lines in which the patient has said that he has cough and choking too. Indeed, the caller is using her right of turn taking to tell about her condition to doctor. So in this conversation turn taking and adjacency pairs has been observed.

Once the doctor has listened about the situation of patient he has not given him immediate response but has tried to avoid it and let the patient kept talking so that she could completely tell him about her condition. Here he just said “Oo dear”. In this the expansion of the conversation is observed. “Oo” or “Oh” are another common example of adjacency pair. For example with the “Oh” sound or uttering “really” they intend to expand and elongate the response to a question. “Oh” is the expansion context is an indication of desire to get more information in the opinion of Heritage (1984). Sometimes “Oh” is interpreted differently in other contexts. The response starting with “Oh” to first pair part indicates the reception of information. As explained in this example “Are you going tonight” and “Oh, I’m not sure” as the result of previous remark the state of person has been changed. The answer with Oh implies. The doctor has tried to repair the conversation because he wants the patient to keep going with her condition that is why repairing of conversation is observed where doctor has just said “[Mm|^hm,]”. When patient gives short pause in the conversation the doctor asked about the cough and then a bit long pause is observed in the conversation. This is example of adjacency pair in which doctor is trying to reconfirm the previous statement of patient. After the short pause patient gives the answer to doctor and then doctor asked him whether she did vomit or not then there was prompt answer to the question yes here another type of adjacency pair was observed which is called preferred and un-prefrred actions. Sometimes it happens that first pair parts or questions are answered promptly but sometimes answers are delayed because they are not the preferred actions about which question are asked. The questions answered promptly are preferred one with the delayed answers are regarded as the un-preferred. For example, when any invitation is accepted then it is prompt repose and considered are preferred action and declining the invitation is delayed response and un-preferred action. The un-preferred actions have delayed response because it considered that their answer would create problems in social relationships.

A long and short pause on line 4, 6,11, 14 and 16 , a repair line 11 an expansion of conversation on line 8 are enough to build an argument that this information has made doctor able to analyze that condition of patient is very serious and he can also analyze the situation in which patient finds herself but still getting the previous information of patient is very difficult because of being delicate object as described by Silverman (1997).In this framework the last comment could be made about the patient statement when she says that she is normally sick. This is attempt of building an acceptable account of delicate matter which represents the feature of adjacency repair.

Results and Discussion

The philosophy of ethnomethodology was adopted in conversation analysis, proposed by Harold Lerner, an American sociologist, in his book “Studies in Ethnomethodology” (Lerner, 2004). Social order is considered as illusory according to ethnomethodology. The social world is actually haphazard and random by appears to us in order and is predictable. Individuals in society consider social order as social construction in their minds. Individuals in the society try to uncover the patterns of advice which they receive even though they receive the suggestions randomly.

The conversation analysis is not based not the specific utterance of word or sentence in the person, but it involves the whole discussion and conversation among the individuals. No individual can interpret in the same any conversation. In order to maintain the sense of order in conversation, the people assume that they can maintain the meaning of utterance of words of other persons (Sidnell, 2009).

People in the conversation take the help of subtle and explicate mannerism, expressions and remarks to maintain the illusion that they can and have understood the meaning of the uttered words by the people in conversation. For this purpose, they can and might mimic the emotional expression of another person. Confusion expression is also evident when they see that there is the violation of their expression. To understand the methods and procedures implied by people to cultivate the sense of procedure ethnomethodological research is implied (Peräkylä, 2008). Scholars can infringe upon social rules to conduct a breaching experiment to achieve their goal if they think that conversation is going the wrong way of the road.

Research Questions

Conversation analysis underpins several assumptions

  • Conversation is ordered and systematic no randomness or unstructured conversation aspect was found
  • There is no universal rule to underpin the structure of conversation, but it is the participants of conversation who cultivate the order, structure and context.
  • Even the structure of conversation is cultivated by the participants still conversation patterns are repeated in many contexts and cultures.
  • The basic role of the conversation analysis is to evaluate the skills, devices and methods used to generate order in conversation which guides the communication, goals and helps in understanding the other person.
  • Tough sometimes while conversation people are not aware how to create the order but researcher can generate the order from the real conversations (Liddicoat, 2011).

Complications and applications of conversation analysis

Some scholars opine that sometimes during the conversation people do not consider the key issues like context and structure of conversation which impinge on discourse. The ideology of social order plays key role in the methods which individuals use to maintain the social order, fulfilling their goals. Conversation analysis must consider the pervasive but unobservable issues opined by the proponents of critical discourse analysis. During the analysis of conversation, the political orientation and theoretical assumptions should be avoided opined by Schegloff (2007). These could create the biases in description and interpretation of conversations. A remark can be interpreted as the mean of dominance but can actually facilitate the conversation.

Conversation analysis, however, has bee. Applied to examine the methods and devices individuals apply to maintain and perpetuate inequalities in power. Hutchby (2008), for instance, utilized conversation analysis to show how radio hosts maintain power over their callers. Hutchby showed that radio hosts use various terms or phrases, like “So” or” And”, to challenge the pertinence of an argument. Similarly, radio hosts often ascribe and challenge a position to the caller, summarizing a version of their argument they can readily dismiss. In addition, Hutchby demonstrates that radio hosts do not need to offer their own position, which simplifies their role. In this work, conversation analysis provides a unique insight into the attempts of individuals to maintain power, offering an empirical insight into the theoretical mechanisms that proponents of discourse analysis posit.

References

Forrester, M. (2010).Doing qualitative research in psychology. Los Angeles [i.e. Thousand Oaks, Calif.]: SAGE Publications.

Gardner, R. (2012). Conversation Analysis and orientation to learning.Journal Of Applied Linguistics,5(3). doi:10.1558/japl.v5i3.229

Goodwin, C. (1990). Conversation Analysis.Annual Review Of Anthropology,19(1), 283-307. doi:10.1146/annurev.anthro.19.1.283

Grant, L. (2009). Book review: PAUL TEN HAVE, Doing Conversation Analysis: A Practical Guide. London: SAGE, 2007, 246 pp.Discourse Studies,11(3), 377-379. doi:10.1177/14614456090110030603

Have, P. (2007).Doing Conversation Analysis. London: Sage Publications.

Hutchby, I., & Wooffitt, R. (2008).Conversation analysis. Cambridge: Polity.

Lerner, G. (2004).Conversation analysis. Amsterdam: John Benjamins Pub. Co.

Liddicoat, A. (2011).An introduction to conversation analysis. London: Continuum.

Maynard, D. (1997). The News Delivery Sequence: Bad News and Good News in Conversational Interaction.Research On Language & Social Interaction,30(2), 93-130. doi:10.1207/s15327973rlsi3002_1

Peräkylä, A. (2008).Conversation analysis and psychotherapy. Cambridge: Cambridge University Press.

Schegloff, E. (2007).Sequence organization in interaction. Cambridge: Cambridge University Press.

Sidnell, J. (2009).Conversation analysis. Cambridge: Cambridge University Press.

Sidnell, J., & Stivers, T. (2013).The handbook of conversation analysis. Chichester, West Sussex, UK: Wiley-Blackwell.

Wetherell, M. (1998). Positioning and Interpretative Repertoires: Conversation Analysis and Post-Structuralism in Dialogue.Discourse & Society,9(3), 387-412. doi:10.1177/0957926598009003005

Woodruff, A., Szymanski, M., Grinter, R., & Aoki, P. (2009). Practical Strategies for Integrating a Conversation Analyst in an Iterative Design Process.Palo Alto Research Center,3(1), 3-9. Retrieved from http://www2.parc.com/csl/projects/guidebooks/publications/dis02.pdf

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