Drew P, Chatwin J, Collins S
Department of Sociology, University of York, York, YO10 5 DD, UK.
Health Expect. 2001 Mar;4(1):58-70. doi: 10.1046/j.1369-6513.2001.00125.x.
It is clear that much of the success of health-care provision depends on the quality of interactions between health professionals and patients. For instance, it is widely recognized that patients are more likely to take medication effectively if they have been involved in discussions about treatment options, and understand and support the decision about what is prescribed (patient concordance). Hence, patient participation is important for the success of medical outcomes. The key is to explore how communicative choices made by health professionals impact on the quality of interactions in general, and of patient participation in particular. However, to date there has not been an appropriate method for investigating this connection or impact.
To outline the perspective and method of Conversation Analysis (CA). Developed within sociology and linguistics, CA offers a rigorous method (applicable to large data sets) to the study of interaction in health settings.
The method of CA is illustrated through a review of CA studies of doctor-patient interactions. Two such studies, one from the US and the other from Finland, are reviewed, in order to show how CA can be applied to identifying both forms of patient participation, and the interactional conditions which provide opportunities for patient participation. These studies focus principally on the medical examination and diagnostic stages of the consultation. Further research will examine the forms and conditions of patient participation in decision-making.
显然，医疗保健服务的许多成功取决于医护人员与患者之间互动的质量。例如，人们普遍认识到，如果患者参与了关于治疗方案的讨论，理解并支持所开处方的决定（患者依从性），他们更有可能有效地服药。因此，患者参与对于医疗结果的成功很重要。关键在于探索医护人员做出的沟通选择如何总体上影响互动质量，尤其是患者参与的质量。然而，迄今为止，尚未有一种合适的方法来研究这种联系或影响。
概述会话分析（CA）的视角和方法。CA是在社会学和语言学领域发展起来的，为研究医疗环境中的互动提供了一种严谨的方法（适用于大型数据集）。
通过回顾医患互动的CA研究来说明CA方法。对两项这样的研究进行了综述，一项来自美国，另一项来自芬兰，以展示CA如何应用于识别患者参与的两种形式以及为患者参与提供机会的互动条件。这些研究主要关注会诊的医学检查和诊断阶段。进一步的研究将考察患者参与决策的形式和条件。
