Pappas Yannis, Seale Clive
Primary Care and Social Medicine, Faculty of Medicine, Imperial College London, Charing Cross Campus, St. Dunstans Road, London W6 8RP, UK.
Soc Sci Med. 2009 Apr;68(7):1229-37. doi: 10.1016/j.socscimed.2009.01.011. Epub 2009 Feb 7.
This paper describes communication in the opening phases of real-time, video-mediated telemedicine consultations, using the method of conversation analysis, in three NHS settings in the UK. The literature on interaction analysis in face-to-face medical consultations indicates that physicians' capacity to determine topics in consultations is established in the opening phases of the encounter. This is because patients concede the communicative floor to physicians who claim it for themselves by using well-established patterns of interaction. Drawing on 10 teleconsultations, the analysis shows that, for health care professionals and patients, video-mediated telemedicine is unfamiliar terrain, where communication requires constant negotiation of skills and roles, this complexity being added to by the fact that more than one professional participates in the encounter. Analysis of the opening phases of teleconsultations shows them to involve 'floor negotiation' between professionals and between professionals and patients in which they experience discrepancies between suggested 'frames', a term coined by Goffman [Goffman, E. (1974). Frame analysis. New York: Harper and Row.] to indicate interpretive schemas that allow people to understand the meaning of events in interactions in which they participate. Frame attunement is achieved during floor negotiation through various interruptions, interjections and attachments that professionals produce to defend their agenda. The novelty of the setting also made participants negotiate the physical space in which the encounter took place. We make tentative suggestions for the training of participants, based on the limited evidence of this study, which requires extending by further studies based on direct observation.
本文运用会话分析方法，描述了英国国民医疗服务体系（NHS）三个机构中实时视频远程医疗会诊开场阶段的沟通情况。关于面对面医疗会诊中互动分析的文献表明，医生在会诊中确定话题的能力是在会诊开场阶段确立的。这是因为患者会把交流主导权让给医生，而医生通过既定的互动模式来为自己争取主导权。基于10次远程会诊的分析表明，对于医疗保健专业人员和患者来说，视频远程医疗是一个陌生的领域，在这个领域中，沟通需要不断协商技巧和角色，而且不止一名专业人员参与会诊这一事实又增加了这种复杂性。对远程会诊开场阶段的分析表明，这一阶段涉及专业人员之间以及专业人员与患者之间的“话语权协商”，在这个过程中，他们会体验到戈夫曼（戈夫曼，E.（1974年）。《框架分析》。纽约：哈珀与罗出版社。）提出的“框架”之间的差异，“框架”这一术语用于表示解释模式，使人们能够理解他们参与的互动中事件的意义。在话语权协商过程中，通过专业人员为捍卫自己的议程而进行的各种打断、插入语和附加语来实现框架协调。这种新环境还使参与者协商会诊发生的物理空间。基于本研究的有限证据，我们对参与者的培训提出了初步建议，而这需要通过基于直接观察的进一步研究来加以扩展。
