Keenan Research Centre, St Michael's Hospital.
Health Commun. 2013;28(6):533-45. doi: 10.1080/10410236.2012.702642. Epub 2012 Aug 13.
This article examines treatment recommendations in orthopedic surgery consultations and shows how surgery is treated as "omni-relevant" within this activity, providing a context within which the broad range of treatment recommendations proposed by surgeons is offered. Using conversation analysis to analyse audiotaped encounters between orthopedic surgeons and patients, we highlight how surgeons treat surgery as having a special, privileged status relative to other treatment options by (1) invoking surgery (whether or not it is actually being recommended) and (2) presenting surgery as the "last best resort" (in relation to which other treatment options are calibrated, described and considered). This privileged status surfaces in the design and delivery of recommendations as a clear asymmetry: Recommendations for surgery are proposed early, in relatively simple and unmitigated form. In contrast, recommendations not for surgery tend to be delayed and involve significantly more interactional work in their delivery. Possible implications of these findings, including how surgeons' structuring of recommendations may shape patient expectations (whether for surgery or some alternative), and potentially influence the distribution of orthopedic surgery procedures arising from these consultations, are considered.
本文考察了骨科手术咨询中的治疗建议，并展示了手术在该活动中是如何被视为“全能相关”的，为外科医生提出的广泛治疗建议提供了一个背景。通过使用会话分析来分析骨科医生和患者之间的录音对话，我们强调了外科医生如何通过以下两种方式将手术视为相对于其他治疗选择具有特殊的、优先的地位：（1）援引手术（无论是否实际推荐），以及（2）将手术呈现为“最后的最佳手段”（相对于其他治疗选择进行校准、描述和考虑）。这种特权地位在建议的设计和提出中表现为明显的不对称：手术建议提出得较早，形式相对简单且没有缓和。相比之下，不建议手术的建议往往会被延迟，并在提出时涉及更多的交互工作。这些发现可能产生的影响，包括外科医生的建议结构如何塑造患者的期望（无论是对手术还是其他替代方案），并可能影响由此类咨询产生的骨科手术程序的分布，都将被考虑在内。
