Macquarie Medical School, Macquarie University.
Department of Primary Health Care and General Practice, University of Otago.
Health Commun. 2023 Mar;38(3):608-617. doi: 10.1080/10410236.2021.1965278. Epub 2021 Sep 9.
How diagnosis fits within the overall activity structure of surgical consultations remains under-researched. We set out to contribute to this developing area of research with a particular focus on responses to diagnosis as an achievement of patient agency. We identified 26 diagnostic sequences in a collection of 35 video recorded surgical consultations and examined these in detail using conversation analysis. The activity of diagnosis and the transition to treatment recommendation appear to be structured somewhat differently in surgeon-patient consultations than has been reported for primary care settings. In particular, patient responses to diagnosis are more frequent and more likely to be extended. The analysis provides evidence that both parties orient to surgeons' accountability for their own diagnostic reasoning, and also the medical authority of the referring doctor and the subjective experience of the patient. In delivering the diagnosis, the surgeon must be cognizant of the opinions of both the patient and the referring doctor, which may align to a greater or lesser extent with their own diagnosis.
如何在外科会诊的整体活动结构中进行诊断仍然是研究不足的。我们着手研究这一不断发展的研究领域，特别关注将诊断作为患者代理的一种成就的回应。我们在 35 段视频记录的外科会诊记录中识别出 26 个诊断序列，并使用会话分析对其进行了详细检查。诊断活动和向治疗建议的过渡在外科医生-患者会诊中的结构似乎与初级保健环境中的报告有所不同。特别是，患者对诊断的反应更频繁，也更有可能延长。该分析提供了证据，即双方都倾向于外科医生对自己的诊断推理负责，也倾向于参考医生的医疗权威和患者的主观体验。在进行诊断时，外科医生必须意识到患者和转诊医生的意见，这些意见可能在更大或更小程度上与他们自己的诊断一致。
