Talk 1: History-taking questions during triage in emergency medicine

Sheung-Hee Lee & Chan Woong Kim

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Triage in emergency medicine is the initial process of assessing and categorizing urgency of patients’ conditions. During triage interaction, nurses proceed by eliciting patients’ complaints and gathering information through history taking and physical exams. This paper examines ways in which nurses manage the task of triage in producing history-taking questions. In video-recordings of triage interactions at an academic emergency department in Korea, nurses pursue history-taking questions along two paths. First, triage nurses tend to undercut urgency of patients’ conditions. They may seek confirmation of a problem patients have described by downgrading its severity. They may also design their questions toward ‘no problem’ responses when asking about urgent risks associated with patients’ problems. Second, nurses tend to search for possible – often, less urgent – causes of patients’ conditions. They thus develop lines of questioning under a particular diagnostic track. In taking these two paths, nurses assess patients’ conditions in ways that rule out their urgency under a diagnostic hypothesis.

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Speaker's bio:

Seung-Hee Lee (Ph.D., UCLA) (presenting and corresponding author) is Professor in the Department of English Language and Literature at Yonsei University, Seoul, Korea. She is a conversation analyst with current interests in practices of talk and action in healthcare contexts. She has published studies on interaction in various settings, including commercial service, healthcare, HIV testing, and ordinary conversation.

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Chan Woong Kim (M.D., Ph.D.) is Professor in the Department of Emergency Medicine, College of Medicine, at Chung-Ang University, Seoul, Korea.

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Talk 2: Recommending no further treatment: Gatekeeping work of generalists at a Japanese university hospital

Shuya Kushida, Michie Kawashima & Tetsuya Abe

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This study explores how recommendations for no further treatment are resisted by patients and how doctors react to resistance in outpatient consultations at a university hospital in Japan. We show how the type of patient resistance shapes doctors' reactions. Problem-focused resistance problematizes the diagnosis or treatment of the patient's problem without focusing on the gate-closing aspect of a recommendation, and is met with doctors’ persuasion through diagnosis-based accounts. Provider-focused resistance focuses on the gate-closing aspect of a recommendation, and leads doctors to manage their dual roles as patient advocate and resource steward. Two subtypes of provider-focused resistance further shape this work differently. Unwillingness-focused resistance is met with persuasion mainly through institution-based accounts. Inability-focused resistance is met with a concession. Doctors systematically respond to patients’ resistance in order to reach an agreement during decision-making. They take measures to reconcile their dual roles, and orient themselves toward the implicit rationale of gatekeeping, which has a moral nature.

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Speaker's Bio:

Shuya Kushida is a professor of sociology at Osaka Kyoiku University. He has been working on psychiatric and primary care consultations from the perspective of conversation analysis. His recent publications include papers on treatment decision-making in psychiatry and patient's justification of visits in primary care consultations.

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Talk 3:  Mild Cataract Patients’ Reactions to Doctors’ ‘No surgery’ recommendations

KK Luke, Augustinus Laude, Yvonne Tse-Crepaldi & Ni-Eng Lim

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Cataract surgery is one of the commonest elective surgeries performed. Surgery is usually recommended either when the visual acuity worsens below a certain level (commonly 6/12), or when it affects daily activities. This paper examines how patients diagnosed with cataracts react to doctors’ recommendations for no-surgery and how doctors handle these encounters. The data comes from video-recordings of consultations with 98 first-visit patients (aged 55 or above) in a specialist eye clinic in Singapore. The transcribed data was examined through the framework of Conversation Analysis. In reaction to doctors’ ‘wait-and-see’ recommendations, some patients displayed understanding, but others appeared to be concerned. A handful of patients inquired about the medical rationale for no surgery; a few expressed dissatisfaction that they would have to live with the blurry vision for an indefinite period of time. The study has implications for clinical communication and healthcare policy.

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Speaker's Bio:

K.K. Luke is President’s Chair Professor of Linguistics at Nanyang Technological University, Singapore. His research is on talk and social interaction using Ethnomethodology and Conversation Analysis. His recent work focuses on doctor-patient interaction in two clinics in Singapore, where issues of empathy displays, multi-party consultations, and patient resistance are explored.