阻抗诊疗建议的会话常规研究

A Conversational Analysis of Resistance to Medical Recommendations

医疗就诊的一个重要环节是医生依据医学检查和专业评估为患者提供诊疗建议。尽管绝大多数情况下,诊疗建议都会被患者接受;但在一些情况下,患者会做出阻抗。阻抗是一种消极社会行为,影响医患沟通和就诊效果。本研究以自然发生在泌尿外科门诊的真实医患沟通为语料,从会话分析研究视角挖掘患者/家属隐性阻抗诊疗建议的一种会话常规,即疑问语气类重复型他人修正发起。研究发现此类修正发起是一种复合行为,同时执行两种主要行为和一种附着行为。主要行为的识别借助交际对方在随后话轮内的回应,附着行为的识别依赖序列发展。本研究的学术价值在于首次提出了附着行为的概念,并挖掘了执行阻抗的他人修正发起,实用价值则在于医生培训和介入应用。

One important element of medical interactions is the medical recommendations offered to patients by doctors. In most cases, medical recommendations are accepted, though they might be resisted. Resistance to medical recommendations is socially negative, derailing medical interactions and negatively affecting the outcome of medical visits. This paper, based on naturally occurring interactions at the urology department and using conversation analysis as its research methodology, studies one particular conversational practice with which patients/patient families resist doctors ’ medical recommendations, namely the question-intoned repeat-formatted other repair-initiation. Repair initiation of this type is a composite action, delivering two primary actions and one parasitic action. The recognition of the former relies on the doctor’s immediate response in the adjacently following turn while the latter depends on sequence development. This study contributes to the theoretical exploration of parasitic action as an academic endeavour and other repair-initiation as a resistance practice, and helps doctors to effectively deal with resistance with possible training and intervention.