医患互动中患者的迂回答复与医生的对策

On patients\evasive responses and doctors\countermeasures in doctorpatient interaction

本文基于会话分析研究,针对医患在问诊时病史采集的互动。主要探讨新加坡医生与患者之间如何针对是否吸烟及其吸烟史进行询问,以及这个过程如何影响医生对于病情的诊断。虽然询问是否吸烟和烟史是病史采集中为了达到初步诊断的必然问题,然而对于新加坡的患者来说,这类问题所投射出来的不仅仅是简单的诊断问询,而可能是引发医生对其生活习惯的一种价值判断。因此,患者常常会选择委婉回应,甚至避开回复这些实际上会影响诊断准确性的门诊问题。然而,医生为了做出最精准的诊断,又必须从患者口中得出如实的回应。因此,我们也分析医生在面对迂回答复时常采用的对策。通过会话分析研究,我们勾画出一种医患沟通中常见的情况,即病史采集中的虚实判断,以及专业医生如何通过互动手段克服这个难题。

This paper focuses on the interactional activity of doctors enquiring patients if they are smokers,as well as subsequent questions on their smoking habits,during the historytaking phase of medical consultations within the context of Singapore hospitals.Although the question of patients\“smoking status”is ostensibly a legitimate diagnostic question,patients often orient to these questions as possible criticisms that undermine their rights to seek medical attention.Hence patients who do smoke often counter with various forms of evasive responses that can potentially affect the validity of medical diagnosis.This poses a challenge to the interviewing doctors,who also have to use certain interactional strategies that encourage reliable answers.Through the perspective of conversation analysis,we outline a common practice within interactive medical consultations;namely the design of disingenuous responses during medical historytaking,and the discursive methods doctors use to overcome them.