Conversation Analysis on Doctor-Patient Communication

目前大多数关于医患关系的研究都认为，医生和患者之间的沟通是不对称的。我不否认非对称性是通过制度化的环境实现的，但在这项研究中，我探索了医患对话中非对称性构成的几个方面。像费舍尔、托德、米什勒和韦斯特这样的作者认为，对话的主动性是由医生采取并垄断的，他们忽视了这次会面的细节所带来的影响。首先，我的研究中的一些发现表明，患者也可以试图影响医学访谈的过程，并经常告诉他们医生的评估。其次，有时，就医几乎就像日常对话一样。某资料显示，一名医生为了告知病人自己的恶性疾病，使用了一种名为“告知坏消息”的对话手段，结果，会诊失败了，因为他们从此无法决定手术治疗的政策。我们应该注意到，机构谈话的结构或身份是持续相关的，并通过两个参与者之间的轮流互动反复产生。

Most of current studies on doctor-patient relationships have shared the idea that communication between physicians and their patients is asymmetrical. I don't deny that asymmetries are achieved or accomplished through institutionalized settings, but in this research I explore on several aspects of the constitution of non-asymmetry in talk of doctor-patient encounter. Authors, like Fisher, Todd, Mishler and West, who argue that conversational initiatives are taken and monopolized by physicians, overlook the implications of details of the encounter. Firstly, some findings in my research suggest that patients can also try to influence the course of the medical interview and often tell the assessments of their physicians. Secondly, sometimes, medical consultations are almost like everyday-conversations. A certain data shows that one conversational device, namely "telling-a-bad-news" was used by a physician in order to inform his patient of his malignancy and as a result, the consultation was failed because they couldn't decide the policy of the surgical treatment from then on. We should note that the structure or identity of institutional talk is continuously relevant and recurrently produced through turn-by-turn interaction between two participants.