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。我不否认不对称是通过制度化的环境来实现的，但在本研究中，我从几个方面探讨了医患谈话中不对称的构成。像费舍尔、托德、米什勒和韦斯特这样的作者认为，谈话的主动性是由医生采取和垄断的，他们忽视了会面细节的含义。首先，我的一些研究结果表明，患者也可以试图影响医疗采访的过程，并经常告诉他们的医生的评估。其次，有时候，医疗咨询几乎就像日常对话。某些数据显示，医生使用了一种对话设备，即“告诉坏消息”，以告知他的病人他的恶性肿瘤，结果，我们应该注意到，机构话语的结构或身份是持续相关的，并且是通过逐轮的方式反复产生的。两个参与者之间的互动。

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.