Agency and Authority: Extended Responses to Diagnostic Statements in Primary Care Encounters

Abstract

In this article, I explore patients' extended responses to doctors' diagnostic statements in Finnish primary care. As extended responses, I considered turns of talk that follow the doctors' diagnostic statements and in which the patients do something more than just acknowledge the diagnosis. The data consist of 71 diagnostic statements collected from a corpus of 100 video-recorded and transcribed general practice consultations. These data were analyzed using conversation analytic methods, both quantitative and qualitative. In the quantitative analysis, it was found that the patients produce extended responses after of diagnostic statements. The type of the patient's response was found to be strongly associated with the way in which the doctor referred to the evidence for the diagnosis: After diagnostic statements in which the evidence is verbally explicated, the patients start to talk about the diagnosis more often than after diagnostic statements in which such explication is not done. In qualitative analysis, different types of extended responses were outlined. These include straight agreements, symptom descriptions, rejections of the proposed diagnoses, and actions related to the interpretation of evidence. In all types of extended responses, the patients displayed an orientation to the doctors' ultimate authority in the domain of medical reasoning.