Patient Responses to Diagnosis in Surgeon-Patient Consultations

ABSTRACT

How diagnosis fits within the overall activity structure of surgical consultations remains under-researched. We set out to contribute to this developing area of research with a particular focus on responses to diagnosis as an achievement of patient agency. We identified 26 diagnostic sequences in a collection of 35 video recorded surgical consultations and examined these in detail using conversation analysis. The activity of diagnosis and the transition to treatment recommendation appear to be structured somewhat differently in surgeon-patient consultations than has been reported for primary care settings. In particular, patient responses to diagnosis are more frequent and more likely to be extended. The analysis provides evidence that both parties orient to surgeons’ accountability for their own diagnostic reasoning, and also the medical authority of the referring doctor and the subjective experience of the patient. In delivering the diagnosis, the surgeon must be cognizant of the opinions of both the patient and the referring doctor, which may align to a greater or lesser extent with their own diagnosis.

Acknowledgment

We acknowledge the assistance from members of the Applied Research on Communication in Health (ARCH) group at the University of Otago, Wellington, New Zealand, for providing access to data archived in the ARCH Corpus of Health Interactions, and assisting with the recording and transcription of additional consultations.

Disclosure statement

We have no known conflicts of interest to disclose.

Notes

1. While a “no problem” diagnosis might not be considered a standard approach clinically, there were examples of such diagnosis delivery in this data set.

Additional information

Funding

This work was supported by the Marsden Fund and by a University of Otago Postgraduate Scholarship.