The Problem With “Problems”: The Case of Openings in Optometry Consultations

Abstract

This article contributes to conversation analytic understanding of openings in health-care consultations. It focuses on the case of optometry: a form of health-care practice in which an optometrist conducts checks of a patient's vision and eye health. Patients are advised to attend regularly for routine assessments and can also request a specific appointment at any time. Analysis of a corpus of 66 consultations shows what happens when the optometrist's opening question solicits the client's “problems” with their eyes. We find three types of patient response. Patients who have requested a specific appointment (most often) report a problem with their eyes and establish a problem-purpose encounter. Patients attending for a routinely timed appointment either report no problems and establish a routine-assessment purpose, or if they do have a problem, they delay reporting it or downplay it. We track through what happens subsequently. The findings have practical implications for diagnosis and treatment.

Acknowledgments

We would like to thank all the practitioners and patients who took part in this study, as well as the Economic and Social Research Council for funding it. We are also grateful to the editor and anonymous reviewers for their helpful comments on the various stages of this article.