Four Ways of Delivering Very Bad News in a Japanese Emergency Room

ABSTRACT

This study explicates the interaction between medical professionals and patients’ family members during Japanese emergency care in cases where the patient’s life is at risk. Nineteen video recordings of conversations between doctors and family members in an emergency room obtained between 2006 and 2012 within a Japanese metropolitan area are analyzed. The analysis reveals four main interactional resources employed by medical staff in their verbal decision-making process: (a) storytelling as forecasting, (b) online commentary at bedside examination, (c) paradoxical proposal, and (d) intricate interactional management of a final decision talk among the doctors and family members. These interactional resources allow the family members not only to understand the situation but also to accept decisions about the end of emergency care. Data are in Japanese with English translation.

Funding

This article is funded by a research and development project by the Research Institute of Science and Technology for Society (RISTEX) entitled “Research for the Realization of Shared Medical Care Through the Introduction of Multi-Aspect Practice” (Representative: Tetsuo Yukioka, Tokyo Medical University). This work was also supported by JSPS KAKENHI 16H03090 and 16K04133.

Notes

¹ During the earlier part of my fieldwork, more than 130 video recordings were made to document communication among the medical staff. For this study, we also asked for the patient’s family members to give us their consent to be filmed, and then we collected 19 cases. This article’s analysis is only based on these cases.

² As mentioned in the main text, obtaining consent from the patient her/himself was not feasible because s/he was unconscious, so patients’ family members consented on the patient’s behalf. We also informed family members about the study by displaying posters in the waiting room, containing the study’s purpose and filming details. Furthermore, so as not to obstruct the family’s involvement in treatment and care, we waited until after care was completed and then approached family members, gave them a verbal and written explanation, and then obtained signed consent forms.

³ In this article, the transcription notation is based on the commonly used Jefferson System. For the abbreviations used in word-by-word gloss of Japanese transcripts, please refer to the notation in the Appendix.

Additional information

Funding

This article is funded by a research and development project by the Research Institute of Science and Technology for Society (RISTEX) entitled “Research for the Realization of Shared Medical Care Through the Introduction of Multi-Aspect Practice” (Representative: Tetsuo Yukioka, Tokyo Medical University). This work was also supported by JSPS KAKENHI 16H03090 and 16K04133.