Keeping “Small Talk” Small in Health-Care Encounters: Negotiating the Boundaries Between On- and Off-Task Talk

ABSTRACT

Health-care interactions often involve social, relational, small-talk, or “off-task” sequences that are largely topically distinct from the institutional business of the setting. In this article we examine data from preoperative assessment sessions in a Scottish hospital in order to explore the transitions between on- and off-task talk. In the majority of instances, the movement between social and medical talk is routine and unproblematic, and both nurse and patient orient to the boundaried nature of off-topic talk. However, occasionally patients’ social talk evolves into personal disclosure and troubles telling that may disrupt the institutional agenda and that can lead to difficulties in the negotiation of sequence closure. Data are in British English.

Notes

¹ See also Komter (1991), Ylänne-McEwan (1997), and McCreaddie (2010) for studies that point to the importance of “small” talk for the goals of the institutional talk.

² The NHS ethics board would not allow us to video record data.

³ Nurses wore lapel microphones with the recorders fastened to their pockets, meaning that they could move around and still be heard on the recordings.

⁴ All place names have been changed.

⁵ See also Mandelbaum (1991) for a similar observation in relation to complaints.

⁶ Boyd and Heritage have noted that “routine history questions are designed to favour … ‘no problem’ responses” (2006, p. 162). Such questions embody particular “best case” preferences (what Boyd and Heritage term “optimization”) via, e.g., negative polarity (“I presume you haven’t,” “no asthma, no breathing difficulties?”).

⁷ Hudak and Maynard also identify in their doctor-patient data this kind of “activity contamination” (Jefferson & Lee, 1981) whereby small talk develops into a complaint involving the participant as a patient.

⁸ Moral and accounting work also frequently accompany the related activity of complaining (e.g., Drew & Holt, 1988; Benwell & McCreaddie, 2016; Edwards, 2005; Stokoe, 2009).

⁹ In the introduction to Antaki’s (2011) collection on Applied Conversation Analysis, he makes the point that CA “interventions” into professional communication may need to substantiate their observations with appeals to ethnographic approaches (Antaki, 2011, pp. 12–13).