Talking About Things: A Patient Cue for Sensitive Healthcare Problems and Effective Physician Responses

ABSTRACT

In routine healthcare consultations, patients often use prefaces containing the word “thing”, including “the thing is”, “there’s this thing” or “one more thing”. Although “thing” is an all-encompassing term that is used in myriad ways, in this article we show that thing-prefaces perform a specific job. This study uses Conversation Analysis to analyze 90 video-recorded primary care consultations with 14 primary care physicians in the United States. Patients’ thing-prefaces mark the upcoming talk as a disclosure of sensitive information that may reflect negatively on the patient, physician or service (e.g., medication nonadherence, refill was not sent to pharmacy). Patients pursue explicit resolution of these problems (e.g., personalized recommendation, lab work, referral) despite these problems being downplayed and treated as delicate. Because patients may “talk around” these sensitive issues, thing-prefaces can be an important cue for physicians that patients are seeking resolution for a sensitive healthcare problem.

KEYWORDS:

• doctor-patient communication
• conversation analysis
• active listening
• healthcare communication
• patient cues
• primary care
• qualitative methods

Acknowledgements

We would like to thank all of the patients and physicians who participated in this study. We also thank Tanya Stivers for her valuable feedback on this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.