The Interactional Construction of Asymmetry: The Medical Agenda as a Resource for Delaying Response to Patient Questions

Abstract

This study is based on transcriptions of twenty-one audiotaped encounters between patients with breast cancer and their oncologists. Using a conversation analytic approach, findings reveal how oncologists invoke a clinical agenda to postopone response to certain patient questions or to mark them retroactively as ‘out of order.’ These deferral actions take the shape of “pre-insert expansions” in which the physician mentions an activity to be performed (e.g. the physical exam) prior to actually initiating the activity. Once this clinical exigency has been invoked, patients do not prusue their questions further. Tney thereby relinquish their request for information and “accept” that answers will be forthcoming. Thus, the oncologist uses the clinical agenda as a resource for managing the direction of the talk, and patients orient collaboratively to that agenda.