Sprache im 20. Jahrhundert. Gegenwartssprache
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Based on German data from history-taking in doctor-patient interaction, the paper shows that the three basic syntactic types of questions (questions fronted by a question-word (w-questions), verb-first (V1) questions, and declarative questions) provide different opportunities for displaying understanding in medical interaction. Each syntactic questionformat is predominantly used in a different stage of topical sequences in history taking: w-questions presuppose less knowledge and are thus used to open up topical sequences; declarative questions are used to check already achieved understandings and to close topical sequences. Still, the expected scope of answers to yes/no-questions and to declarative questions is less restricted than previously thought. The paper focuses in detail on the doctors’ use of formulations as declarative questions, which are designed to make patients elaborate on already established topics, giving more details or accounting for a confirmation. Formulations often involve a shift to psychological aspects of the illness. Although patients confirm doctors’ empathetic formulations, they, however, regularly do not align with this shift, returning to the description of symptoms and to biomedical accounts instead. The study shows how displays of understanding are responded to not only in terms of correctness, but also (and more importantly) in terms of their relevance for further action.
This article focuses on the qualitative and quantitative analysis of patients’ responses to different types of doctors’ prediagnostic statements. Prediagnostic statements document the doctors’ process of understanding in the on going interactive event and simultaneously move it to an intersubjective level within the boundaries of communicability, for example, in the case of problematic symptom patterns. Four types of prediagnostic statements will be distinguished: the preliminary, unspecific diagnosis, the establishing of a (causal) link, information about the findings, and diagnoses of exclusion. On the basis of 29 doctor-patient-conversations, 150 patients’ responses to prediagnostic statements are analyzed in their contextual organization. Although many patients’ responses turn out to be affirmatively minimal, there are differences both in the elaborateness and regarding the reference type, depending on the statements’ degree of certainty, the patients’ self-diagnoses as well as on influences of the interaction type’s asymmetrical properties. Both patients and doctors work together on establishing interactive and epistemic territories and pay attention to the maintenance of their self-images and their interaction relationship.