Heritage & Robinson: The structure of Patient's presenting compliants

Question 1

What is the theme of this piece?

Answer 1

Seeking and providing information

Question 2

What is the title of the piece by Heritage and Robinson?

Answer 2

The structure of patient’s presenting concerns: Physician’s opening questions

Question 3

What is the problem presentation?

Answer 3

The phase of the medical visit in which patients present medical problems to their physicians

Greeting –> problem presentation –> history taking –> diagnosis –> treatment –> leave taking

Question 4

What part of the appointment allows the patient to express their illness experience?

Answer 4

It is a structural opportunity and it is the problem presentation

Question 5

True or False.

Once history taking (information gathering) begins, it is easy for patients to pursue their agenda?

Answer 5

False.

It can be difficult and there is a loss of interactional initiative.

Question 6

What is the context for patient’s problem presentation?

Answer 6

Medical professionals collecting patient concerns before they meet with their physicians.
Patients generally expect that the physician will have reviewed this information before entering exam room
Creates ambiguity around reciprocal conversational norms

Question 7

What are two important principles of interaction?

Answer 7

1. Conditional Relevance

2. Turn Taking

Question 8

What is conditional relveance?

Answer 8

Questions set agendas for what will “count” as an appropriate or sufficient response
E.g. open-ended vs. closed-ended

Question 9

What is turn taking?

Answer 9

Question askers generally maintain the right to speak again after an answer is provided “My turn again now”
Physicians have the right to determine when the patient has sufficiently presented the problem.

Question 10

What are the 5 types of physician problem solicitations?

Answer 10

1. General inquiry questions
2. Gloss for confirmation questions
3. Symptoms for confirmation questions
4. “how are you” questions
5. History taking questions

Question 11

What examples of Type 1?

Answer 11

“What can I do for you today?”

See table 1 pg 92!!!!!

Question 12

What are examples of Type 2?

Answer 12

So, you’re sick today, huh?
A “gloss” is a reference that invites additional elaboration.
The physician indicates some prior knowledge of the problem, seeking both confirmation and elaboration
Pre-screening problems by medical assistants (MA) and nurses creates pressure for the physician to be familiar with the patient’s problem
This can create confusion/awkwardness:

Question 13

What are examples of type 3?

Answer 13

“Alight so having headache and sore throat and cough with phlegm for five days?

Makes very clear and explicit use of MA and/or nurse comments in the chart
Don’t consistenly lead to patient’s problem presentation
Function more as summarites
Used in an “inhospitable” interactional environemnt

Question 14

What are examples of Type 4?

Answer 14

“So how are you feeling?”
only axamined these questions when they occured AFTER the opening greeting
Designed to solicit a general self-evaluation rather than a specific problem presenation
Can be confused with everyday greeting which invites a “troubles resistant” stance

Question 15

What are examples of Type 5?

Answer 15

This type essentially bypasses problem presentation altogether by simply “fast forwarding” to the information gathering (history taking) phase.
Even though this design is the most constraining of patients’ problem presentations, patients do manage to work past this constraint.