Seeking Narrative Coherence: Doctors' Elicitations and Patients' Narratives in Medical Encounters

摘要

This thesis presents research on how doctors and patients negotiate meaningthrough interaction, focusing on the role of narrative in the medical encounter. Within sociolinguistics, most previous studies using discourse analysis to analyze patients’narratives have adopted the canonical (Labovian) framework. This thesis adds morerecent approaches to narrative analysis, within an interactional sociolinguistics (IS)framework in order to examine the relationship between doctor elicitations and patient narratives. The analysis also explores the clinical approach of Narrative Medicine (NM),which offers patients “space” in which to construct their narratives, to create aninterdisciplinary lens for exploring data.The data comprised 69 videotaped medical interviews, amounting to 18 hours ofnaturally occurring medical interactions, plus evaluative feedback from questionnairesand interviews with 12 doctors. All interactions were initially analyzed for canonical narrative components. Twelve interactions were then selected for more detailed analysison the basis of the frequency of doctors’ elicitations, which represent medical interview approaches. The analysis of these interactions demonstrates how and to what extentparticipant roles and identities frame the co-construction of patient narratives.Evaluations of three of the interactions by 12 doctors provided information on howaspects of patient narratives are perceived by clinicians, particularly with respect to thetypes and amounts of patient information considered necessary for making diagnosticdecisions. Key findings demonstrate that both patients and doctors seek to constructnarrative coherence. The analysis shows how the frame of developing narrativecoherence offers insights on the interactional narratives as they are co-constructed byparticipants. Patients living with chronic illness may have difficulty constructing coherent narratives, and thus, strategies for developing narrative coherence are important for bothpatients and doctors when managing patients’ chronic illnesses. Additionally, in constructing narrative coherence, patients present important aspects of their identitiespotentially offering important information related to their illness and intervention.Evaluating doctors’ also engaged in using this frame which offers insight into one way doctors develop their professional identities and perhaps indicates the strength of the role of narrative in our lives. This research represents a first attempt to use both interactional sociolinguisticsand NM to contribute to the understanding of doctor-patient interaction. Overall, the research indicates that narrative plays an important part in constructing relevant meanings in medical interactions between doctor and patient. Patients strive to create a coherentnarrative as they present their medical problem to their doctor. Although this analysisprovides further evidence of the relevance of the power asymmetry in medical interviews,it also suggests ways in which patients can shape their narratives to construct themselvesas active agents to their benefit in medical interactions.