Communication 423:
Patient-Provider Communication
Wayne A. Beach, Ph.D.
Professor, School of Communication
COM 201A/594-4948
wbeach@mail.sdsu.edu
Office Hours T-Th @ 1:30-2:15, and by Appointment
Adjunct Professor, Department of Surgery
Member, Moores Cancer Center
University of California, San Diego
http://www.rohan.sdsu.edu/~wbeach/index.htm
http://advancement.sdsu.edu/marcomm/features/2008/cancer.html
http://psfa.sdsu.edu/faculty.php
http://www.kpbs.org/news/2011/apr/11/positive-communication-yields-positiveresults-can/
School of Communication Website: http://communication.sdsu.edu/
http://www.ucsd.tv/search-details.aspx?showID=25956
Course Description
This class focuses on communication between patients and providers. Attention will be
given to medical interviews occurring during routine clinical visitations. A variety of
types of medical encounters will be examined, with primary focus given to interactions
between cancer patients and their oncologists. Opportunities will be provided to work
with diverse literature, and to analyze naturally occurring video recorded interactions
involving cancer patients, family members, and doctors.
Activities will involve:
1) Engaging in repeated and direct examinations of video recorded and transcribed
medical interviews, drawn from the UCSD Cancer Center, School of Medicine, and a
large HMO located in the Southwest United States. We will work toward extending an
already substantial empirical foundation for understanding specific interactional
practices and communication patterns through which clinical encounters get
organized.
2) Reviewing and integrating extant literature on provider-patient relationships,
providing a familiarity with alternative theoretical/methodological approaches to
(and concerns about) medical interviews.
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3) Addressing the possible relevance and application of research findings for enhancing
and refining communication between oncology/medical professionals and lay
persons.
Learning Objectives
1. To identify and provide written analyses of video recorded and transcribed
interactions between patients and doctors.
2. To integrate diverse and key literature supporting these empirical findings.
3. To work within several different research groups focusing on selected patterns of
communication between patients and doctors, across multiple sources of recorded
and transcribed data.
4. To develop creative presentations increasing awareness of social actions comprising
communication in the clinic, a reflexive stance toward improving relationships
during clinical encounters, and implications for enhancing health and quality of
living in contemporary society.
Blackboard & Text(s)
The syllabus, selected readings, assignments (written and digitized audio/video clips),
data handouts, and related materials are available on SDSU’s Blackboard:
http://www.Blackboard.sdsu.edu
An overview of my research activities is available at:
http://advancement.sdsu.edu/marcomm/features/2008/cancer.html
Downloaded PDF’s from my website* are available at:
http://www.rohan.sdsu.edu/~wbeach/index.htm
Media files may also be downloaded from:
http://www-rohan.sdsu.edu/~wbeach/media/
The textbook for this class is:
Beach, W.A. (2013). Handbook of patient-provider interactions:
Raising and responding to concerns about life, illness, and disease.
Cresskill, NJ: Hampton Press, Inc.
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(Available at SDSU Bookstore; Full Table of Contents and Subject Index on Blackboard):
The major sections of this Handbook are as follows:
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Offers and Responses
Inadequacy of Biomedicine
Asymmetry, Authority, and Control
Patient-Initiated Actions: Explanations, Expectations, Requests, Solicitations,
& Resistance
Doctor-Responsive Actions: Attending and Disattending Issues Raised by Patients
Empathy-in-Action: Responding to Patients’ Emotional Concerns
Other Delicate Moments During Medical Interviews
Embodied Actions: Talk, Gaze, Gesture, and Body Orientations
Communication and Consultation Skills: Promises and Potential Outcomes
Our course structure generally follows this format. Additional readings appear, as assigned
and noted.
I may also forward additional PDF’s to class participants as the semester progresses.
Availability of additional readings will be discussed in class, as needed.
Background & Significance
Interactional materials are drawn from a growing collection of oncology interviews
recorded at two UCSD Cancer Center sites: the Perlman Clinic/Thornton Hospital and
the Moores UCSD Cancer Center. Additional materials are also available for analysis and
contrast (e.g., Surgery interviews at UCSD, and Health Appraisal interviews at Kaiser
Permanente), but will be focused upon only minimally throughout this semester.
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Increasing priority is being given to “patient-centered” cancer care, yet a fundamental
understanding of patients as active collaborators during oncology interviews is in its
infancy. Limited attention has been given to unique communication patterns between
doctors and patients during what are often highly charged, yet routine interviews in
oncology clinics. Little is known about: a) patient-initiated actions (PIA’s) designed to
express concerns, worries, and fears about cancer diagnosis and treatment; and
b) doctor-responsive actions (DRA’s) designed to attend and/or disattend patients’
issues. We propose to extend prior research through systematic studies of patientinitiated and doctor-responsive actions within an oncology clinic, and (eventually) to
implement a pilot intervention designed to improve oncologists’ communication skills
for addressing patients’ concerns and fears.
Indeed, recent surveys suggest that more than 1/3 Americans consider cancer to be
their most fearful health concern, and half of those people believe cancer is difficult or
impossible to prevent. Limited attention has been given to how these fears get enacted
during oncology interviews, and to unique communication patterns between doctors
and patients within which such social activities are embedded.
Classroom Activities, Attendance, & Exercise Points
While class activities will involve lectures and discussions on extant literature, primary
attention will be given to “informal data/listening sessions” – repeated, rigorous, and
grounded attempts to identify and substantiate patterns of human conduct-in-interaction.
Analysis of naturally occurring recordings, through repeated listenings and in unison with
transcriptions, yields a rich understanding of the primary interactional patterns employed
by men and women as the interactionally construct social realities. Emphasis will be given
to close examinations of single instances as well as analysis of "collections" of interactional
phenomena.
In order to understand how to analyze data excerpts of human interaction, regular and
prompt attendance to classes is necessary. Prior students will attest to the fact that this is
not a typical lecture course, where students can simply gain “lecture notes” from others
and read materials independently before taking exams – especially when there are not
exams for this class!
Classes will be devoted to a) data sessions directly related to the analytic papers, and b)
discussions of relevant literature/studies. Thus, you are strongly encouraged to come to
class expecting that each day will facilitate your independent analytic and writing efforts,
skills which you will need as a contributing research member of your teams.
To encourage regular attendance and participation, on a random basis students will be
asked to form into groups and engage in various exercises (which will vary, including
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critical examinations of literature, detailed analyses of data, responses to watching videos,
etc.). If you are in attendance that day, and participate in the exercise that is assigned, you
will be assigned a full 10 points for your engagement and commitment to class. There will
be 10 Exercises throughout the semester – allowing each student, with perfect attendance,
to receive 100 total Exercise Points to enhance their final grade. Thus, 1 Exercise absence =
90 points, 2 absences = 80 points, etc.
Academic Dishonesty Policy
The Academic Dishonesty Policy for the School of Communication is located on
Blackboard.
Grading & Evaluation:
Analytic Paper #1
Analytic Paper #2
Analytic Paper #3
Exercise Points
100 points (Individual)
100 points (Group)
100 points (Group)
100 points
---------400 points total
(90% = 360; 80% = 320; 70 % = 280; 60% = 240)
Analytic Papers, Presentations, & Participation/Attendance
Handout for Analytic Paper #1 is in Appendix B (below). A handout for Analytic Paper #2
will appear on Blackboard when announced. The general format for these papers is as
follows:
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
Month long take-home exercises designed to teach students how to closely analyze
and write about interactional materials, integrate key quotes, references, and
relevant information from readings and course lectures/discussions/data sessions.
Analytic papers will be written by research teams of 2-4 students.
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Paper findings will be presented and/or discussed in class.
Length restrictions on papers are: #1 – 15 pages, double spaced/12 font, + title page
and references for #1; 25 + pages for #2 and #3.
Papers should follow appropriate APA formatting.
All papers should include title pages, organized sections with tailored
headings/sub-headings, and listing of references.
In summary: Key literature and quotes will be integrated, practices and patterns of
conversational interaction will be identified, conclusions will be drawn about the
data analyzed, and key implications for research and education will be identified.
Students are encouraged to read carefully and critically, and (as best possible) offer
constructive, thoughtful, and detailed comments throughout class lectures, discussions,
and activities.
Exercise Points
In order to understand how to analyze data excerpts of human interaction, regular and
prompt attendance to classes is necessary. Prior students will attest to the fact that this is
not a typical lecture course, where students can simply gain “lecture notes” from others
and read materials independently before taking exams – especially when there are not
exams for this class!
Classes will be devoted to a) data sessions directly related to the analytic papers, and b)
discussions of relevant literature/studies. Thus, you are strongly encouraged to come to
class expecting that each day will facilitate your independent analytic and writing efforts,
skills which you will need as a contributing research member of your teams.
To encourage regular attendance and participation, on a random basis students will be
asked to form into groups and engage in various exercises (which will vary, including
critical examinations of literature, detailed analyses of data, responses to watching videos,
etc.). If you are in attendance that day, and participate in the exercise that is assigned, you
will be assigned a full 10 points for your engagement and commitment to class. There will
be 10 Exercises throughout the semester – allowing each student, with perfect attendance,
to receive 100 total Exercise Points to enhance their final grade. Thus, 1 Exercise absence =
90 points, 2 absences = 80 points, etc.
Course Listings:
Beach/Communication 423:
Patient-Provider Communication
7
(Preliminary Topics/Readings; All readings on Blackboard.)
I.
Background: Historical & Contemporary Approaches to Medical Interviews
Introductory Readings:
Heritage, J.H. (2013). Foreword. In W. Beach, Handbook of patient-provider interactions:
Raising and responding to concerns about life, illness, and disease (i-vi). Cresskill, NJ:
Hampton Press, Inc.
Beach, W.A. (2013). Introduction: Raising and responding to concerns about life, illness,
and disease. In W. Beach, Handbook of patient-provider interactions:
Raising and responding to concerns about life, illness, and disease (1-20). Cresskill, NJ:
Hampton Press, Inc.
Beach, W.A. (in press). Doctor-patient interactions. In K. Tracy (Ed.), Encyclopedia of
Language and Social Interaction. Sage.
Beach, W.A. (2009). Patients, doctors, and other helping relationships. In W.F. Eadie
(Ed.), 21st century communication: A reference handbook (358-370). Thousand Oaks,
CA: Sage Publications. (Blackboard)
Basic Concerns with Institutions and Medical Encounters:
Paul Drew & John Heritage (1992). Analyzing talk at work: An introduction. In Drew
and Heritage (Eds.). Talk at work: Interaction in institutional settings (pp.3-65).
Cambridge, England: Cambridge University Press. (Blackboard)
Debra L. Roter and Judith A. Hall (1992), Doctors talking with patients/patients talking
with doctors. Westport CT: Auburn House, Chapter 1: 'The significance of talk'
and Chapter 2: 'Models of the doctor-patient relationship'.
William T. Branch (2000). Is the therapeutic nature of the patient-physician relationship
being undermined? Archives of Internal Medicine, 160, 2257-2260.
Frichard M. Frankel & Terry Stein (1999). Getting the most out of the medical
encounter.
The Permanente Journal, 3, 47-56.
*(“Fears” handout available on Blackboard – print and bring to class)
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II.
‘Offers and Responses’ (Unless noted, all readings below are reprinted in
Handbook. See Blackboard for full Table of Contents)
Michael Balint (1957/1972). The patient’s offers and the doctor’s responses. In The doctor,
his patient, and the illness. (Chp. 3, pp.21-36). Madison, CT: International University
Press.
Barbara M. Korsch & Vida F. Negrete (1972). Doctor-patient communication. Scientific
American, 227, 66-74.
Irving K. Zola (1973). Pathways to the doctor – from patient to person. Social Science &
Medicine, 7, 677-689.
Patrick S. Byrne & Barrie E.L. Long (1976). (Ch.3), The structure of the
consultation: An analysis of behavioral phases (Chapter 3, pp.19-29);
[Chapter 10]Analyzing detailed behavior and discovering basic styles (Ch.13,
pp.143-159). in Doctors talking to patients : A study of the verbal behaviour of general
practitioners consulting in their surgeries. London: H. M. Stationery Off.
Arthur Kleinman, Leon Eisenberg, & Byron Good (1978). Culture, illness, and care:
Clinical lessons from anthropologic and cross-cultural research. Journal of
Internal Medicine, 88, 251-258.
III.
‘The Inadequacy of Biomedicine” (Handbook – see also end of syllabus)
George F. Engel (1977). The need for a new biomedical model: A challenge for
biomedicine. Science,196, 129-136
Howard B. Beckman & Richard M. Frankel (1984). The effect of physician
behavior on the collection of data. Annals of Internal Medicine, 101, 692-696.
Inui, T.S. & Carter, W.B. (1985). Problems and prospects for health services research on
provider-patient communication. Medical Care, 23, 521-538.
Allen Barbour (1995). The limitations of the medical model. In Caring for patients: A
critique of the medical model. (Ch.1, pp.9-30). Stanford University Press.
M. Kim Marvel, Ronald M. Epstein, Kristine Flowers, & Howard B. Beckman (1999).
Soliciting the patient's agenda: Have we improved? Journal of the American
Medical Association, 281: 283 - 287.
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Debra Roter (2000). The enduring and evolving nature of the patient-physician
relationship. Patient education and counseling, 39, 5-15.
IV.
Asymmetry, Authority, & Control (Handbook – see also end of syllabus)
ten Have, Paul. (1991). Talk and institution: A reconsideration of the
`asymmetry’ of doctor-patient interaction. In Talk and social structure:
Studies in ethnomethodology and conversation analysis, D. Boden and D.
Zimmerman (eds.),138-63. Cambridge: Polity Press.
Anssi Peräkylä (1998). Authority and accountability: The delivery of diagnosis in
primary health care. Social Psychology Quarterly, 6, 301-320.
Felicia Roberts (2000). The interactional construction of asymmetry: The medical
agenda as a resource for delaying response to patient questions.
Sociological Quarterly, 41, 151-170.
Richard L. Street, Jr., Edward Krupat, Robert A. Bell, Richard L. Kravitz, & Paul Haidet
(2003). Beliefs about control in the physician-patient relationship: Effect on
communication in medical encounters. Journal of General Internal Medicine, 18,
609-616.
V.
Patient-Initiated Actions: Explanations, Expectations, Requests, Solicitations,
and Resistance (Handbook – see also end of syllabus)
Virginia T. Gill (1998). Doing attributions in medical interaction: Patients’ explanations
for illness and doctors’ responses. Social Psychology Quarterly, 61, 342-360.
John Heritage & Tanya Stivers (1999). Online commentary in acute medical
visits: A method of shaping patient expectations. Social Science & Medicine,
49, 1501-1517.
Jeffrey D. Robinson (2001). Asymmetry in action: Sequential resources in the
negotiation of a prescription request. Text, 21, 19-54.
Virginia Teas Gill, Timothy Halkowski, Felicia Roberts (2001). Accomplishing a
request without making one: A single case analysis of a primary care visit. Text,
21, 55-82.
Richard M. Frankel (2001). Clinical care and conversational contingencies: The role of
patients’ self-diagnosis. Text, 21, 83-112.
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Paul Drew (2005). The voice of the patient: Non-alignment between patients and
doctors in the consultation. (Handbook)
Richard L. Street, Jr., Howard S. Gordon, Michael M. Ward , Edward Krupat, & Richard
L. Kravitz (2005). Patient participation in medical consultations: Why some
patients are more involved than others. Medical Care, 43, 960-969.
Timothy Halkowski (2007). ‘Occasional’ drinking: Some uses of a non-standard
temporal metric in primary care assessment of alcohol use. (Handbook)
See also:
Beach, W.A. (2013). Patients’ efforts to justify wellness in a comprehensive cancer
clinic. Health Communication, 28, 577-591.
VI.
Doctor-Responsive Actions: Attending and Disattending Issues Raised by
Patients (Handbook – see also end of syllabus)
Tanya Stivers & John Heritage (2001). Breaking the sequential mold: Answering
“more than the question” during comprehensive history taking. Text, 21,
151-186.
Charlotte M. Jones (2001). Missing assessments: Lay and professional orientations in
medical interviews. Text, 21, 113-150.
Anssi Peräkylä (2002). Agency and authority: Extended responses to diagnostic
statements in primary care encounters. Research on Language and Social
Interaction 35:219-247.
Anita Pomerantz and E. Sean Rintel (2004). Practices for reporting and
responding to test results during medical consultations: Enacting the
roles of paternalism and independent expertise. Discourse Studies,
6, 9-26.
Wayne A. Beach & Jenny Mandelbaum (2005). “my mom had a stroke”: Understanding how
patients raise and providers respond to psychosocial concerns. In L.H. Harter, P.M.
Japp, & C.M. Beck (Eds), Constructing our health: The implications of
narrative for enacting illness and wellness (343-364). Mahwah, NJ: Lawrence
Erlbaum Associates.
11
VII.
Empathy-in-action: Responding to Patients’ Emotional Concerns
(Handbook – see also end of syllabus)
Suchman, A., Markakis, K., Beckman, H. B., & Frankel, R. (1997). A model of empathic
communication in the medical interview. Journal of the American Medical Association,
277, 678-682.
Wayne A. Beach & Christie M. Dixson (2001). Revealing moments: Formulating
understandings of adverse experiences in a Health Appraisal interview.
Social Science & Medicine, 52, 25-45.
Jeffrey D. Robinson (2003). An interactional structure of medical activities during
acute visits and its implications for patients’ participation. Health Communication,
15, 27-59.
Debra L. Roter & Judith A. Hall (2004). Physician gender and patient-centered
communication: A critical review of empirical research. Annual Review of Public
Health, 25, 497-519.
Johanna Ruusuvuori (2005). “Empathy” and “sympathy” in action: Attending to
patients' troubles in Finnish homeopathic and general practice consultations.
Social Psychology Quarterly, 68, 204-222.
See also:
Beach, W.A. (2014). Managing hopeful moments: Initiating and responding to
delicate concerns about illness and health. In H. E. Hamilton & W. S. Chou
(Eds.), Handbook of language and health communication (459-476). Routledge.
Jones, C.M. & Beach, W.A. (2005). “I just wanna know why”: Patient’s attempts and
doctors’ responses to premature solicitation of diagnostic information. In Judith
F. Duchan & D.Kovarsky (Eds.), Diagnosis as cultural practice (103-136). New
York: Mouton de Gruyter.
VIII. Other Delicate Moments During Medical Interviews
(Handbook – see also end of syllabus)
Anssi Peräkylä (1993). Invoking a hostile world: Discussing the patient’s future in AIDS
counseling. Text, 13, 302-338.
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Lutfey, K., & Maynard, D. W. (1998). Bad news in oncology: How physician and patient
talk about death and dying without using those words. Social Psychology
Quarterly, 61, 321-341.
Markku Haakana (2001). Laughter as a patient’s resource: Dealing with delicate aspects
of medical interaction. Text, 21, 187-220.
Tanya Stivers (2002). Participating in decisions about treatment: Overt parent pressure
for antibiotic medication in pediatric encounters. Social Science & Medicine, 54,
1111-1130.
Douglas W. Maynard (2004). On predicating a diagnosis as an attribute of a person.
Discourse Studies, 6, 53-76.
Wayne A. Beach, David E. Easter, Jeffrey S. Good, & Elisa Pigeron (2005). Disclosing
and responding to cancer “fears” during oncology interviews. Social Science &
Medicine, 60, 893-910.
John Heritage and Jeffrey D. Robinson (2006). The structure of patients' presenting
concerns 1: Physicians' opening questions.' Health Communication, 19, 89-102.
Anita Pomerantz, Virginia Teas Gill, & Paul Denver (2007). When patients present
serious health conditions as unlikely: Managing potentially conflicting issues
and constraints. In Alexa Hepburn & Sally Wiggins (Eds.). Discursive research in
practice: New approaches to psychology and interaction (pp.127-146). Cambridge:
Cambridge University Press.
See also:
Richard M. Frankel (2001). Challenges and opportunities in delivering bad news.
Managing Risk, 3, 1-5.
Douglas W. Maynard (1990). Bearing bad news. Medical Encounter, 7, 2-3.
Douglas W. Maynard (1997). How to tell patients bad news: The strategy of
“forecasting”. Cleveland Clinical Journal of Medicine, 64, 181-182.
IX.
Embodied Actions: Talk, Gaze, Gesture, & Body Orientations
(Handbook – see also end of syllabus)
13
Jeffrey D. Robinson (1998). Getting down to business: Talk, gaze, and body orientation
during openings of doctor-patient consultations. Human Communication
Research 21, 97-123.
Johanna Ruusuvuori (2001). Looking means listening: coordinating displays
of engagement in doctor-patient interaction. Social Science & Medicine, 52,
1093-1108.
Christian Heath (2002). Demonstrative suffering: The gestural (re)embodiment of
symptoms. Journal of Communication, 52, 597-616.
Wayne A. Beach & Curtis LeBaron (2002). Body disclosures: Attending to personal
problems and reported sexual abuse during a medical encounter. Journal of
Commmunication, 52, 617-639.
Timothy Koschmann, Curtis LeBaron, Charles Goodwin, Alan Zemel & Gary Dunnington
(2007). Formulating the triangle of doom. Gesture, 7, 97-118.
X.
Communication & Consultation Skills: Promises and Potential Outcomes
(Handbook – see also end of syllabus)
Peter Maguire, Susan Fairbairn, & Charles Fletcher (1986). Consultation skills of young
doctors: I – Benefits of feedback training in interviewing as students persist.
British Medical Journal, 292, 1573-1576.
Wendy Levinson & Debra Roter (1995). Physicians’ psychosocial beliefs correlate
with their patient communication skills. Journal of General Internal Medicine,
10, 375-379.
Wendy Levinson, Debra L. Roter, John P. Mullooly, Valerie T. Dull, & Richard M.
Frankel (1997). Physician-patient communication: The relationship with
malpractice claims among primary care physicians and surgeons.
Journal of the American Medical Association, 277, 553-559.
Donald J. Cegala, Leola McClure, Terese Marinelli, Douglas M. Post (2000). The effects of
communication skills training on patients’ participation during medical
interviews. Patient education and counseling, 41, 209-222.
F. Daniel Duffy, Geoffrey H. Gordon, Gerald Whelan, Kathy Cole-Kelly, Richard M.
Frankel (2004). Assessment of competency in interpersonal and communication
skills: Kalamazoo II. Academic Medicine, 79, 495-507.
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See also:
Wendy Levinson, Editorial (1994). Physician-patient communication: a key to
malpractice prevention. Journal of the American Medical Association, Nov
272:1619-1620.
23/30,
Additional References on: Communication and Cancer Care
Baile, W. F., Kudelka, A. P., Beale, B. A., Glober, G. A., Myers, E. G., Greisinger, A. J.,
Bast, R. C., Jr., Goldstein, M. G., Novack, D., Lenzi, R. (1999). Communication
skills training in oncology. Description and preliminary outcomes of workshops
on breaking bad news and managing patient reaction to illness. Cancer, 86, 887897.
Baile, W. F., Lenzi, R., Kudelka, A. P., Maguire, P., Novack, D., Goldstein, M., Myers,
E. G., & Bast Jr., R. C. (1997). Improving physician-patient communication in
cancer care: Outcome of a Workshop for oncologists. Journal of Cancer
Education, 12, 166-173.
Fallowfield, L., Jenkins, V. (1999). Effective communication skills are the key to good
cancer care. European Journal of Cancer, 35(11), 1592-1597.
Fallowfield, L., Jenkins, V., Farewell, V., Saul, J., Duffy, A, & Eves, R. (2002). Efficacy
of a cancer research UK communication skills training model for oncologists: A
randomized controlled trial. Lancet, 359(9307), 650-657.
Fallowfield, L., Lipkin, M., Hall, A. (1998). Teaching senior oncologists communication
skills: Results from phase I of a comprehensive longitudinal program in the
United Kingdom. Journal of Clinical Oncology, 16(5), 1961-1968.
Ford, S., Fallowfield, L., Lewis, S. (1996). Doctor-patient interactions in oncology. Social
Science and Medicine, 42(11), 1511-1519.
Ford, S., Hall, A., Ratcliff, D., Fallowfield, L. (2000). The Medical Interaction Process
System (MIPS): An instrument for analyzing interviews of oncologists and
patients with cancer. Social Science & Medicine, 50(4), 553-566.
Gutzmer, K. & Beach, W.A. (in press). ‘Having an ovary this big is not normal’:
Physicians’ use of normal to assess wellness and sickness during oncology
15
interviews. Health Communication.
Maguire, P. (1990). Can communication skills be taught? Br J Hosp Med, 43(3), 216-216.
Maguire,P. (1999). Improving communication with cancer patients. Eur J Cancer, 35,
1415-1422.
Maguire, P., Booth, K. Elliott, C., Jones, B. (1996). Helping health professionals involved
in cancer care acquire key interviewing skills—the impact of workshops.
European Journal of Cancer, 32A(9), 1486-1489.
Maguire, P., Faulkner, A. (1988). Communicate with cancer patients: 1. Handling bad
news and difficult questions. British Medical Journal, 297(6653), 907-909.
Maguire, P., Faulkner, A. (1988). Communicate with cancer patients: 2. Handling
uncertainty, collusion, and denial. British Medical Journal, 297(6654), 972-974.
Maguire, P., Faulkner, A. (1988). Improve the counselling skills of doctors and nurses in
cancer care. BMJ, 297(6652), 847-849.
Maguire, P., Faulkner, A., Booth, K., Elliott, C., Hillier, V. (1996). Helping cancer
patients disclose their concerns. European Journal of Cancer, 32A(1), 78-81.
Maguire, P., Faulkner, A., Regnard, C. (1993). Eliciting the current problems of the
patient with cancer—a flow diagram. Palliative Medicine, 7(2), 151-156.
A Sampling of Additional/Background Readings
Barbour, Allen (1995). Caring for Patients. Stanford University Press.
Beach, W.A. (1995). Preserving and constraining options: “Okays” and `official’
priorities in medical interviews. In G.H. Morris & R. Cheneil (Eds.). The Talk of
the Clinic: Explorations in the Analysis of Medical and Therapeutic Discourse
(pp.259-289). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.
Howard B. Beckman & Richard M. Frankel (1984). The effect of physician behavior on
the collection of data. Annals of Internal Medicine, 101, 692-696.
Bergmann, J.R. (1992). Veiled morality: Notes on discretion in psychiatry. In Paul Drew
& John Heritage (Eds.), Talk at work: Interaction in institutional settings (pp.137162). Cambridge: Cambridge University Press.
“Let me See if I Have this Right…”: Words that Help Build Empathy” (2001). John L
Coulehan et al., Annals of Internal Medicine, 135, 221-227.
Patrick Byrne and Barrie Long (1976). Doctors Talking to Patients: A Study of the Verbal
Behaviours Of Doctors in the Consultation. London:H.M.S.O.
Eric J. Cassell (1976). Volume I: Talking with Patients – The Theory of Doctor-Patient
Communication; Volume II: Clinical Technique. Cambridge: MIT Press.
Ronald J. Cheneil & G.H. Morris (1995). Introduction: The talk of the clinic. In G.H.
Morris & Ronald J. Cheneil (Eds.), The Talk of the Clinic: Explorations in the
Analysis of Medical And Therapeutic Discourse (pp.1-15). Hillsdale, NJ:
16
Lawrence Erlbaum Associates, Inc.
Vincent J. Felitti (1997). Caring for patients (review). The Permanente Journal, 1, 19-20.
Christian Heath (1988). Embarrassment and interactional organization. In Paul Drew
and Tony Wootton (Eds.) Erving Goffman: An Interdisciplinary Appreciation
(pp.136-160). Cambridge: Polity Press.
Christian Heath (2002). Demonstrative suffering: The gestural (re)embodiment of
symptoms. Journal of Communication, 52, 597-616.
Paul Drew and John Heritage (1992) (Eds.) Talk at Work. New York: Cambridge
University Press.
Heritage, J., Stivers, T. (1999). Online commentary in acute medical visits: A method of
shaping patient expectations. Social Science & Medicine, 49, 1501-1517.
Richard M. Frankel (1995). Some answers about questions in clinical interviews. In G.H.
Morris & R. Cheneil (Eds.). The talk of the clinic: Explorations in the analysis of
medical and therapeutic discourse (pp.233-258). Hillsdale, NJ: Lawrence Erlbaum
Associates, Inc.
Judith Hall et al. (1994). Gender in medical encounters: An analysis of physician and
patient communication in a primary care setting. Health Psychology, 13(5):384392.
Christian Heath (1992). The delivery and reception of diagnosis in the generalpractice consultation. In Paul Drew & John Heritage (Eds.), Talk at work:
Interaction in institutional settings (pp.235-267). Cambridge: Cambridge
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Christian Heath (1986). Body Movement and Speech in Medical Interaction.
Cambridge: Cambridge University Press.
John Heritage & Sue Sefi (1992). Dilemmas of advice: Aspects of the delivery and
reception of advice in interactions between health visitors and first-time mothers.
In Paul Drew & John Heritage (Eds.), Talk at Work: Interaction in Institutional
Settings (pp.359-417). Cambridge: Cambridge University Press.
Ivan Illich (1976). Medical nemesis: The expropriation of health. New York: Pantheon
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Jones, C.M. & Beach, W.A. (1995). Therapists’ techniques for responding to unsolicited
contributions by family members. In G.H. Morris & R. Cheneil (Eds.). The Talk of
the Clinic: Explorations in the Analysis of Medical and Therapeutic Discourse
(pp.49-70). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.
Barbara Korsch, Samuel Putnam, Richard Frankel and Debra Roter (1995). An
overview of research on medical interviewing. in Mack Lipkin, Samuel Putnam
and Aaron Lazare (Eds.), The Medical Interview: Clinical Care, Education and
Research (pp.475-481). New York: Springer-Verlag.
Wendy Levinson et al. (1997). Physician-patient communication: The relationship
with malpractice claims among primary care physicians and surgeons. Journal of
the American Medical Association, 277, 553-559.
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Anssi Peräkylä (1998). Authority and accountability: The delivery of diagnosis in
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NOTES
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Appendix A: Transcription Symbols
The transcription notation system employed for data segments is an adaptation of Gail
Jefferson's work (see Atkinson & Heritage (Eds.), 1984, pp.ix-xvi; Beach (Ed.), 1989, pp.8990). The symbols may be described as follows:
:
Colon(s): Extended or stretched sound, syllable, or word.
Underlining: Vocalic emphasis.
(.)
Micropause: Brief pause of less than (0.2).
(1.2)
Timed Pause: Intervals occuring within and between same or
different speaker's utterance.
(( ))
Double Parentheses: Scenic details.
( )
Single Parentheses: Transcriptionist doubt.
.
Period: Falling vocal pitch.
?
Question Marks: Rising vocal pitch.

Arrows: Pitch resets; marked rising and falling shifts
in intonation.
° °
Degree Signs: A passage of talk noticeably softer than
surrounding talk.
=
Equal Signs: Latching of contiguous utterances, with
no interval or overlap.
[ ]
Brackets: Speech overlap.
[[
Double Brackets: Simultaneous speech orientations to
prior turn.
!
Exclamation Points: Animated speech tone.
Hyphens: Halting, abrupt cut off of sound or word.
> <
Less Than/Greater Than Signs: Portions of an
utterance delivered at a pace noticeably quicker
than surrounding talk.
OKAY CAPS: Extreme loudness compared with surrounding talk.
hhh .hhh H’s: Audible outbreaths, possibly laughter. The more h’s,
the longer the aspiration. Aspirations with periods indicate audible
inbreaths (e.g., .hhh). H’s within (e.g., ye(hh)s)
parentheses mark within-speech aspirations, possible laughter
pt
Lip Smack: Often preceding an inbreath.
hah Laugh Syllable: Relative closed or open position of laughter
heh
hoh
$
Smile Voice: Laughing/chuckling voice while talking
19
Appendix B:
Handout for Analytic Paper #1
This take-home exam focuses on a portion of an oncology interview between a patient and
doctor. The transcript for this excerpt appears on Blackboard, and is entitled “the lucky
one”. Access “Digital Media Files” in Course Documents to play video clip. Transcription
for “the lucky one” is also in Course Documents.
Your task is to provide a detailed analysis of the actions PAT (Patient) and DOC (Doctor))
are co-producing within this excerpt. In so doing, attend carefully to how this excerpt is
initiated, delivered, and responded to -- i.e. co-authored by PAT & DOC, thus, what both
speakers are orienting-to throughout this segment:
Consider these questions:
* In what activities are they engaged? (i.e., how do the activities get "brought off" or
"accomplished", and what resources are employed?)
* In what precise ways are they co-producing these activities, i.e. what is the detailed
and moment-by-moment character of these activities ?
* What is the "work" of the activities produced? (i.e., how do these participants make
available to one another their understandings of the altogether contingent unravelings
of this interaction?)
First, during the first several weeks of this class, read the available papers – they are, in
many ways, relevant to moments in “the lucky one”. Second, in particular, read the
Beach et al (2004) paper on “Disclosing and Responding to Cancer ‘Fears” During an
Oncology Interview”. Third, you should engage in repeated listenings to this segment,
available on Blackboard through “External Links/Digital Media Files”. Fourth, make
notes in the margins of the transcript reflecting your abbreviated analysis of the
organization of these activities. Fifth, focus on the talk and speakers’ bodies. Sixth, write
your notes into paragraphs, and gradually into positions about the interactional
organization of “the lucky one”. Seventh (and ‘hint’), compare your findings to key
moments in “cancer, cancer, cancer” – transcription on Blackboard under “Excerpts for
Promotional Video”. Video clip will be played in class.
Time permitting, write multiple drafts of your analysis, turning directly to class
readings as resources for understanding both how to write an analysis and how to
structure/organize your paper.
You are expected to integrate the following into your paper:
1) Short data segments for purposes of substantiating claims: from both the assigned
excerpt and (this is required) any related data segments from class readings you
20
deem relevant for purposes of revealing similarities and/or contrasts. Number all
segments (i.e., 1-?), label all segments (e.g., SDCL: OC#1:2:1-3), and indent
according to appropriate format (see most any class reading that analyzes
interaction). Any number of research articles for this class employ this format, so
look to see how they have organized their data and manuscripts to assist your
writing for this assignment.
2) Direct quotes from readings (with authors, years, and page numbers) and, where
relevant, discussions in class. Outside literature review may also be helpful.
All papers should be typed, double spaced, with a 15 page (double spaced/12 font)
length restriction (title page and references not included). Thoughtful introductions and
conclusions are required, as are descriptive headings/sub-headings (i.e., capturing the
social actions you analyze and describe in any following section of your paper).
Write sections of your paper in the following order: 1) Data analysis; 2) Introduction; 3)
Conclusion/Discussion; 4) References. Also, think carefully about an appropriate title
for the title page. Final drafts should be organized as follows: 1) Title page; 2)
Introduction; 3) Data analysis; 4) Conclusion/Discussion; 5) References
References/bibliography should be fully listed in appropriate APA format, and appear
at the end of your paper.
21
Classroom Comportment
The School of Communication, as a representative of SDSU and higher education,
expects students to engage in behaviors enhancing classroom learning environments.
The Instructor is responsible for optimizing learning not only for individual students,
but for all students comprising a class. Behaviors disruptive to the classroom instruction
are thus not tolerated. Among the actions that are considered disruptive to the learning
environment are:

The use of cell phones, and/or computers/laptops/tablets, not directly related to
the course and its instructional objectives, materials, or contents (e.g., using
social media or Facebook for conversation, correspondence, emailing, texting,
tweeting, or other activities).

Conversations with other students, during class lectures and related activities,
that are distracting to shared attention and collaborative learning.

Reading, sleeping, harassing, bullying, or related activities exhibiting disrespect
to the instructor or fellow students.

Consistently entering late, leaving early, or leaving often from class.

Activities that are grossly inappropriate, threatening or dangerous.
When students’ actions distract from learning objectives, instructors may be required to
intervene to minimize disruptive conduct. For example, if a student is observed texting
in class, Instructor may request that the cell phone be turned in for the remainder of
class. Or if a student is using a laptop to access Facebook or e-mail, Instructor may ask
the student to close the technology until the end of class. Each Instructor will clearly
describe and enforce these inappropriate behaviors.
Should repeat offenses occur, with fair warning, each Instructor will determine fair and
22
appropriate consequences for these disruptive behaviors. Should an emergency occur or
require monitoring, or if students observe violations of these policies distracting to their
learning, they are encouraged to inform the instructor as soon as possible.
Certain other activities may be acceptable, but only with permission or by direction of
the Instructor. Such activities include:
 Filming, taping, or otherwise recording the class;
 Accessing the Internet to elaborate or clarify class content;
 Requesting that computers/laptops/tablets may be permitted. If a student is
found to be surfing the net unrelated to classes, for example, they will be asked
to be seated in the front row(s) of the classroom when using their laptop.
Students with Disabilities
If you are a student with a disability and believe you will need accommodations for this
class, it is your responsibility to contact Student Disability Services at (619) 594-6473. To
avoid any delay in the receipt of your accommodations, you should contact Student
Disability Services as soon as possible. Please note that accommodations are not
retroactive, and that accommodations based upon disability cannot be provided until you
have presented your instructor with an accommodation letter from Student Disability
Services. Your cooperation is appreciated.