Wayne A. Beach, Ph.D.
Professor, School of Communication (COM 201A)
San Diego State University
San Diego, CA 92182-4561 wbeach@mail.sdsu.edu p: 619-594-4948 f: 619-594-0704
Adjunct Professor, Department of Surgery, School of Medicine
Member, Moores Cancer Center, Medical Center
University of California, San Diego
SDSU/UCSD Joint Doctoral Program in Public Health
Office Hours: T, 1-2:30 and prior to Seminar
Course Description
This seminar focuses on communication during medical interviewing, how relationships between patients and providers get accomplished through interaction, and possibilities for improving care by closely examining real clinical materials. Diverse clinical encounters between cancer patients and their oncologists will be examined, involving both
“new/first-visit” and “return” visitations recorded at UCSD’s Moores Cancer Center.
Additional materials are also available for analysis and contrast (e.g., UCSD’s Department of Surgery; Health Appraisal interviews in Kaiser Permanente’s Department of Preventive
Medicine), but will be focused upon only minimally throughout this semester. These are fascinating and relevant materials as well, however, and available for emerging research projects if students are interested in pursuing them.
This seminar is designed to enhance and integrate key components of your graduate training:

Observational, theoretical, and writing/analytic/research skills.

Abilities to practice technically competent yet compassionate social science.

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
Understandings of how to bridge university-based, academic research (and teaching) with practical concerns faced by medical practitioners and institutions on a daily basis.
The ongoing refinement of analytic and observational skills regarding recorded and transcribed interactional materials is a primary goal for this seminar. Frequent data sessions will provide the foundation for diverse and interesting discussions regarding data, method, theory, and in general the central relevance of interaction studies to the social and medical sciences.
And by focusing directly on communication in natural health/medical settings, your emerging role as a positive change agent – across diverse communities and cultures – becomes more likely, viable, and significant for addressing and solving communication problems, promoting effective and efficient practices, and building creative and strong collaborations across disciplines and professions.
The following activities will be utilized to pursue these possibilities:

Analyzing naturally occurring, video recorded and transcribed interactions involving cancer patients, doctors, and family members (and related materials).
Data sessions will contribute to an already substantial empirical foundation for understanding specific interactional practices and communication patterns through which clinical encounters get organized.

Reviewing and integrating diverse literature on patient-provider relationships, including health disparities, providing a familiarity with alternative theoretical/methodological approaches to (and concerns about) medical interviews.

Addressing the relevance and application of research findings for refining communication between oncologists, medical professionals, and lay persons
(patients, family members, and significant others). A specific concern rests with improving oncologists’ communication skills for addressing patients’ concerns
(e.g., hopes, fears, and uncertainties) and, in turn, assisting patients with activities such as raising questions, pursuing responses, and being assertive with medical authorities.

Encountering prominent scholars who employ Conversation Analytic and/or quantitative methods to study patient-provider interactions.

Encountering highly skilled and respected doctors (and nurses) committed to healing, and promoting quality of life, for cancer patients and their family members/significant others.

Articulating, in speaking and writing, the importance of communication in medical care in academic and medical/professional settings.

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.
New York, NY: Hampton Press, Inc.
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Additional readings are available to seminar participants on Blackboard.
Seminar activities will be organized around lectures and discussions from relevant literature. All (or most all) sessions will involve repeated and informal analysis of video recorded and transcribed medical interviews. The overriding focus of the seminar will be to begin to discover the kinds of interactional patterns patients and their providers co-produce throughout medical interviews, particularly during visits within the Moores
Cancer Center at UCSD. Emphasis will be given to making and analyzing "collections" of interactional phenomena, and seeking to substantiate their patterned nature.
Background & Significance
While increasing priority is being given to “patient-centered” cancer care, a fundamental understanding of patients as active collaborators during oncology interviews remains a much needed area of inquiry. Limited attention has been given to unique communication patterns between patients and providers 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

4 attend and/or disattend patients’ issues. Prior research will be extended through systematic studies of patient-initiated and doctor-responsive actions within an oncology clinic. 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. However, limited empirical attention has been given to how these fears get enacted during oncology interviews, and to unique communication patterns between patients and providers within which such social activities are embedded. One primary, though long-term goal, is to design and implement interventions to improve cancer patients’ and oncologists’ communication skills for addressing critical matters such as concerns, fears, hopes, uncertainties, and healing.
Blackboard & Text(s)
The syllabus, selected website readings, assignments (written and digitized audio/video clips), data handouts, and related materials are available on SDSU’s Blackboard: http://www.Blackboard.sdsu.edu
Media files may be downloaded from: http://www-rohan.sdsu.edu/~wbeach/media/
Downloaded PDF’s from my website are available at: http://www.rohan.sdsu.edu/~wbeach/index.htm
Additional websites of a sampling of colleagues from around the world are listed at the end of the syllabus. Students may access, download, and print relevant articles from their websites.

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Grading & Evaluation:
100 points Data Analysis Exercise #1: ‘just my speculation’ (OC#5)
100 points Data Analysis Exercise #2 : (TBA ‘collection’)
100 points Handbook (and related) Literature Review
100 points Scholar/Doctor/Nurse ‘Contact’
150 points Final Research Project
100 points Seminar Participation
-----
650 points
(95% = 617; 90% = 585; 85% = 552; 80% = 416)
(100 points ) Data Analysis Exercise #1
Access and repeatedly view OC#5: ‘just my speculation’ on Blackboard. Write a detailed analysis of the interactional organization of these moments, integrating key quotes from key readings to support your observations and claims (see Appendix B for more detailed handout).
(100 points ) Data Analysis Exercise #2
This second short paper will involve a comparative analysis of moments from the available course materials. Emphasis will be given to working with a small collection of instances. The assignment will be discussed and posted on Blackboard at a later date.
(100 points ) Handbook (and related) Literature Review
1) Form a group of 3 seminar members.
2) As a group, review major sections/headings for the Handbook. Select readings from one of these general areas of research/practice. (Other articles could also be included for this assignment, including those listed on the syllabus but not in the
Handbook).
3) Have each group member select one article from the Handbook, and one article from additional readings. Identify key issues as ‘bullets’, and highlight revealing quotes.
Focus specifically on selected data excerpts.
4) Summarize and integrate these articles/issues in a single handout for the class.
5) Present your findings in 15-20 minutes.

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(100 Points) Scholar/Doctor/Nurse ‘Contact’
Identify and contact a scholar, doctor, and/or nurse to discuss issues such as a) the current status of research on medical interviews, b) future applications, c) the importance of communication in medical care, d) possible collaborations between communication researchers and clinical professionals, and/or…whatever you might want to focus on!
Summarize your ‘findings’ in a 2-3 page (single spaced) description of topics addressed, responses provided, and how this encounter broadened and deepened your understandings of medical interactions. Be prepared to briefly overview these ‘findings’ during seminar with a one page handout/overview.
(150 Points) Final Research Project
The second half of the semester will focus on moments/practices you have identified (or will) in medical interviews. You may work alone or in small research groups (2-3 seminar members) to a) review materials, b) build collections, c) closely analyze data, d) review and integrate relevant literature, and e) produce a final research paper.
We will discuss the options for these projects, and I will provide specific papers that can be pursued building on current/ongoing research efforts.
It is expected that all final papers will carefully integrate seminar and additional readings
(tailored to the phenomena studied), systematically collect and analyze the patterned nature of naturally occurring interactional phenomena, and report well-articulated findings, conclusions, and implications of the work (including a reflexive examination of the strengths and weaknesses of these preliminary efforts).
The overriding goal is to produce a "finding" or “set of findings” about how patients and clinicians talk through medical problems that is not only inherently interesting and defensible, but extends prior research. Papers may provide a detailed case study of a single interactional phenomenon/set of moments, and/or work with larger collections of social actions. A related and important goal is to submit and present these papers at conventions, and eventually publish these findings (see below).
Details of paper formatting and presentation will emerge as the seminar unfolds, and
More specific discussions of these projects will occur mid-semester.

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Intellectual Property
All materials that I have collected are ‘restricted’ by IRB requirements, and based on explicit understandings with particular medical groups and experts. Thus, these materials cannot be used for any purposes by seminar participants without my explicit consent.
I will work directly with student research teams to produce manuscripts that could be: a) Submitted and presented at national, international, and regional conferences; and b)
Published in prominent journals and edited volumes. You are invited to be involved in these pursuits. However, to become a co-author you will need to commit to work with me beyond this seminar, revising and generating final drafts of manuscripts as part of an ongoing research team. Details about these arrangements will be discussed further in seminar.
(100 points) Seminar Participation
It is expected that seminar participation will involve: regular and prompt attendance; preparation (e.g., fulfillment of assignments, displays of careful and critical examination of readings/data); constructive, thoughtful, and detailed involvements in seminar discussions and activities; individual innovativeness and motivation, including seminar presentations and integration of diverse literature.
NOTES
Beach/Communication 783:

Patient-Provider Interactions
(Preliminary Topics/Readings; Most All Classes Involve Data Sessions)
I. Overview - (Weeks 1 & 2) – Data “just my speculation”
Drew, P. & Heritage, J. (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.
Maynard, D. & Heritage, J. (2005). Conversation analysis, doctor-patient interaction and medical communication. Medical Education 39:428-435.
Beach, W.A. (2009). Communication and patient-provider relationships. In W.F. Eadie
(Ed.), 21 st century communication: A reference handbook (358-370). Thousand Oaks,
CA: Sage Publications.
Handbook: Foreword, Introduction, & Section I, Offers & Responses
II. Illness, Disease, Authority, & Control – (Weeks 3 & 4) -
Data: “I’m running out of time”
Handbook: Sections 2 (Inadequacy & Biomedicine) & 3 (Asymmetry, Authority, & Control)
III. Patient Initiated Actions (PIA’s) & Doctor-Responsive Actions (DRA’s) –
(Weeks 4 & 5) - Data: Fears, Uncertainties, & Hopes
Wayne A. Beach, Jeffrey W. Good, Elisa Pigeron, & David W. Easter (2004). Disclosing and responding to cancer fears during oncology interviews. Social Science &
Medicine, 60, 893-910. (Section 7 in Handbook)
Beach, W.A. & Dozier, D. (2015). Fears, uncertainties, and hopes: Patient-initiated actions and doctors’ responses during initial oncology interviews. Journal of
Health Communication. DOI: 10.1080/10810730.2015.1018644
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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.
Beach, W.A. (2013). Patients’ efforts to justify wellness in a comprehensive cancer

clinic. Health Communication, 28, 577-591.
Handbook: Sections 4 (Patient-Initiated Actions) & 5 (Attending & Disattending...)
IV. Empathy, Sympathy, & Compassion - (Weeks 6 & 7) – Data: “Wow bam”
Handbook: Section 6 (Responding to Patients’ Emotional Concerns)
V. Other Delicate Moments – (Weeks 8 & 9) – Assorted Data: (e.g., “Normal”;
Laughter & Humor; Pain & Suffering)
Gutzmer, K. & Beach, W.A. (2015). ‘Having an ovary this big is not normal’:
Physicians’ use of normal to assess wellness and sickness during oncology interviews. Health Communication , 30, 8-18.
Beach, W.A. & Pricket, E. (under review). Laughter, humor, & cancer: Delicate moments when managing sickness and wellness.
Christian Heath (1989). Pain talk: The expression of suffering in the medical consultation. Social Psychology Quartery, 52, 113-125.
Handbook: Section 7 (Other Delicate Moments...)
VI. Embodied Actions: Talk & the Body – (Weeks 10 & 11) – Data: “tiny tiny little nothings”; Averted Gazes)
Handbook: Section 8 (Talk, Gaze, Gesture, & Body Orientations)
VII. Final Research Projects – (Weeks 12-15)
Additional Readings: Communication About Cancer
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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.
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, 887-
897.
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.
Maguire,P. (1999). Improving communication with cancer patients. Eur J Cancer, 35,
1415-1422.
Maguire, P. (1990). Can communication skills be taught? Br J Hosp Med, 43(3), 216-216.
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.

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Sampling of Additional Readings on Medical Interactions
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.137-
162). 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: 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 (1992). The delivery and reception of diagnosis in the general-practice consultation. In Paul Drew & John Heritage (Eds.), Talk at work: Interaction in institutional settings (pp.235-267). Cambridge: Cambridge University 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.
Paul Drew and John Heritage (1992). Analyzing talk at work: An introduction. In Paul
Drew & John Heritage (Eds.), Talk at Work: Interaction in Institutional Settings
(pp.3-65). Cambridge: Cambridge University Press.
Halkowski, T. (in press). Realizing the illness: Patients’ reports of symptom discovery in primary care visits. In J. Heritage & D. Maynard (Eds.). Practicing medicine: Talk and action in primary care consultations. Cambridge: 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

12
& 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):384-392.
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 Books.
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.
Jones, C.M. & Beach, W.A. (2005). “I just wanna know why”: Patients’ attempts and doctors’ responses to premature solicitation of diagnostic information. In Judith
M. Duchan & Dana Kovarsky (Eds.), Diagnosis as cultural practice (103-136).
New York: Mouton de Gruyter Publishers.
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.
Wendy Levinson, Editorial (1994). Physician-patient communication: a key to malpractice prevention. Journal of the American Medical Association, Nov 23/30,
272, 1619-1620.
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.
Mack Lipkin, Samuel Putnam and Aaron Lazare (Eds.), The Medical Interview: Clinical Care,
Education and Research, New York: Springer-Verlag.
Douglas W. Maynard (1992). On clinicians co-implicating recipients' perspective in the delivery of diagnostic news. In Paul Drew and John Heritage (Eds.) Talk at work:
Interaction in institutional settings (pp. 331-358). Cambridge: Cambridge
University Press.

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Elliott Mishler (1984). The Discourse of Medicine: Dialectics of Medical Interviews. Norwood,
NJ: Ablex.
G.H. Morris & Ron Cheneil (Eds.). (1995). The talk of the clinic: Explorations in the analysis of medical and therapeutic discourse. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.
Anssi Peräkylä (1993). Invoking a hostile world: Discussing the patient’s future in AIDS counseling. Text, 13:291-316.
Anssi Peräkylä (1995). AIDS counseling: Institutional interaction and clinical practice. Cambridge:
Cambridge University Press.
Anssi Peräkylä (1995). Addressing ‘dreaded issues’. Ch.6 in AIDS Counseling: Institutional
Interaction and Clinical Practice (pp.232-286). Cambridge University Press, Cambridge.
Anssi Peräkylä (1998). Authority and accountability: The delivery of diagnosis in primary health care. Social Psychology Quarterly, 6, 301-320.
Anita M. Pomerantz, J. Emde, F. Erickson, F. (1995). Precepting conversations in a general medicine clinic. In G.H. Morris & R. Cheneil (Eds.). The talk of the clinic:
Explorations in the analysis of medical and therapeutic discourse (pp.151-169)
Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.
Roberts, F. (2000). The interactional construction of asymmetry: The medical agenda as a resource for delaying response to patient questions. The Sociological Quarterly, 41,
151-170.
Debra L. Roter and Judith A. Hall (1992). Doctors Talking with Patients/Patients Talking with
Doctors, Westport CT: Auburn House.
Tanya Stivers, (1997). On-line commentary in veterinarian-client interaction. Research on
Language and Social Interaction 31(2): 109-131
NOTES

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Appendix A: Transcription Symbols
In data headings,“SDCL” stands for “San Diego Conversation Library”, a collection of recordings and transcriptions of naturally occurring interactions; “Malignancy #1” represents the title and number of call in the data corpus(see Data and Method section); page numbers from which data excerpts are drawn are also included, and line numbers represent ordering in the original transcriptions. 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.89-90). 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
15

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Appendix B:
Analytic Paper #1: ‘just my speculation’
This analysis focuses on a portion of an oncology interview between a patient and doctor, entitled “just my speculation” – and should be familiar! (The numbered transcript for this excerpt appears below.)
Your task is to provide a detailed analysis of the actions Patient and Doctor are coproducing within this excerpt. Work in unison with speakers’ talk and as embodied throughout this excerpt (i.e., through gaze, gesture, body positions, and medical record).
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 general 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, overview the available papers. An assortment of these articles are, in many ways, relevant to moments in “just my speculation”.
Second, in particular, read and integrate the following articles (Handbook…) as you begin your analysis – then add additional articles as your work progresses:
Virginia T. Gill (1998). Doing attributions in medical interaction: Patients’ explanations for illness and doctors’ responses. Social Psychology Quarterly 61:342-360.
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.

Third, you should engage in repeated listenings to this segment, available on
Blackboard through “External Links/Digital Media Files”. Fourth, make notes in the
17 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”. 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) Copy and paste short data segments for purposes of substantiating claims: from both the assigned excerpt and any related data segments from class readings (or other readings) you deem relevant for purposes of revealing similarities and/or contrasts. Number all segments (i.e., 1-?), label all segments (e.g., SDCL: OC#5:1-7), and indent according to appropriate format (see most any class reading that analyzes interaction).
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, and not exceed 15 pages in length (plus title page and references). 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; 5) Title Page (appropriate and thoughtful titles reflect good scholarship).
References/bibliography should be fully listed in appropriate APA format, and appear at the end of your paper.

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OC#5:: “just my speculation”
(5:30-6:30 on video)
Beach/SDSU
Restricted Materials
(OC5: 4-5)
5
6
7
8
9
10
11
12
1
2
3
4
Doctor: =Um (.) (An:) just to rule ou:t, for instance, you’re not anemic, so I’m not
thinking that this is from anemia. (0.2) >Okay.<

Um anybody else um <that
you’r:e> around ah (.) like >
 you know

< your girlfriend, >(an- a-)< that is sick
(.) besides you?
Patient: .hh Girlfriend is not sick. [ Ah: ]=
Doctor: [Okay.]
Patient: = and she’s bee:n ah with me, she was on (.) on that tri:p?
Doctor: Mm hm.
Patient: To the east co:ast,=
Doctor: =Okay.=
Patient: =with me:, and she has not started with any symptoms.
Doctor: Okay.=
13
14
15
16
17
Patient: U:m (1.5) I w- (0.2) was afra:id that (0.5) i:t was some sort of:- (0.2) i:t was maybe
Doctor:
related- (0.2) li:ke (.) before, to the toxicity [of the ] chemo I had in Ja:nua:ry.=
[Mm
 hm.]
Doctor: =Right.=
Patient: .hh And maybe we’re just catching it- (.) this =
((3 circular gestures ))
18 Patient: = p n e u m o : : n i a tha- that’s=

19
20
Patient: going to start up.=
Doctor: =Mm [hm.] ((begins scratching head))
21
22
23
24
25
26
27
Patient: [Um ] This is just spec- my speculation [right?]
Doctor: [ Yeah.]=
Doctor: =[ Right. Right. ]
Patient: [$Huh$ huh heh$ ] .hh $I wa:s thinking that ah-$=
Doctor: =Well-=
Patient: =because she’s not getting sick, and [ I’m ] going through=
Doctor: [

Yeah

.]
28
29
30
31
32
Patient: =some- s:ome of the si:milar- some of the same symptoms.
Doctor:

Okay.

Patient:

So.

Doctor: Sure. .hh

Are you short of breath?
Patient: .hh W- w- (0.2) I did a lot of walking in New York and
((continues))
NOTES
 ye:ah,
19

Appendix C
Selected Scholars’ Websites Involved in the Study of
Interactions During Medical Interviewing
Richard Frankel http://www.regenstrief.org/bio/full?member=rfrankel
Virginia Gill http://www.soa.ilstu.edu/soa_database/facultydwt.aspx?page=0
Tim Halkowski http://www.uwsp.edu/comm/faculty/thalkows/index.shtm
Christian Heath https://www.umds.ac.uk/schools/sspp/mgmt/staff/christianheath.html
John Heritage http://www.sscnet.ucla.edu/soc/faculty/heritage/
Doug Maynard http://www.ssc.wisc.edu/soc/faculty/pages/DWM_page/DWM_index3.htm
Anssi Peräkylä http://www.valt.helsinki.fi/staff/perakyla/english.htm
Anita Pomerantz http://www.albany.edu/~apom/
Jeff Robinson http://www.pdx.edu/communication/jeffrey-robinson
Debra Roter http://faculty.jhsph.edu/?F=Debra&L=Roter http://scholar.google.com/scholar?q=%22author%3AD.+author%3ARoter%22
Tanya Stivers http://www.mpi.nl/Members/TanyaStivers
Rick Street http://comm.tamu.edu/people/street_rick.html
20

Appendix D
Table of Contents for ‘Handbook’
Wayne A. Beach, Editor
Professor, School of Communication
San Diego State University
San Diego, CA 92182-4561 wbeach@mail.sdsu.edu p: 619-594-4948 f: 619-594-0704
Adjunct Professor, Department of Surgery, School of Medicine
Member, Moores Cancer Center, Medical Center
University of California, San Diego
SDSU/UCSD Joint Doctoral Program in Public Health
Hampton Press, Inc. (2013)
21

22
Overview: From doctor-centered
 patient-centered

relationship-centered

interactionally enacted and investigated care; abbreviated history of communication studies between patients and providers; relationships among basic and applied concerns; overview and organization of volume. Synopsis and preview of each chapter.
To preserve a sense of historical emergence, articles and chapters included in this volume are listed chronologically. Sections are organized into themes and prominent social actions identified as primary for communication between patients and providers during medical encounters:

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

23
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);
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.
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.
Debra Roter (2000). The enduring and evolving nature of the patient-physician relationship. Patient education and counseling, 39, 5-15.
24
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.

25
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.
Paul Drew (2005). The voice of the patient: Non-alignment between patients and doctors in the consultation. Unpublished manuscript.
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. Unpublished manuscript.
Wayne A. Beach & David M. Dozier (2009). Initiating hopeful actions during oncology interviews: Benign orientations to malignancy and cancer care.
Unpublished manuscript.

26
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.
Suchman, A., Markakis, K., Beckman, H. B., & Frankel, R. (1997). A model of empathic communication in the medical interview. Journal of the American MedicalAssociation,
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.

27
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.
Anssi Peräkylä (1993). Invoking a hostile world: Discussing the patient’s future in AIDS counseling. Text, 13, 302-338.
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.
28
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.
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,

29
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.
NOTES