ABSTRACT

How diagnosis fits within the overall activity structure of surgical consultations remains under-researched. We set out to contribute to this developing area of research with a particular focus on responses to diagnosis as an achievement of patient agency. We identified 26 diagnostic sequences in a collection of 35 video recorded surgical consultations and examined these in detail using conversation analysis. The activity of diagnosis and the transition to treatment recommendation appear to be structured somewhat differently in surgeon-patient consultations than has been reported for primary care settings. In particular, patient responses to diagnosis are more frequent and more likely to be extended. The analysis provides evidence that both parties orient to surgeons’ accountability for their own diagnostic reasoning, and also the medical authority of the referring doctor and the subjective experience of the patient. In delivering the diagnosis, the surgeon must be cognizant of the opinions of both the patient and the referring doctor, which may align to a greater or lesser extent with their own diagnosis.

摘要

诊断如何适应外科咨询的整体活动结构仍未得到充分研究。我们着手为这一发展中的研究领域做出贡献，特别关注将诊断反应作为患者能动性的一项成就。我们在 35 个视频记录的手术会诊集合中确定了 26 个诊断序列，并使用对话分析对这些序列进行了详细检查。诊断活动和向治疗建议的过渡在外科医生患者咨询中的结构似乎与在初级保健环境中报告的有所不同。特别是，患者对诊断的反应更频繁，更可能延长。该分析提供的证据表明，双方都将外科医生对自己的诊断推理负责，以及转诊医生的医疗权威和患者的主观体验。在提供诊断时，外科医生必须了解患者和转诊医生的意见，这可能或多或少地与他们自己的诊断一致。