Claiming Power in Doctor-Patient Talk [Paperback]

Nancy Ainsworth-Vaughn studied stories, topic control, true questions, and rhetorical questions in 101 medical encounters in US private-practice settings. In exceptionally lucid and accessible style, Ainsworth-Vaughn explains how power was claimed by and co-constructed for both patients and doctors (previous studies have focused upon doctors' power). The discourse varied along a continuum from interview-like talk to conversational talk. Six chapters are organized around data and include extended examples of actual talk in detailed transcription; four of these data-oriented chapters focus upon dynamic, moment-to-moment use of speech activities in emerging discourse, such as doctors' and patients' stories that co-constructed selves, and a patient's sexual rhetorical questions. Two more chapters offer non-statistical quantitative data on the frequency of questioning and sudden topic changes in relation to gender, diagnosis, and other factors. Contributing to discourse theory, Ainsworth-Vaughn significantly modifies previous definitions for topic transitions and rhetorical questions and discovers the role of storytelling in diagnosis. The final chapter provides implications for physicians and medical educators.

This book is an important landmark in doctor-patient literature. In a unique way, the book combines empathy with the patients with an understanding of the doctors. -- Britt-Louise Gunnarsson, Uppsala University Convener, Scientific Commission on Communications and the Professions, AILA

Ainsworth-Vaughn has developed a data collection technique which gives her a reliable basis for extracting generalizable patterns while keeping sight of individual variation. It should serve as model for any conversation-based investigation that aims at being socially relevant. -- Madeleine Mathiot, State University of New York at Buffalo

More than any other work in the last two decades, Ainsworth-Vaughn's examination of the medical encounter brings ls)