The interaction order and clinical practice: Some observations on dysfunctions and action steps

Patient Educ Couns. 2011 Sep;84(3):338-43. doi: 10.1016/j.pec.2011.05.022. Epub 2011 Jun 29.


Objective: This paper examines three dysfunctional communication processes in the primary care consultation using conversation analysis theory and methods: dysfunctions in problem presentation, medical questioning that limits the expression of additional concerns, and the emergence of discordance between physicians and patients in the context of treatment recommendations.

Results: It is proposed that these dysfunctions arise from the transfer of normative conventions that function well in the practice of ordinary conversation into medical contexts where they serve to limit the effectiveness of communication. Because these conventions are rooted in, and reinforced by, the activities of daily life, they may be difficult to eradicate from the medical visit.

Practice implications: Reduction of these dysfunctions is most likely to emerge when physicians recognize the nature of these dysfunctional practices and their roots in everyday social life. Recognition of these practices together with their functions and dysfunctions may hold a solid prospect for improvements in medical communication.

MeSH terms

  • Clinical Competence*
  • Communication*
  • Humans
  • Interpersonal Relations*
  • Physician-Patient Relations*
  • Physicians
  • Practice Patterns, Physicians' / statistics & numerical data*
  • United States