Clinical Interaction in Context

- A Sociological Observational Study of Naturally Occurring Primary Care Consultations

Clinical Interaction in Context is a sociological observational study of interactions between patients and general practitioners (GPs) in naturally occurring consultations, with an emphasis on shared decision-making. Although our empirical exploration focuses on in situ encounters between patients and GPs as they unfold, we situate their interaction in the sociocultural context in which it is embedded and explore their negotiations in relation to their institutionalised positions and roles.

Theoretical perspective: Based on Bourdieu’s field theory, we depict the clinical consultation as a social field that has its own distinct logic, constituted by a set of interrelated hierarchical social positions. Interaction within this field is underpinned by a shared set of informal rules of conduct that are culturally fostered through social interaction, and tacitly claimed as expectations. Contextualising negotiations observed in the clinical encounters enables us to see how the actions of both patients and GPs are constrained by their different institutionalised positions.

Empirical data: The study is based on verbatim transcripts of 212 naturally occurring GP consultations, sourced from the One in a Million data archive in the UK. Consultations involve musculoskeletal, psychological, digestive, cardiovascular, neurological, endocrine/metabolic and general conditions. By exploring the moment-to-moment unfolding of complete consultations with a heterogenous sample of patients, we capture the interactional dynamics of negotiations in relation to a wide range of consultation aspects and clinical conditions. Supplementary data (patient records; longitudinal patient pre- and post-consultation survey data; sociodemographic data of patients and GPs and GP practice data) are used to support our interpretations of the consultation transcripts.

Methodology: Our main analytical approach is qualitative interpretive narrative analysis. In line with this methodology, we analyse the consultations as narratives, and explore complete consultation transcripts in relation to what was uttered (content), how it was uttered (form) and by whom (speaker). By focusing on the interactional dynamics; quoting long extracts; analysing components in light of the whole, and attending to sequentiality, we respect the integrity of the narrative. Through a data-grounded semantic coding of all 212 consultations in NVivo, we are able to relate single cases to the wider dataset.

Configuration: Patient centred care and shared decision making is a key theme, which we address in six different studies with three partly overlapping sub-themes:

(1) modes of interaction (paper 1-2);

(2) risk and uncertainty (paper 3-4), and

(3) patient agency (paper 5-6).

Researchers: professor Sarah Nettleton, University of York; professor Christopher Dowrick, University of Liverpool; associate professor Åge Wifstad, UiT; postdoc researcher Huw Grange, UiT, and professor Olaug S. Lian, UiT (project leader and contact person).

Project affiliation: The Medial Humanities research group, UiT.