The Problem With "Problems": The Case of Openings in Optometry Consultations

Abstract

This article contributes to conversation analytic understanding of openings in health-care consultations. It focuses on the case of optometry: a form of health-care practice in which an optometrist conducts checks of a patient's vision and eye health. Patients are advised to attend regularly for routine assessments and can also request a specific appointment at any time. Analysis of a corpus of 66 consultations shows what happens when the optometrist's opening question solicits the client's "problems" with their eyes. We find three types of patient response. Patients who have requested a specific appointment (most often) report a problem with their eyes and establish a problem-purpose encounter. Patients attending for a routinely timed appointment either report no problems and establish a routine-assessment purpose, or if they do have a problem, they delay reporting it or downplay it. We track through what happens subsequently. The findings have practical implications for diagnosis and treatment. © 2013 Copyright Taylor & Francis Group, LLC.