'Why didn't you say just that?' Dealing with issues of asymmetry, knowledge and competence in the pharmacist/client encounter

Abstract

The existence of asymmetry in medical encounters has been discussed many times in previous research, beginning with Parsons' influential functionalist view of socially prescribed roles for physician and patient. Both theory and research have undergone many transformations since, creating a general agreement amongst conversation analysts that asymmetry is 'interactively achieved' rather than imposed (Maynard 1991). However, most of the 'micro' sociological literature dealing with asymmetry in doctor/patient consultations is based on episodic encounters, as opposed to long term relationships. Conversation analysts in particular have not tended to focus on long term interactional sequences. The data presented here are drawn from a paediatric oncology clinic, which deals with long term cancer and leukaemia patients. These patients make regular visits to the clinic, often over a period of several years, and as such are an unusual group with respect to their knowledge of their conditions and treatment. This paper considers the implications of this with respect to the 'knowledge-based asymmetry' which has been documented in a range of lay-professional encounters. In so doing, it examines to what extent pharmacists in the clinic constitute their clients as people with expertise and/or knowledge, what difficulties client knowledgeability can create, and how this is managed or pre-empted within the interaction. In many cases, the knowledge of the patient does appear to 'diminish' the interactional symmetry commonly seen in lay/professional encounters to some extent. However, there are still observable incidences of what is termed 'interactional submission' by apparently knowledgeable patients or carers during the course of the encounters.