Achieving activity transitions in physician-patient encounters..

Abstract

This article examines how physicians and patients interactionally accomplish the transition from the activity of history taking to that of physical examination. Prior research focuses on participants’ reliance on overt verbal resources (e.g., physicians’ requests for permission to examine patients or explanations that foreshadow examination). Using the methodology of conversation analysis, this article draws on a corpus of 40 primary-care encounters to dem- onstrate that: (a) In addition to verbal behavior, nonverbal behavior is integral to the accom- plishment of transitions; and (b) patients’ understandings of physicians’ verbal and nonver- bal behavior as communicating transitions are achieved through situating those behaviors in other contexts of embodied action, talk, activity, and social structure (i.e., the phase structure of encounters). Findings have implications for: (a) the theoretic relationship between verbal and nonverbal behavior in terms of social meaning, (b) what it means to explain transitions and reduce patients’ uncertainty, (c) the organization of physician-patient interaction, and (d) the relationship and interface between macro- and microconceptualizations of context.