Practitioners' accounts for treatment actions and recommendations in physiotherapy: When do they occur, how are they structured, what do they do?

Abstract

This paper examines healthcare communication between physiotherapists and patients during treatment sessions, using the perspectives and methods of conversation analysis. In particular, it examines communication about reasons and rationale for treatment actions by analysing physiotherapists' accounts (explanations) for these actions during treatment sessions. Circumstances in which accounts arise are identified, structural aspects described and their functions demonstrated. These accounts can be persuasive, can foster mutuality, minimise resistance and provide education. They contribute to sensitive handling of patients' physical failures and of removing clothing. Questions arising, but as yet unanswered, include whether clinicians' accounts impact on patients' perceptions and their long-term outcomes. Analysis sheds some light on why observers have found accounts are uncommon in actual consultations. It thereby contributes to sociological understandings about why certain matters are and are not communicated during healthcare encounters, demonstrating the significance of practical and interactional constraints. The findings also provide clinically relevant information about when and how accounts can be provided, and what accounting can achieve in terms of both local procedures and the overall character of the consultation and relationship. © 2009 Foundation for the Sociology of Health and Illness/Blackwell Publishing Ltd.