Both physicians and patients contribute to the final decision regarding appropriate and efficacious cancer treatment, yet to date there has been no detailed linguistic study of this crucial phase of doctor-patient interaction. This study attempts to fill that gap in our understanding of medical encounters. Based on 22 audio-recorded oncologist-patient sessions, this study focuses specifically on visits in which recommendations for breast cancer treatment are made. Techniques are drawn from Conversation Analysis (grounded in Ethnomethodology) to reveal the details of the conversational work shaping the form and content of these medical interactions. Extensive conversational work goes onsometimes over an hour of talkin which the doctor and patient do much more than simply cover information about treatment options. They cooperatively construct the visit as a forum for giving and receiving expert medical advice and information.
Three data analysis chapters form the core of this dissertation. The first analytic chapter describes the phased organization of the clinic visit, focusing on how the verbal management of the component phases by both physician and patient contributes to establishing the event as a 'service encounter' in which the giving and receiving of advice is a legitimate concern.
The second analytic chapter reveals how discourse identities are established interactionally; that is, how the roles of 'expert' and 'novice' are deployed with the tools of everyday language practices. Establishing these roles is crucial to the process of making recommendations in this setting.
The third analytic chapter focuses on the delivery and receipt of the recommendation itself. The patient is an active participant in constructing her understanding of the medical situation. And we see how the doctor maintains a balance between not guaranteeing a cure while still promoting a particular treatment approach.
The current study contributes to our understanding of how institutional roles are oriented to and developed through talk, how 'context' is a locally managed, non-static phenomenon, and how linguistic events constitute the way in which women with breast cancer and their oncologists arrive at decisions which ill seriously affect the patient's future.
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