Setting the agenda: an analysis of negotiation strategies in clinical talk

This article analyzes the process whereby physicians and patients set the agenda for medical interviews. Applying a conversation analytic perspective to the analysis of 22 videotapes of primary care interviews at a large, urban, teaching and research hospital, a 3-stage model is developed, consisting of (a) an opening sequence, (b) an initial statement of concerns by the patient, and (c) the negotiation process. The analysis illustrates the critical function of the opening verbal exchanges, showing how patient responses to the physician's first question and subsequent queries and summaries by the physician are intricately interwoven. The interaction at the very beginning of the interview is shown to significantly alter the ensuing interaction. The analysis provides a discursive framework for analyzing problematic communication during the primary care interview.