Communicating for a clinical purpose: strategy in interaction in healthcare consultations

Many studies of communication employ interviewing techniques and conversation analysis, particularly in situations where one participant brings specialist resources. Interviews and recorded interactions are usually handled separately: ethnographic data are introduced once conversation analysis is complete, to validate findings or illustrate their wider significance. However, integrating interview data in conversation analysis has the potential to illuminate analysts' interpretations, and to enhance professionals' contributions from analysis through to dissemination. In this study, interviews highlighted a parameter between professionals who actively used communication to manipulate the consultation's course, engaging patients at particular points and in particular ways, and professionals whose consultation management was more 'clinical' and less dependent on interaction. The different ways professionals talked in interview were paralleled by differences identified from conversation analysis of consultations. For some, 'clinical' orientation was more prevalent in the organization of their consultations than 'active' manipulation of communication, and their management of the consultation more 'unilateral'. For others, communication played a more strategic and integral part in clinical practice, and their management of the consultation was more 'bilateral'. These contrasts in professionals' descriptions of their consultation management suggest that at least some features of a 'bilateral' approach are consciously employed and may be teachable.