Claiming Power in Doctor-Patient Talk

Nancy Ainsworth-Vaughn studied stories, topic control, "true" questions, and rhetorical questions in 101 medical encounters in US private-practice settings. In exceptionally lucid and accessible style, Ainsworth-Vaughn explains how power was claimed by and co-constructed for both patients and doctors (previous studies have focused upon doctors' power). The discourse varied along a continuum from interview-like talk to conversational talk. Six chapters are organized around data and include extended examples of actual talk in detailed transcription; four of these data-oriented chapters focus upon dynamic, moment-to-moment use of speech activities in emerging discourse, such as doctors' and patients' stories that co-constructed selves, and a patient's sexual rhetorical questions. Two more chapters offer non-statistical quantitative data on the frequency of questioning and sudden topic changes in relation to gender, diagnosis, and other factors. Contributing to discourse theory, Ainsworth-Vaughn significantly modifies previous definitions for topic transitions and rhetorical questions and discovers the role of storytelling in diagnosis. The final chapter provides implications for physicians and medical educators.