诊疗方案给出方式、诊疗内容与序列位置之关系的会话分析研究
A Conversation Analytic Research on the Relationship among Treatment Regime Delivery Practice, Treatment Content, and Sequential Position
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摘要: 本研究采用会话分析研究方法, 以泌尿外科门诊录像及转写为语料, 探讨医生诊疗方案给出方式与诊疗内容及序列位置之间的内在关系。语料分析发现医生主要通过宣告、建议、给予三种行为给出诊疗方案。宣告类诊疗方案为直接解决疾患的生物医学手段, 建议类诊疗方案是解决疾患的辅助手段或生活方式干预, 而给予类诊疗方案只舒缓症状。从序列位置看, 宣告类诊疗方案往往出现在明确的诊断和诊断解释之后, 建议类诊疗方案出现在宣告类诊疗方案之后, 而给予类诊疗方案或者出现在患者无器质性疾病诊断之后, 或者出现在宣告类和/或建议类诊疗方案之后。从行为决定权来看, 宣告类诊疗方案最大程度体现医生决定患者后续行为的权力, 建议类和给予类次之。诊疗方案的给出方式与诊疗内容及序列环境之间的上述关系是医患双方共同建构和观照的一种社会规范。Abstract: Adopting conversation analysis as its research methodology and taking video recordings and transcriptions of doctor-patient interaction at the urology clinic as its data, this paper investigates the relationship among treatment regime delivery practice, treatment content and its sequential position.It is found that the doctor mainly resorts to three actions, namely pronouncement, suggestion, and offering, to deliver treatment regimes.Pronouncements are the most direct biomedical solution to the patient's problems.Suggestions are supplementary solution or lifestyle interference, and offerings are medication prescribed to ease the patient's symptoms.In terms of its sequential position, pronouncement-formulated treatment regime occurs right after the doctor's explicit diagnosis and embodies the highest degree of deontic right.Suggestion comes after the pronouncement-formatted treatment regime, and offering comes either after good news diagnosis or after the pronouncement and/or suggestion-formulated treatment regime.There exists a normative relationship among the social action that the doctor adopts to deliver a treatment regime, its content and its sequential position.