Interaction Between Doctors & Patients in KOREAN Primary Care Settings (영문판)

이 책은 저자의 박사 학위 논문인 ‘대화분석을 통한 한국 의사-환자 커뮤니케이션 연구’ (UCLA, 2009)의 일부 내용을 수정 보완하여 저술한 것이다. 이 연구에서는 먼저 한국의 병원에서 환자와 의사 사이에서 일어나는 대화와 활동을 대화 분석이라는 이론적 틀을 이용하여 관찰하고 분석하였다. 그리고 분석의 결과를 중심으로 하여 의사와 환자 사이의 사회문화적 의사소통 구조를 고찰해 보고 앞으로의 연구 방향을 논의해 보았다. 이 연구에서 분석한 자료는 한국의 의료 기관에서 수집한 육십여 건의 의료 담화 자료이다. This book used observations of participants’ actual conduct during medical encounters as a basis for theorizing the grammar and social organization of actions in Korean primary care settings during different phases of the visits mainly by employing the theoretical orientations and techniques of conversation analysis.

CHAPTER 1INTRODUCTION_ 11 1.1. Importance of Communication Skills in Medicine 13 1.2. Theoretical Background 16 1.2.1. Conversation Analysis and Institutional Talk 17 1.2.2. Embodied Work 22 1.3. Research on Doctor‐patient Communication 23 1.3.1. Research on Different Phases of the Medical Visit 25 1.3.2. Medical Communication Research in the Korean Context 31 1.4. Data and Method 35 1.5. Ethnography of Korean Medical Settings 39 1.5.1. Private Clinic 39 1.5.2. Hospital 40 1.6. Overview of the Book 42 IN KOREAN PRIMARY CARE CONSULTATIONS_ 43 2.1. Introduction 43 2.2. Taxonomy of Opening Actions in Korean Primary CareConsultations 48 2.2.1. Question Formats used to Solicit Follow‐up and RoutineConcerns 50 2.2.2. Using an Inappropriate Opening Format 54 2.3. The Normative Organization of Two Opening Formats 57 2.3.1. ‘Where does it hurt?’ as a Literal Question 57 2.3.2. ‘Name of patient ＋ topical marker’ type Openings 86 2.4. Discussion 98 2.4.1. Constraining Opening Sequences: a CollaborativeAchievement 98 2.4.2. Institutional Relevance of Opening Designs 101 CHAPTER 3DOCTORS’ QUESTIONS AND PATIENTS’ RESPONSES: NEGOTIATING AND CLAIMING EPISTEMIC RIGHTS_ 105 3.1. Introduction 105 3.2. Setting the Background: Questioning Actions 107 3.2.1. The Grammar of Building Questions in Korean 107 3.2.2. Questioning Practices in Korean and English:A Comparative Review 110 3.2.3. Dimension of Questioning and Fitted Responses 122 3.2.4. Studies on Stance Markers and Social Distribution ofKnowledge in Negative Yes/No Questions 125 3.3. Quantitative Distribution of Question Forms Found in the Data 128 3.3.1 Moving from Content Questions to Polar Questions 134 3.4. Epistemic Gradients Encoded in Different Korean NegativeQuestions 143 3.4.1. Short Form, Nominalized Form, Long Form NegativeQuestions 145 3.4.2. Question Forms and their Co‐occurrence with Committaland Connective Suffixes 160 3.5. Various Responses 169 3.5.1. Agreeing with the Question: Fitted Response 171 3.5.2. Rejecting through Downgraded Epistemic Claims 177 3.5.3. Disconfirmation through ‘No’ Tokens 188 3.5.4. Matching Epistemic Claims 190 3.6. Discussion 196 CHAPTER 4REPETITIONS IN 3rd POSITION: FORMING DIAGNOSTIC HYPOTHESES_ 201 4.1. Introduction 201 4.2. Functions, Actions and Forms of Repetitions 203 4.3. Repetitions in Third Position 207 4.3.1. Reversed polarity questions: Forming diagnostic hypothesis 210 4.3.2. Doctor’s Repetition in Third Position: Prompting Revision 232 4.4. Discussion: Findings and Implications 254 CHAPTER 5CLOSINGS AND MANAGING LAST MINUTE CONCERNS_ 257 5.1. Introduction 257 5.2. The Interactional Structure of Closing the Medical Encounter 259 5.2. Computer as a dominant source of the doctor’s attention 267 5.3. Patient Medical Record as a Primary Source of Attention 270 5.4. The Record Keeping Activity during the Closing Minutes 272 5.6. Managing Last Minute Concerns 280 5.7. Discussion 298 CHAPTER 6CONCLUSION_ 303 6.1. Chapter Two: Openings 304 6.2. Chapter Three: Korean Questions and Responsesin Medical Interviewing 306 6.3. Chapter Four: Doctors’ Repetitions in Third Turn 309 6.4. Chapter five: Closings and managing last minute concerns 310 6.5. Significance of Findings and Directions for Future Research 311 APPENDIX 1. LIST OF TRANSCRIPTION CONVENTIONS 316 APPENDIX 2. YALE ROMANIZATION SYSTEM FOR KOREAN 317 APPENDIX 3. LIST OF ABBREVIATIONS USED FOR THE KOREAN GLOSS 318 APPENDIX 4. EXAMPLE OF AN ACUTE VISIT TO A PEDIATRIC CLINIC 319 REFERENCES 345 LIST OF TABLES Table 1. Inventory of Participating Physicians 36 Table 2. Frequency of Visit Types 38 Table 3. Nature of the Visit and Physicians’ Solicitation 4) 48 Table 4. Frequency of Response Types to the Question‘Where does it hurt? 59 Table 5. Final Endings According to Sentence type and Politeness Level 108 Table 6. Korean Negative Yes/No Interrogative Forms 113 Table 7. Negative yes/no Interrogatives and its Responses(English and Korean) 118 Table 8. Frequency of Content and Polar questions in the Data Set 132 Table 9. The Distribution of Negative Yes/No Interrogatives Types 147 LIST OF FIGURES Figure 1. DOC：eti‐ka ettehkey apha‐se wa‐ss‐e‐yo?Where and how does (it) hurt that (you) came? 61 Figure 2. PAT: i ^sonkalak‐i‐yo::, This ^finger::, 69 Figure 3. Diagram of Ruling out Sequence with Reversed Polarity 1 217 Figure 4. Diagram of Ruling out Sequence with Reversed Polarity 2 221 Figure 5. The Internal Medicine Clinic Office 268 Figure 6. The Computer Patient Record 271