Reducing asymmetry in doctor-patient interaction: patients' initiatives in specialised clinical encounters

This study identifies and describes a specific multimodal practice that patients use during medical encounters, in which they interact with a team of doctor in an Italian specialized centre for prosthesis construction and application. Focusing on the early stages of these encounters, in which participants are engaged in history-taking and physical examinations, the paper analyses the way in which patients delicately orchestrate their gaze, gesture and verbal behaviour to gain some extra speaking space, beyond that of mere respondents to doctors’ questions. By using the analytic and methodological framework of Conversation Analysis, we show that patients produce this recurrent multimodal pattern, whose features are methodically produced and recognizable. The study shows that, through this specific pattern, patients manage to acquire the interactional role of “action initiators”; thus constraining doctors to respond: for instance, by producing unrequested information about their health status, by correcting implicit assumptions in the doctors’ questions, or by producing independent assessments. Thus, the paper contributes to previous research, which has documented patients’ agency and initiative, revising the notion of asymmetry in medical settings and highlighting the active role of the patient in every stage of these encounters.