Abstract
Clinical guidelines require the patient’s participation in the entire rehabilitation process, including discharge planning. However, very little is known about how this institutional requirement is actually dealt with in everyday clinical practice. Adopting a conversation analytic approach, our paper tackles the matter, looking at situations in which patients achieve interactional initiatives within interdisciplinary entry meetings (IEMs) at a rehabilitation clinic in German-speaking Switzerland. Based on audio-visual recordings of 11 IEMs, whose central aim is to formulate patients’ rehabilitation goals and to plan their discharge, the paper offers a detailed analysis of two conversational environments in which patients accomplish initiatives: incipient disagreement among the interdisciplinary team and difficulties faced by the professionals in moving towards the formulation of a goal. In both situations, the progress of the activity is at stake. Moreover, the analysis reveals the interactive and stepwise accomplishment of patients’ initiatives. Our paper argues that shedding light on how patients’ initiatives are interactively implemented makes it possible to discuss how issues of epistemic rights and entitlement to participate are locally negotiated. In the final discussion, the paper raises the question of how patients’ competence in intervening in the goal-formulation activity can be taken into account in clinical guidelines on patient participation.
About the authors
Sara Keel is a postdoctoral researcher and lecturer at the French Seminar of the University of Basel. Her current research interests include young children’s display of competences in everyday parent–child interactions, patients’ interactions with healthcare providers and their participation in discharge planning meetings, and public events organized and held by immigrants’ protest movements. Her book Socialization: Parent–Child Interaction in Everyday Life (2016) was published by Routledge in the Directions in Ethnomethodology and Conversation Analysis series.
Veronika Schoeb is Assistant Professor in the Department of Rehabilitation Sciences at the Hong Kong Polytechnic University and HES Professor at the School of Health Sciences, Department of Physiotherapy at the University of Applied Sciences in Western Switzerland. She holds a first degree as a healthcare professional and received her PhD in Sociology and Social Policy from the University of Nottingham (UK). Her research interests lie in patient–health professional communication and goal-setting procedures in physiotherapy, as well as in all aspects of interaction in healthcare.
Appendix. Conventions for transcription (Jefferson 2004; Mondada 2007a)
- [ ]
A left/right bracket indicates the beginning/end of overlapping talk.
- (1.0)
Numbers in parentheses indicate a timed pause (measured in tenths of seconds).
- (.)
A dot in parentheses indicates a brief interval (+/− a tenth of a second).
- WORDS
Upper case indicates extra loud sounds relative to the surrounding talk.
- °words°
Degree signs bracketing an utterance or parts of it indicate that the sounds are softer than the surrounding talk. The more degree signs there are, the softer the sound.
- >words<
Right/left carats bracketing an utterance or utterance part indicate that the bracketed material is speeded up, compared to the surrounding talk.
- ((smile))
Double parentheses contain transcriber’s descriptions.
- ::
Colons indicate prolongation of the immediately prior sound.
- par-
A dash indicates a cut-off.
- =
Equal signs indicate no break or gap (latching talk).
- .h
A dot-prefixed row of h’s indicates an in-breath. Without the dot, the h’s indicate an out-breath.
- ( )
An empty parenthesis indicates that the transcriber was unable to grasp what was said.
- (a little)
Parenthesized words indicate a guess at the talk.
- ?
The question mark indicates upward, questioning intonation.
- .
The dot indicates a downward final intonation.
- ,
The comma indicates a continuing intonation.
- ↓↑
Arrows indicate shifts into high or low pitch.
- Participants’ acronyms …
… and symbols for multimodal transcription:
- PA: patient
*
- NUR: reference nurse
£
- OTH: occupational therapist
+
- PTH: physiotherapist
%
- MDR: medical doctor
$
- STH: speech therapist
&
- pa1
identifies the participant doing the described gesture or action.
- * / £ / &
a described gesture or action by an individual, indicating the moment at which the action begins in relation to the transcribed talk (or silence) and where it ends. If there is more than one transcribed action, they are listed chronologically.
- rh
a gesture or action accomplished by the participant’s right hand.
- lh
a gesture or action accomplished by the participant’s left hand.
- -->
the described gesture or action continues across subsequent lines.
- #
the exact point within a turn at talk where a figure has been taken.
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