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Engagement of patients with psychosis in the consultation: conversation analytic study * Commentary: Understanding conversation

McCabe, R. (2002). Engagement of patients with psychosis in the consultation: conversation analytic study * Commentary: Understanding conversation. BMJ, 325, pp. 1148-1151. doi: 10.1136/bmj.325.7373.1148

Abstract

Objective: To investigate how doctors engage with patients with psychotic illness in routine consultations.

Design: Conversation analysis of 32 consultations between psychiatrists and patients with schizophrenia or schizoaffective disorder.

Setting: Two psychiatric outpatient clinics in east London and south west London.

Participants: 7 psychiatrists and 32 patients with schizophrenia or schizoaffective disorder.

Main outcome measure: Mutual engagement in communication during the consultation.

Results: Patients actively attempted to talk about the content of their psychotic symptoms in consultations by asking direct questions, repeating their questions and utterances, and producing these utterances in the concluding part of the consultation. In response, doctors hesitated, responded with a question rather than with an answer, and smiled or laughed (when informal carers were present), indicating that they were reluctant to engage with patients' concerns about their psychotic symptoms.

Conclusions: Patients repeatedly attempted to talk about the content of their psychotic symptoms, which was a source of noticeable interactional tension and difficulty. Addressing patients' concerns about their illness may lead to a more satisfactory outcome of the consultation and improve engagement of such patients in the health services.

Publication Type: Article
Additional Information: This article has been accepted for publication in BMJ, 2002, following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/bmj.325.7373.1148. © Authors (or their employer(s)). Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified)is permitted strictly pursuant to the terms of theCreative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0) https://creativecommons.org/licenses/by-nc/4.0/
Subjects: R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Departments: School of Health Sciences > Healthcare Services Research & Management
URI: http://openaccess.city.ac.uk/id/eprint/21835
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