Asymmetry: Makes or Breaks?
A conversation analysis of doctor-patient encounters in Chinese medical settings

Presented by Zheng Huan annsidewalks@gmail.com Guangdong University of Foreign Studies

1. Background
The interaction between doctors and their patients is “asymmetrical” (ten Have, 1991), which is widely shared among both researchers and participants of medical encounters. But, is this against our “assumed reality”?
With the current trend towards commercialization of medical service and patients’ increasing awareness of their rights as consumers, it is claimed that doctor-patient interaction has moved from “an asymmetrical pattern in which patients regard doctors as the authority to a symmetrical one in which doctors and patients work as partners” (Tsai and Lu, 2001) Actually in mainland China, too much has been recently informed and reported about the complaints on the part of patients and about the physical attack and the legal cases sued against doctors and hospitals. Doctor-patient interaction has remain under-researched in the Chinese context.

2. Objective
To examine asymmetrical verbal behavior and power relations of doctors and patients in the consultation room of Chinese medical institution, with focus on conversation openings and closings, questions and answers, interruptions, and topic control.

3. Research questions
Whether and how asymmetry is interactively and locally produced through doctor-patient talk at the Chinese consultation room;
How power is interactively and locally represented through asymmetrical doctor-patient conversation behavior;
How this power-loaded asymmetry works for the Chinese medical institution.

4. Key terms
Asymmetry: the unbalanced verbal behavior of participants in talk, with examples from the consultation room where doctors ask more questions than patients and from the classroom where teachers decide what topics to be covered in discussion.
Institutional talk: talk at institutions (courtroom, radio show, classroom, and medical consultation room) which is goal or task oriented, involves constraints on what count as legitimate contributions to the goal or task, and produces kinds of inference in the way speakers interpret or orient to utterance.

5. Analytic tool conversation analysis (CA)：the study of talk-in-interaction, used for identifying, describing, coding, transcribing, and analyzing the observed institutional talk.

6. Interpretative framework critical discourse analysis (CDA)：viewing power as inherent in any institutional setting where participants doing institutional tasks and activities are all apportioned different institutional roles, which in return make their differing verbal behavior in interaction.

7. Methodology
7.1 Settings three consultation rooms at three hospitals of both cityship and township, both in coastal and inland areas.
7.2 Participants
Doctors: five doctors all with over ten years’ experience of medical practice, among whom two have their conversations audio-recorded with consent.
Patients: the author herself who chanced to be a patient and participant; about sixty patients recruited for a small-scale survey.
7.3 Data collection
Audio-recording of the consultation conversations: to capture the asymmetrical phenomena of doctor-patient verbal communication;
Ethnographic interviews with doctors: to elicit information about how doctors perceive themselves as dominant participants in talk with their patients;
Questionnaire to patients: to be informed about patients’ views on doctors and the hospital as an institution by recalling their experience at the consultation room.

8. Findings & Discussion
8.1 Asymmetrical verbal behavior
Doctors: skipping the normal opening and closing of conversation rituals; using over-proportionate questioning with most responded; ‘relentlessly’ and frequently interrupting patients’ narrating; almost in total control of conversation topics.
Patients: seen as frequent in acclimating to the seemingly exclusive an oppressive verbal behavior of their doctors by recognition, acceptance, tolerance, or collaboration.
8.2 Unbalanced power relations
The observed conversational behavior of doctors and patients further reflects and represents the imbalance of power relations between the two parties inherent in their different institutional roles, with which doctors explicitly and implicitly exercise their authority, to which patients defer even with occasional attempts at struggle for power.
8.3 Makes or breaks?
Such asymmetry does not break down the flow of communication to the extent of conflicts and noncompliance, due to a good consensus on the estimate of a doctor’s behavior by trust-worthy benevolence and professional efficiency. Such benign nature the asymmetrical interaction is required of internalized medical institution in today’s China.