Accomplishing a request without making one: a single-case analysis of a primary care visit

Abstract

Physicians and other care-givers need to recognize the various and often subtle ways that patients make initiatives, such as requesting medical interventions, in medical encounters. Prior research on patients' requests and physicians' responses has limited real-world relevance because it treats `requesting' and `responding' as straightforward, discretely codable categories. In this study, we use conversation analysis to investigate how a primary care patient delicately hints that an HIV test is warranted and how her physician recognizes (and responds to) her implicit request for this diagnostic test. Our findings provide an empirically grounded and detailed account of some of the subtle interactional dynamics involved in making and responding to medical requests. By documenting the diversity of patients' and physicians' practices, we will gain a more comprehensive understanding of patients' initiatives, physicians' responsiveness, and patient-centered behavior.