9. Components of a Clinical Discourse Framework
Barry Saferstein [+]
California State University, San Marcos
Chapter Nine analyzes more interventional radiology consultation data in order to explain the components of discourse frameworks. Topics include the effects of verbal, visual, and gestural information on process narratives, the interrelationship of discourse frameworks and communication patterns, and the relation of discourse frameworks to patients’ understandings of medical information. The data show how patterns of communication related to discussing images contribute to discourse frameworks that provide detailed information to patients. Each patient’s recallable process narratives result from creating a discourse framework, which includes discussion, pointing, gesturing, and head movements related to the images. An example shows how the various components of the discourse framework contributed to a patient developing process narratives related to a potential post-procedure complication, a sloughed necrotic fibroid. The process narratives that the patient recalls during a post-consultation telephone discussion correlate with the moments at the consultation when she completed the nurse’s utterances, voiced comprehension or participation, and turned her head toward images and gestures that related to the nurse’s verbal explanation. Examining the components of the consultation discourse framework explicates how a patient’s agency during a consultation is supported by the presence of information resources that the patient responds to and discusses with the practitioner. The patient shapes the agenda of topics and forms of expression. This contributes to a customized discourse framework that suited the patient’s concerns. The practitioner applies the visual information resources to explanations that address the specific information gaps expressed by the patient. The patient’s understandings of symptoms and treatments of uterine fibroids result from the creation of a discourse framework that both reduces her interpretive contingencies and increases those of the practitioner.