Paper

Engagement of patients with psychosis in the consultation: conversation analytic studyCommentary: Understanding conversation

BMJ 2002; 325 doi: 10.1136/bmj.325.7373.1148 (Published 16 November 2002)
Cite this as: BMJ 2002;325:1148.1
  1. Rosemarie McCabe, senior research fellow (r.mccabe{at}qmul.ac.uk)a,
  2. Christian Heath, professor of work and organisationsb,
  3. Tom Burns, professor of community psychiatryc,
  4. Stefan Priebe, professora
  1. aUnit for Social and Community Psychiatry, Barts and the London School of Medicine, Newham Centre for Mental Health, London E13 8SP
  2. bManagement Centre, King's College London, Franklin-Wilkins Building, London SE1 8WA
  3. cDepartment of Psychiatry, St George's Hospital Medical School, London SW17 0RE
  4. Interactive Skills Unit, Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT
  1. Correspondence to: R McCabe
  • Accepted 1 August 2002

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.

Footnotes

  • Funding None.

  • Competing interests None.

  • Accepted 1 August 2002

Commentary: Understanding conversation

  1. John Skelton, director. (j.r.skelton{at}bham.ac.uk)
  1. aUnit for Social and Community Psychiatry, Barts and the London School of Medicine, Newham Centre for Mental Health, London E13 8SP
  2. bManagement Centre, King's College London, Franklin-Wilkins Building, London SE1 8WA
  3. cDepartment of Psychiatry, St George's Hospital Medical School, London SW17 0RE
  4. Interactive Skills Unit, Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT

    Footnotes

    • Transcripts and the transcript conventions appear on bmj.com

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