Thesis (Ph.D.)--Duquesne University, 2005. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 156-169) and index.

Thesis (Ph. D.)--University of Hong Kong, 2002. / Includes bibliographical references.

Thesis (Ph. D)--University of Alberta, 2009. / "A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Slavic Linguistics, Modern Languages and Cultural Studies." Title from pdf file main screen (viewed on July 14, 2009). Includes bibliographical references.

Working at the intersection of medical sociology and the psychology of health, language and communication, in this PhD I use thematic analysis (TA) and conversation analysis (CA) to provide an insight into various aspects of doctor-patient communication that may be considered, or are constructed as, challenging and/or delicate for either the patient, doctor or both at a Gender Identity Clinic (GIC) in the UK. This project involves the secondary analysis of two existing data-sets: (i) 21 recorded telephone interviews between my PhD supervisor and transsexual patients who attended the GIC; (ii) 156 transcribed audio-recordings and 38 video-recordings (total = 194) of psychiatrist-patient consultations in the GIC. The first original research paper uses TA to investigate the views and experiences of transsexual patients regarding their communication with psychiatrists at the GIC. An important finding was that patients actually appreciated being challenged in this setting, subsequently the implications of this are considered with regards to the achievability and desirability of patient centred communication. The second research paper uses CA to consider how patients overtly challenge psychiatrists in the GIC in ways that have not been shown in conversation analytic research on medical interactions to date. Analysis of the data corpus revealed that there were three common ways in which patients challenged psychiatrists at the GIC, which are (1) by problematising their questions; (2) by disagreeing with statements that are made regarding their treatment; (3) and by initiating complaints. The findings of this study are considered in relation to the implications that they have for clinicians and for the persistence and desirability of asymmetry in clinical interaction in light of the current debates surrounding the concept of patient-centeredness. The final research paper also uses CA, in this instance to study how the topic of weight, which is often constructed and orientated towards as delicate in talk-in-interaction, is occasioned and discussed by psychiatrists and patients at the GIC. Whereas previous CA research on this topic has focused on how this is constructed by speakers as a moral issue, this paper is concerned with focusing on how psychiatrists (1) establish with patients that their weight is an issue, (2) encourage patients to lose weight by informing them that this is their responsibility and (3) offer advice on the behavior changes associated with weight loss. The results of this paper are discussed with regards to the implications that they have for clinicians who discuss the potentially delicate topic of weight with patients in a number of different settings. This project contributes towards the growing debates regarding the achievability and desirability of patient centred communication and the persistence of asymmetry in clinical interaction. It also contributes to medical conversation analytic literature to date on asymmetry and talk about weight in clinical interactions.

Bakgrund: Kommunikation innebär en relation mellan en sändare och en mottagare samt ett möte på en jämlik nivå. Att lyssna aktivt är en grundläggande kunskap inom omvårdnad och lyssnandet leder till att sedan kunna kommunicera effektivt. Vårdprofessioner kommunicerar på varierande sätt, har olika mål med kommunikationen samt att det finns flera samtalstekniker. Ett hinder i kommunikationen beskrivs som avsaknad av ett gemensamt språk eller att tolk används till hjälp. Syfte: Att belysa kommunikation, samtalet och lyssnandet i mötet mellan patient och vårdare i vårdmiljö. Metod: En beskrivande litteraturstudie. Resultat: Indelades i tre olika kategorier: Tala är silver, Tiga är guld och Att inte förstå varandra. God kommunikation ledde till trygghet och följsamhet hos patienter. Patient-centrerad kommunikation stimulerade empowerment och gav bättre hälsa. Samtal som redskap var det viktigaste redskapet och krävde träning för att utföras. Aktivt lyssnande ledde till nöjdare patienter, färre återbesök och en ökad tillfredställelse hos patienten. Att avbryta eller leda samtalet ledde till ineffektiv kommunikation. Hinder i kommunikationen kunde äventyra patientsäkerheten samt öka patientens lidande. Med tolk kunde de kulturella skillnaderna försvåras, men även att vara tre i en vårdrelation kunde leda till missförstånd. Slutsats: Kommunikation var basen i vårdmötet. Tala var silver men att tiga var guld. / Background: Communication is a relationship between a transmitter and receiver, and a meeting on an equal level. Active listening is a basic knowledge in nursing and listening leading to communicate effectively. Health care professionals communicate in different ways have different goals with communication and that there is several conversations techniques. One obstacle in communication is described as the absence of a common language or interpreter is used to help. Aim: Highlighting communication, conversation and listening in the meeting between patient and caregiver in the healthcare environment. Method: A descriptive literature-review. Result: Divided into three categories: Speech is silver, silence is golden, and Not understanding each other. Good communication led to patients felt safe and adherence. Patient-centered communication stimulated empowerment and provided better health. Conversation as a gear was the main tool and required training to be performed. Active listening led to more satisfied patients, fewer return visits and increased patient satisfaction. To interrupt or lead the conversation leads to ineffective communication. Barriers in communication could jeopardize patient safety and increase patient suffering. With an interpreter could be the cultural aspects complicate but also to be three in a health care relationship could lead to misunderstanding. Conclusion: Communication was the basis of health meeting. Speech was silver but silence was golden.