A conversation analysis approach to alternative medicine sessions

This dissertation presents a descriptive study of discourse practices used in the context of a doctor-patient interaction in alternative medicine sessions. Alternative medicine is oriented toward a mind-body integration in which the mental state of the patient is considered a significant contributor to the illness (Larson, 2007). Based on this philosophical background, I explore the communication in alternative medicine within the frame of patient-centred communication which informs the principles of modern healthcare. I investigate the dimensions of elicitation and rapport, and their linguistic realizations in the form of speech acts, backchannels, joint productions, and repetitions. I examine the genre of the dialogues within the Systemic Functional Linguistics framework with a focus on stages and lexico-grammatical features related to discourse and semantics. I apply Conversation Analysis to a data comprised of nine recorded sessions between two alternative medicine doctors and their patients, native speakers of English. The corpus contains 5,378 turns and 3,139 units of analysis in total for all dyadic conversations. The present study reveals that the alternative medicine speech event is an institutional genre with characteristics of patient-centred communication. The four linguistic features are used strategically — they contribute to conversational power-sharing and to collaborative creation of knowledge. Simultaneously with the conversational dominance (through questions), doctors accommodate and collaborate with patients (through backchannels, joint productions and repetitions). Reaching a diagnosis is often an incremental process in which doctors engage patients in an ongoing interactional meaning-making and shared knowledge. These practices advance the therapeutic alliance, rapport building, and shared responsibility — components that are at the core of patient-centred communication. Seen in this perspective, the study findings can bring about insights into a linguistically underexplored area such as discourse in alternative medicine visits. It contributes to the body of research that applies Conversation Analysis techniques to study medical communication.