Doctor-patient interaction in a Russian private clinic

This dissertation analyzes the interactional organization of medical consultations in a Russian private clinic. Under the Conversation Analysis framework, this research project explores specific ways in which patients enact agency and actively participate in consultations. The dissertation advances our understanding of patient’s agency and examines an under-investigated language and institutional setting, a Russian private clinic. First, I explore how patients use epistemic markers such as "I read," "I heard," and "I was told" to enact such interactionally delicate actions as treatment requests, diagnostic assertions, and resistance to medical advice. By framing their contributions with these markers, patients acknowledge the doctor's epistemic authority while simultaneously assert their own agency, performing actions they are not institutionally expected to initiate. The analysis reveals how epistemic markers allow patients to balance orientation to medical authority with exercising personal knowledge and preferences. Second, I examine how patients request diagnostic tests and treatments. In particular, I show that forms of requests are sensitive to their positions in the overall structural organization of the visit and, at the level of turn design, tilted towards the most likely outcome. Requests launched early in the consultation (before diagnosis and treatment discussions) are designed as positive interrogatives and tilted towards a yes-type answer since, at this stage, it is reasonable to assume that some tests and medications will be offered. Requests launched late in the consultation (after diagnosis and treatment discussions) are designed as negative interrogatives and tilted towards a no-type answer since, at this point, all tests and mediations had already been offered. These practices show how patients delicately balance the expression of treatment preferences with recognition of medical authority, thereby enacting agency. Third, I analyze how children are questioned in pediatric consultations with a particular focus on how doctors and parents design questions. I demonstrate that when children provide inapposite responses - or no response at all - doctors and parents either pursue further responses or provide answers on behalf of the child, thereby working to sustain the doctorability of the problem. Pursuing sequences and parental interventions can be considered socializing moments: they make evident to the child what is missing in their responses, either via additional questions or via accounts, thus socializing the child into the patient’s role and responsibilities.