Revealing moments: formulating understandings of adverse experiences in a health appraisal interview

• Published in: Social science & medicine (1982) 2001, Vol.52 (1), p.25-44
• Main Authors: Beach, W.A., Dixson, C.N.
• Format: Article
• Language: English
• Subjects: Adult; Appraisal; Biological and medical sciences; California; Communication; Communication Health appraisal Formulations Medical interviews; Conversation; Diagnosis, Differential; Empathy; Evaluation; Formulations; Fundamental and applied biological sciences. Psychology; Health; Health appraisal; Health care; Health participants; Health Status Indicators; Humans; Interpersonal Communication; Interviewers; Interviews; Medical care; Medical History Taking; Medical interviews; Medical sciences; Medical treatment; Middle aged women; Miscellaneous; Negative experiences; Patients; Physician-Patient Relations; Psychology and medicine; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Public health. Hygiene; Public health. Hygiene-occupational medicine; Sociology, Medical
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/S0277-9536(00)00118-0

Analysis of a health appraisal interview reveals how an interviewer employs formulations to organize talk about a patient’s medical history. When selected reportings by patient are paraphrased, a three-part formulations cycle is initiated: (1) interviewer’s formulated understandings, (2) patient’s confirmation, and (3) topic shift by interviewer. The reenactment of this interactional pattern promotes increasing attention to patient’s adverse experiences as “root problems” underlying adult health status (e.g. molestation, obesity, depression). Creating an environment for patient’s emergent disclosures is facilitated by displaying non-judgmental sensitivity to patient’s stated concerns, soliciting alignment to particular reconstructions and avoidance of moving the interview forward prematurely and to issues not grounded in patient’s illness circumstances. The identification and utilization of communication techniques for attending to patient’s bio-psycho-social history is critical for refining understandings of empathic interviewing, enhancing diagnosis and treatment (e.g. referrals), decreasing patients’ utilization of health care systems, and ultimately reducing costs for quality medical care.