Talking an Institution into Being: the Opening Sequence in General Practice Consultations
A visit to one’s GP (General Practitioner) is a very common social event, at least in the British context. We (patients) visit our GPs for a variety of reasons, including reporting a new medical condition, reporting developments on an ongoing concern, renewing a prescription, and even obtaining a certificate for sick leave from work. The fact that a ‘list’ (Jefferson 1990) of the reasons for visiting one’s GP can be attempted is an important indication of the nature of doctor-patient interaction. It is a goal-oriented activity, an instance of institutional talk (Drew and Heritage 1992b; Heritage 1997). At once these two facts, diversity of goals and goal-focus, lead to the important issue of opening, of how participants enter the interactional world of the consultation. Time constraints within which consultations are conducted (more or less ten minutes) add to the urgency to get the consultation underway as soon as possible. The ordinary everyday conversational method of introducing topics in a stepwise progression (Sacks 1992) is not likely to be helpful here. Rather, participants in a consultation overwhelmingly use the strategy of topic initial elicitors (Button and Casey 1984). Such topic initial elicitors include questions such as ‘How are you?’, ‘What can I do for you?’, ‘What’s the problem?’, ‘How are you feeling?’ and even commands such as ‘Fire away’. Given this diversity of first concern elicitors, the question arises as to whether they are equivalent, whether the choice between alternative ways of opening the consultation is random or whether it is orderly.
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