Workshops /Symposia / Patient Education and Counseling 34 (1998) S43 –S55 S45

diagnosis, or of a proposed treatment. It can be general the institutional nature of the interview and the sequentialadvice (e.g., about lifestyle or diet) or the provision of effects of talk in action.general medical or biological knowledge that is necessary

Counselling in a health promotion environment: di-for the understanding of a specific condition or advicelemmas and solutions(education). It can also be a form of counselling or a

form of emotional support. Patients can respond in manyDavid Silverman, Department of Sociology, Goldsmith’sdifferent ways to providers’ talk: by showing surprise, orCollegeNew Cross, London SE14 6NW, UKrelief, anxiety, anger, resistance, misunderstanding, or

understanding. An emerging theme of conversationThe perceived non-directive character of counselling isanalytic studies of communication in health care is thechallenged in settings where health professionals desiredescription of patterns that can be found in theseto pass on particular health promotion messages. On theactivities of delivery of information (by the provider) andbasis of an international study of HIV-test counselling,reception (by the patient). This will be the topic of thetwo solutions to this dilemma are identified:following five presentations.* extended interviews where, largely through the use of

hypothetical questions, clients are encouraged to iden-Interactional forms of informing, counselling andtify a piece of tacit adviceeducating clients in dietary counselling

* short information-based sessions where lack of clientuptake is masked by concealing the advice-givingLinda Tapsell, University of Wollongong, Dep. of Bio-character of the enterprise.medical Science, University of Wollongong, NSW, 2522

The advantages and limitations of both ‘solutions’ areAustraliadescribed and the practical implications for health profes-sionals are discussed.Introduction. One of the central features of interactions

between health care workers and clients is the provisionAchieving a patient-centred consultation by givingof professional advice. Reference to assessment protocolsfeedback in the early stages of the consultationfor student dietitians in Australia suggests that this advice

may occur in the provision of information on the diet-Tony Hak, University of Liverpool, Peter Campion,

disease relationship, assessing current dietary intakeUniversity of Hull

patterns and negotiating dietary change. In this paper weexamine how these three actions are displayed in inter- Since the publication of the seminal study Doctorsviews involving student dietitians working in an outpati- Talking to Patients (Byrne & Long 1976) the concept ofent clinic of a major regional hospital in New South a patient-centred consultation has been central both toWales, Australia. studies of doctor-patient interaction and to communica-Methods. During the period 1992-1994, sixty two inter- tion skills training. However, there is a considerableviews involving student dietitians and clients were mismatch between research in this field and the applica-audiorecorded with consent. Methods of conversation tion of its findings, e.g. in training. Extant quantitativeanalysis were applied to the data to identify interactional research, which is based on coding of interactionalforms specific to that of dietary counselling involving moves, cannot contribute to training because its data areentry level practitioners. not specific enough to allow precise and detailed advice.Results. Information on the diet-disease relationship In contrast, qualitative interaction analysis can producetended to occur in the early stages of the interview and descriptions of interactional techniques by which doctorslargely took the form of ‘‘information delivery’’ iden- achieve a patient-centred consultation. The paper pre-tified in other studies of healthcare counselling. Pro- sents a description of an interactional strategy whichviding assessments of dietary intakes and negotiating consists of providing the patient with information andchange were often packaged in a way similar to a clarifications in the early (history taking) part of the‘‘perspective display series’’ found in paediatric consulta- consultation, By using this, doctors are able to teachtions. This particular presentation could be interpreted as patients to become competent interpreters of their owna form of ‘‘client centred’’ practice, albeit limited within experiences and hence experts on their own condition. Itthe constraints of the interview context. will be discussed whether this technique could be taughtConclusion. In the student driven dietary interview, the and learned.giving of professional advice was readily identified andfound to have a fairly consistent structure. This may Bad News, Good News, and Uncertain News in thereflect constraints such as assessment protocols, a third Primary Care Clinicparty observer and the relative inexperience of thepractitioner. Overall, the interview was judged as having Doug Maynard, Richard Frankel, Department of Sociolo-a rather more educative than counselling flavour. Be that gy, Indiana University, Ballantine Hall 747, Blooming-as it may, the interactional products were seen to reflect ton, IN 47403, USA