S52 Workshops /Symposia / Patient Education and Counseling 34 (1998) S43 –S55

but a responsibility, for medical schools to teach and The Interactional Construction of Lay and Profes-assess communication skills. However, it is important to sional Roles: Patients’ Candidate Explanations fornote that similar calls issued in the past did not generate Illness and Doctors’ Responsesa great deal of curricular change. While the LCME/CACMS resolution is likely to have more of an effect, Virginia Teas Gill, Department of Sociology - Anthropol-given its link to accreditation, at present there is tremend- ogy Illinois State University, Campus Bos 4660, Normal,ous variation in the way, and extent to which, communi- IL 61790-4660, USAcation skills are taught and assessed in medical schools.This workshop is designed to facilitate the process of

This paper analyzes the strategies patients use to presentmoving from the repeated calls and resolutions to moretheir own candidate explanations for illness as they areeffective communication skills teaching and assessmentinteracting with doctors during medical visits, and theby working with participants to:ways doctors respond to these lay explanations. Analysisd Define the scope of communication and communica-of video- and audio-taped data from patient visits to antion skills in health care.American outpatient medical clinic reveals that patientsd Develop institutional-level goals and objectives re-employ several methods to offer their own explanationsgarding communication.yet avoid appearing knowledgeable about causation.d Develop educational strategies.Patients also construct their explanations in ways that ared Develop assessment strategies.non-disruptive of doctors’ data-gathering activities; theirIn so doing, this workshop will draw from a survey ofexplanations do not compel doctors to provide confirm-communication skills teaching and assessment in Northing or disconfirming assessments, and in several waysAmerican medical schools. It will also contribute anallow doctors to accountably maintain a selective focusinternational perspective in the form of a consensuson gathering data rather than attending to patients’statement issued as a product of the July 1996 Oxfordexplanations. Patients do present themselves as legiti-Conference on Teaching about Communication in Medi-mately entitled to knowledge of what they see, feel, andcine. In addition to gaining these broad perspectives,experience, and doctors also orient to this entitlement.participants in this workshop will become familiar withThus, within doctor-patient interaction there appears tothe SEGUE framework for teaching and assessing com-be a selective rather than a general devaluing of ‘‘whatmunication. Most importantly, the workshop will providepatients know’’ about their illnesses. This study repre-participants with materials, strategies and skills to de-sents a further effort to show how knowledge–and anvelop or strengthen communication skills teaching andasymmetrical knowledge distribution–is collaborativelyassessment at their own institution.realized through organized sequences of talk and inter-action, and to show how patients and doctors therebyenact their respective roles as lay members and profes-11 symposium sionals.

THE INTERACTIONAL CONSTRUCTION OF PA-TIENTS’ AND PROVIDERS’ IDENTITIES AND

Medical communication: the production of genderedROLESand professional meanings

Hanneke Houtkoop-Steenstra, University of Utrecht, and Sue Fisher, Department of Sociology, Wesleyan Universi-Tony Hak, University of Liverpool (for adress: see ty, Middletown, CT 06457, USAsymposium 3).

In the United States doctors have a medical monopolyPatients and providers of health care usually display but under some circumstances nurse practitioners candifferent orientations to the topics they deal with (pa- deliver health care. They do so under strict limits whichtients’ problems in particular), to the provider-patient vary across the states. In this paper I compare the wayencounter itself and to its interactional order, and to the doctors and nurse practitioners talk with women patientsdesired outcome of the encounter. There are systematic to explore how gendered and professional meanings aredifferences regarding these aspects between categories of produced and resisted.providers (e.g., between doctors and nurse practitioners) While doctors and nurse practitioners each speak aand categories of settings (e.g., primary care and clinics). social / ideological discourse which interrupts the pur-Participants and providers might be interactionally con- ported objectivity of the medical encounter, they do sostructed as faulty (as in the construction of noncom- very differently. Doctors consistently recirculate theirpliance and in complaints about other doctors). This institutional authority and their gender superiority whilesymposium includes five presentations. recirculating dominant cultural meanings about women