Seeking information in a medical setting: Vietnamese doctor-patient interaction

Seeking information in a medical setting: Vietnamese doctor-patient interaction

Eliciting information about a patient’s health concerns is a fundamental task that all doctors engage in. It enables the doctor to gather relevant information about the patient’s pathological status, which is then used to inform their diagnosis, propose a treatment plan, and/or recommend appropriate interventions. At the same time, the patient’s provision of information is also partly shaped by the doctor, whose deployment and use of elicitation strategies can play a role in the quality and quantity of the information the patient discloses. This study examined how doctors elicited and sought information from their patients, how patients disclosed information to their doctors, what information doctors elicited and sought, and what information patients disclosed, during medical consultations at two public hospitals in Vietnam. The data were gathered from audio-recordings of 66 primary care visits involving 15 doctors and 66 adult patients. Demographic data were collected using standard questionnaires. The data were analysed using conversation analysis methods.

The findings showed that information exchanges between doctors and patients were dispersed throughout the consultation, from the very beginning until after its
termination. In the initial stages of the visit, patients talked about their major concerns. This information established the main reason for the visit, and often
influenced the trajectory of the interaction that followed. Once the patient’s chief concerns became known, the doctor explored these in detail by eliciting information relating to the presenting problem or to the patient’s medical history. In the former case, the doctor updated the patient’s condition, noted their symptoms, and/or established the causes and duration of the problem. In the latter, the doctor focused on past diagnoses and treatments, lifestyle issues, and past individual medical problems. These two types of information played a key role in shaping the treatment, in which the doctor offered multiple treatment options and/or sought the patient’s agreement with the recommended treatment plan. In recommending this plan, the doctor also collected some information about the patient’s life-world (e.g.,
difficulties with day-to-day living).

The findings also revealed that doctors used questions as their main type of information elicitor. They also used partial and/or full repeats of patients’ responses,
fishing devices or examples of patients’ conditions, and/or assessments of patients’ information. Patients employed five different strategies to disclose information to doctors: using examples, producing a narrative, invoking the opinion of a third party, elaborating on their responses, and making a list. These strategies enabled patients not only to provide the information being elicited by doctors but also to demonstrate their knowledge of the main problem, disclose minor problems, establish the reasons for the visit, increase the perceived severity of the problem, and make an assessment of the problem. Such information was volunteered without being elicited in several cases.

The findings of this study can be used as a resource for the training of medical students on how to interact with patients. Hence, this study contributes to enhancing the quality of medical care, especially in the cultural context of Vietnam.