《“你有抽烟吗？”：病人的迂回答复及其医生的对策 》= "Do you smoke?" : on patients' 'less-than-direct' responses and doctors' countermeasures

• Main Author: 蔡永盛 Chua, Benjamin Yong Sheng
• Other Authors: Lim Ni Eng
• Format: Final Year Project
• Language: Chinese
• Published: Nanyang Technological University 2020
• Subjects: Humanities::Language
• Online Access: https://hdl.handle.net/10356/137362
• Institution: Nanyang Technological University

这篇论文是一篇语言在社会运用的会话分析研究，特别针对医生与病患在问诊时的互动。互动语言在各种社会机构的运作里，扮演者举足轻重的角色。医疗系统中的医患互动，可能直接影响医生的诊断，也可能影响患者对医生实行医疗诊断时的观感。医患互动中的一个重要环节就是进行问诊时的病史采集（history-taking）。 在病史采集的过程中，医生会向病人询问一系列与健康相关的基本问题。由于病人是否抽烟会影响医生对于病情的诊断，因此“你有抽烟吗？”这等敏感性问题是在问诊中必然产生的。虽然这类问题从医生的角度与医学相关，是病史采集中为了达到初步诊断的必然问题，然而对于病人来说，这类问题所投射出来的不仅仅是简单的诊断程序，而更是对其生活习惯的一种价值判断。因此，病人常常会选择委婉回答、侧面回答或甚至避开回答这一类可能会导致他人对他们有负面价值判断的一些问题。 在医疗场景的前提下，医生和病人对于什么问题构成“相关信息”有截然不同的判断。病人在进入问诊的时候，他们的目的在于对他们现下的病情得到一种解释以及相应的治疗。这是病人主要所关心的问题。而其它的，比如一般的生活习惯，虽然可能间接影响病人的健康，但对于病人来说，不一定能够直观地看出它们之间的联系。因此，在会话的过程中，这类问题或许产生一些不必要的解读和诠释而导致的误会，进而影响了整个会话进程的顺利完成。 本论文将探讨病人面对这类抽烟有关问题时所给予的种种迂回答复。当中，病人的迂回答复就包括了：不及时回答问题、侧面回答问题和附加辩解的回应。为了作出最准确的诊断，医生在病史采集过程中必须从病人口中得出如实的回应。因此，本论文也将分析医生在面对迂回答复时常采用的两种对策：一、以重复回应的方式再次求证信息；二、提供一个较易认同的回应选择。 通过此研究，我们将证明精细的话轮设计可以有助于更好地进行医患问诊。只要医生能够了解病人是如何看待这类敏感性问题，从中修饰和设计一个较为容易认同的回应选择，整个会话进程将可以更加顺利的完成。 In a regular medical consultation, doctors will ask patients a series of basic health-related questions during the history-taking procedure. As smoking is deemed harmful to the health of the body, “Do you smoke?” is a question that doctors will inevitably ask patients. As such questions are medically relevant from the doctor’s point of view, it is necessary to seek a truthful response from the patient in order to arrive at an accurate preliminary diagnosis. However, due to the sensitivity of such questions, patients often choose to answer euphemistically, indirectly, or even avoid provision of any response, as they perceive these questions to be preliminaries to negative moral assessments of their lifestyle habits. Under the premise of medical context, doctors and patients have very different judgements about what constitutes “relevant information”. For patients, their main concern will be to obtain a diagnosis and treatment for their current condition. Although some sorts of information such as general lifestyle habits, may be medically relevant to a diagnosis, but for patients, they may not intuitively understand the connection between such questions and the medical agenda. Therefore, during doctor-patient interaction, such questions by doctors may lead to untoward interpretation from patients, which may disrupt the progressivity of the history-taking phase of the consultation. This thesis will explore the various responses provided by patients in the face of smoking-related questions. The range of “less-than-direct” responses from patients include: delayed responses, obfuscative answers and mitigative answers with accounts. In order to make a good medical diagnosis, doctors can and will have to counter such responses with appropriate interactional strategies. Hence, this thesis will also describe two common countermeasures that doctors have adopted: the use of confirmational repeats, and providing candidate answers for patients.