Talk about medicines

Abstract

Background Thousands of patients and general practitioners (GPs) talk about medicines every day during their consultations. Due to the confidential setting in which these conversations take place, little is known about the ways in which they play out between participants. Alongside the benefits provided by medicines doctors prescribe, there is a worrying degree of avoidable harm and expenditure introduced by errors and misunderstandings about these treatments. This thesis sets out to explore talk about medicines in GP consultations and enhance our understanding of the ways in which medicines are requested, reviewed and included in the fabric of talk-in-interaction. Methods GPs working at five practices were approached. Eight GPs agreed to take part. Surgery lists were assigned to the research and adult patients from each surgery were contacted. Information about the research was provided to all patients recruited to take part in the study. Video recordings of their consultations were made with the participants’ consent. These were collected at eleven surgeries. Talk from the recordings of these consultations were analysed using a conversation analytic approach. The analysis of conversation was made alongside review of non-verbal communication and body position of participants captured in the video recordings. Results Seventy-nine patients were recruited and 78 consultations were recorded. Patients and GPs used a spectrum of practices during their talk about medicines. Features of patient talk included expression of their lifeworld experiences, concerns and considerations in relation to medicines. Doctors varied in their responses to these biopsychosocial contexts, with a range of practices. Some took a biomedical perspective and excluded these contexts; others embraced the lifeworld as part of the fabric of their consultation. Requests for medicines were made during a variety of consultation activities. Doctors and patients were both seen to orient to contingencies around the supply of prescription medicines as part of this talk. In the review of medicines, the electronic record played a powerful part in the consultation. Doctors used a range of conversational and non-verbal practices in relation to this resource. Some practices inhibited and constrained patient slots in conversation, and some opened out possibilities for patients to participate in talk. Conclusions The analysis of talk that takes place between GPs and patients as they discuss medicines has revealed a rich and informative insight into the ways in which participants conduct these conversations. The findings from this research can help guide future design of education and practice, focused on the creation of slots for talk about medicines during medical consultation.

Date of Award	1 Aug 2019
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Susan Speer (Supervisor) & Sarah Collins (Supervisor)