On diagnostic rationality: Bad news, good news, and the symptom residue

Douglas W. Maynard, Richard M. Frankel

Research output: Chapter in Book/Report/Conference proceedingChapter

37 Scopus citations

Abstract

“Consideration of the patient’s condition,” or the fourth phase of the medical interview is, according to Byrne and Long (1976), the point at which the physician-having performed introductory matters, ascertained the reason for the patient’s visit, and conducted a history and exam-delivers diagnostic information. In the “three function model” of the medical interview (Cohen-Cole 1991; Lazare et al. 1995), conveying diagnostic information fits within the third function of carrying out patient education and treatment plans. To date, research on this phase and function of the interview has been minimal, and has emphasized “bad” news and the communication problems surrounding it. And this literature, as Ptacek and Eberhardt (1996) concluded in a comprehensive review, is overwhelmingly anecdotal, based on clinical experience, written from the physician’s point of view, and rarely theoretically justified or accompanied by empirical investigation.1 Moreover, the preoccupation with bad news has meant that other kinds of diagnoses, such as those that are good news or uncertain, have received virtually no study. For the medical profession, this neglect in research also means there is not much of a base on which to build curricula or standards of practice. Recently, Frankel (1994), Heath (1992), Maynard (1991c, 2003), and Peräkylä (1998, 2002, this volume), approaching the delivery and receipt of diagnostic news as an interactional event, have employed video recordings of actual interviews as a basis for analysis.

Original languageEnglish (US)
Title of host publicationCommunication in Medical Care
Subtitle of host publicationInteraction Between Primary Care Physicians and Patients
PublisherCambridge University Press
Pages248-278
Number of pages31
ISBN (Electronic)9780511607172
ISBN (Print)9780521621236
DOIs
StatePublished - Jan 1 2006

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ASJC Scopus subject areas

  • Social Sciences(all)

Cite this

Maynard, D. W., & Frankel, R. M. (2006). On diagnostic rationality: Bad news, good news, and the symptom residue. In Communication in Medical Care: Interaction Between Primary Care Physicians and Patients (pp. 248-278). Cambridge University Press. https://doi.org/10.1017/CBO9780511607172.011