Interactional Context and Intervention

Turn Taking

Harvey Sacks, Emanuel Schegloff, and Gail Jefferson demonstrated that interaction is organized on a turn-by-turn basis, that there are rules governing how turns are constructed and allocated, and that these rules independently affect the content, process, and understanding of both verbal and nonverbal communication. Just one example relevant to health communication involves physicians' gaze behavior. Historically, in studies of physician-patient communication, gaze had been operationalized in terms of its duration and frequency (e.g., in seconds) across (sometimes randomly selected) segments of consultations. However, this operationalization is (in many cases) not ecologically valid because participants organize their gaze according to turn-taking rules. Outcomes related to physicians' establishment of mutual gaze with patients—for example, patients' levels of disclosure and evaluations of physicians' rapport—vary (at least in part) according to where physicians' gaze is positioned relative to physicians' and patients' turns of talk.

For instance, when soliciting stories or tellings, it is normative to establish mutual gaze by the beginning of the telling, but not necessarily before that point. As such, at the outset of visits, when primary care physicians solicit patients' chief complaints (i.e., a type of telling), physicians recurrently organize a transition from a state of nonmutual gaze—which is “normal,” such as gazing at patients' medical records—to one of mutual gaze, such that mutual gaze is coordinated with the end of the solicitation turn and the beginning of its response. For example, in Extract 1 (the first of several extracts of conversations between a doctor and a patient), the physician shifts his gaze from a computer screen to the patient at the “s” of the word ears (line 1), that is, just as the physician is about to become a “recipient” of the patient's telling:

Extract 1:

• 1.
  Doctor: What's wrong with your ears?
• 2.
  (Doctor gazes at computer, then gazes at the patient upon the “s” of the word ears).
• 3.
  Patient: I think they're both infected…

The effect of physicians' gaze (or lack thereof) on patients' behavior, as well as on patients' postvisit evaluations of physicians' gaze behavior as positive or negative (i.e., on health outcomes), depends (at least in part) on where physicians position their gaze relative to turns of talk.

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