The public, the private and the intimate in doctor–patient communication: Admission interviews at an outpatient mental health care service

Abstract

This article analyzes doctor-patient communication at admission interviews in an outpatient mental health care service at a public hospital in Buenos Aires, Argentina. These interviews are the first contact between professionals and patients, and they result in the admission or rejection of the latter into the medical institution. In particular, we observe how context, understood as a sociocognitive and scalar concept, is reshaped with gaze direction and agenda-setting through interaction, resulting in three hierarchical spaces which can be represented as degrees in a scale: the public, the private, and the intimate level. This description will allow us to understand a series of communicative difficulties that may result from scale maladjustments, in which professionals interact with patients at different levels and therefore cannot give adequate feedback to satisfy mental health care needs.

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“…These issues may be better addressed by means of qualitative in-depth interviews or ethnographic studies. 43 , 44 …”

Treating without diagnosis: Psychoanalysis in medical settings in Argentina

“…The purpose of the first interview is thus both to admit some applicants as patients and refer them to specific services (individual therapy, group therapy, addictions, among others), and to reject others. In 2012, 85% of those who attended a first interview did not go on to receive a course of treatment: 35% were rejected, while a further 50% chose not to return (Bonnin 2014). Interviews are thus an important link between the 'outside' and the 'inside' of the mental health service, and performance in the clinical encounter is a major factor in accessing appropriate treatment.…”

“…although the first part of the interview is devoted to asking institutional questions to complete a statistical standardized form, at this time patients usually present the reasons why they have approached the mental health service (Bonnin 2014). In Extracts 1 and 2, r offers a series of diagnostic labels which are not developed, but dismissed by the professional.…”

“…as a consequence, patients adopt them 'in the service of communicating efficiently with a health care professional' . I have examined these strategies of communicative accommodation elsewhere (Bonnin 2014).…”

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“…In this context the family register will switch to the professional register briefly forcing the speaker to modulate both almost simultaneously. Something similar often happens to doctors and patients, when they are required to communicate with each other at public, private and intimate levels (Bonnin, 2013). Therefore the question that arises is how speakers deal with these changes and adjustments so naturally.…”