戈夫曼互动理论视角下的医患会话研究

摘要

人与人之间的交流互动是人类生活的基本形式，人们出于各种各样的目的进行交流互动。医患沟通作为最具有代表性的互动行为，与人们生活息息相关，但很少有学者从社会学角度进行分析解。本文借助美国社会学家戈夫曼互动理论，对医患会话进行深入研究。研究对象是医生与病人会诊时的对话，具体研究方法是通过搜集门诊会话录音进行转写，翻译;以戈夫曼的互动理论为框架进行分析，考察分析医生病人会话中的互动理论的体现形式及其反应出的医患沟通中存在的问题。
　　主要参照戈夫曼的三个重要理论观点:拟剧论、游戏论和仪式论对搜集到的医患会话进行分析。经过研究发现:(1)在农村的家庭诊所中，医生与病人在会话过程中，需在熟人、医患两组身份平台上进行转换。(2)不同场合下，病人在面对医生时采取不同的印象管理策略。(3)医患双方在医学信息，机构身份不对称的情况下，表现出对社会服务互动原则不同的遵循情况。医生常违反平等与礼貌原则，以居高临下的姿态命令病人;而病人则比较尊重和顺从医生的安排即使在威胁到面子的情况下，也不愿采取反抗行为。结合实际的研究结论，本文提出了三条建议以供医院医生参考，构建更加良好的医患会话模式，促进医患平等、和谐沟通。

目录

声明

Acknowledgements

Contents

Abstract

摘要

Chapter One Introduction

1．1 Background of the study

1．2 Purpose and significance of the study

1．3 Research methodology

1．4 Organization of the thesis

Chapter Two Literature Review

2．1 An overview of Goffman’s interaction order

2．1．1 Goffman and his interaction order

2．1．2 A general model of conversational interaction order

2．2 Doctor-patient conversations

2．2．1 Institutional interaction and docor-patient interaction

2．2．2 The flames of doctor-patient conversation

2．3 Approaches to doctor-patient conversations research

2．4 Research questions for the present study

Chapter Three Goffman’s Interaction Order as the Theoretical Basis

3．1 Social psychological presupposition of interaction order

3．2 Basic concepts of Goffman’s interaction order

3．2．1 Interaction order

3．2．2 Focused and unfocused interaction

3．3 Three metaphors in Goffman’s interaction order

3．3．1 The dramaturgical metaphor

3．3．2 The game metaphor

3．3．3 The ritual metaphor

3．4 Summary of the three metaphors

Chapter Four Analyzing Doctor-patient Communication

4．1 Data collection

4．2 Data analysis

4．3 Interaction order in doctor-patient communication

4．3．1 Unfocused and focused interaction in doctor-patient communication

4．3．2 Dramaturgical metaphor in small-talk

4．3．3 Naive moves versus medical expressions

4．3．4 Covering，uncovering and counter-uncovering moves in story-telling

4．3．5 Rituals in questioning

4．3．6 Equality and courtesy in doctor-patient interaction

Chapter Five Conclusion

5．1 Major findings of the study

5．2 Implications of the study

5．3 Limitations and suggestions for further study

References

Appendix