From asymmetry in talk-in-interaction to power in society: how interactional order meets social order in medical consultations

01 Jun 2024
Conference Room

From asymmetry in talk-in-interaction to power in society: how interactional order meets social order in medical consultations

While the observation of asymmetry has been persistent in research on doctor-patient interaction (cf: Pilnick and Dingwall, 2011), the results do not provide a holistic picture of asymmetry in talk in interaction. For example, some research focuses on interruption and turn-taking (Robinson, 2001), while others explore epistemic and deontic asymmetries (Stivers et al., 2018). Furthermore, while most CA studies on DPI consider asymmetry as an internal-to-talk phenomenon and hence do not necessarily link it to the external-to-talk phenomenon of social power (Maynard and Heritage, 2005; Robinson, 2001), Stevanovic and Peräkylä (2014) propose the correspondence between deontic asymmetry to the external account of power. This study takes up this proposal and argues that previous studies on the concept of asymmetry have been somehow inadequate in explaining its multifaceted angles. It is argued that asymmetry needs to be theoretically reconceptualized through the lens of interactional pragmatics (Arundale, 2020), which involves a top-down approach of theorization and then a bottom-up approach of investigating the theorized account in the details of the interaction, using ethnomethodological conversation analysis (EMCA). It is further argued that any attempt of relating the asymmetries in talk in interaction to the external account of power should be carefully grounded in all relevant orders of epistemic, deontic, emotional and benefactive domains which undergird formation and ascription of social actions. To support the argument throughout the presentation, transcriptions of audio-recorded talk in Persian doctor-patient interactions in Iranian medical consultation visits are used as data. The study attempts to offer cross-culturally valid theoretical grounds for future research in talk-in-interaction and pragmatics.



Arundale, R. B. (2020). Communicating and relating: Constituting face in everyday interacting. Oxford: Oxford University Press.

Pilnicks, A. and Dingwall.  R. (2011). On the remarkable persistence of asymmetry in doctor-patient interaction: a critical review. Social Science and Medicine, 72, 1374-1382.

Maynard and Heritage, (2005). Conversation analysis, doctor-patient interaction, and medical communication. Medical Education, 39, 428-435.

Robinson, J. D. (2001). Asymmetry in action: sequential resources in the negotiation of prescription requests. Text, 21 (1-2), 19-54.

Stevanovic, M., & Peräkylä, A. (2014). Three orders in the organization of human action: On the interface between knowledge, power, and emotion in interaction and social relations. Language in Society43(2), 185-207.

Stivers, T., Heritage, J., Barnes, R.K., McCabe, R., Thompson, L., & Toerien, M. (2018). Treatment recommendations as actions. Health Communication, 33, 1335-1344.