As part of the ESRC funded project The Practical Work of the Optometrist Helena Webb, Christian Heath, Dirk vom Lehn, Will Gibson and Bruce Evans have published an article concerned with the opening of optometric consultations in the journal Research on Language and Social Interaction. The paper particularly explored the sensitivity clients display to the use of the word ‘problem’ in the opening questions of the history taking.
The Problem With “Problems”: The Case of Openingsin Optometry Consultations
This article contributes to conversation analytic understanding of openings in health-care consulta-tions. It focuses on the case of optometry: a form of health-care practice in which an optometristconducts checks of a patient’s vision and eye health. Patients are advised to attend regularly for rou-tine assessments and can also request a speciﬁc appointment at any time. Analysis of a corpus of 66 consultations shows what happens when the optometrist’s opening question solicits the client’s“problems” with their eyes. We ﬁnd three types of patient response. Patients who have requested aspeciﬁc appointment (most often) report a problem with their eyes and establish a problem-purposeencounter. Patients attending for a routinely timed appointment either report no problems and estab-lish a routine-assessment purpose, or if they do have a problem, they delay reporting it or downplay it.We track through what happens subsequently. The ﬁndings have practical implications for diagnosisand treatment.
Over the past few years, together with comments at the Work, Interaction & Technology Research Centre (Christian Heath and Helena Webb) at KCL, Will Gibson at the Institute of Education and the optometrists Bruce Evans, David Thomson and Peter Allen I worked on research and knowledge exchange projects exploring the practical work of optometrists and developing communications training material. some of the research now has been written up and a few months ago a paper “Engendering Response: Professional Gesture and the Assessment of Eye Sight in Optometry Consultations” was published in Symbolic Interaction. This paper focuses on a particular procedure, the so-called Subjective Refraction that involves optometrist and patient in a sequence of interaction through which some of the characteristics of any corrective lens the patient might need, are determined. Some may recognise the test as the better/worse test as it is characterised by a procedure during which the optometrist alternates a patient’s vision by placing a lens in front of their eye as asking, “better with or without”. Our study here was particularly interested in the practice of placing the lens in front of the patient’s eye, a practice that we described as “professional gesture”. Although not specifically taught in optometric training the optometrists in our research deployed the lens by moving it in a particular way in front of the patient’s eye. The gestural movement of the lens in front of the patient’s eye followed almost exactly the same route through the air in all consultations that we filmed. Our analysis reveals that such a carefully designed gesture is required for the optometrist to be able to arrive at reliable and robust data about the patient’s sight. They need the patient to respond to a series of different stimuli presented in front of them without reflecting about it.
Here is a video-abstract on the YouTube channel of Symbolic Interaction in which the lead author of the paper, Helena Webb, discusses the content of the paper and shows the gesture.