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In:A Pragmatic Agenda for Healthcare: Fostering inclusion and active participation through shared understanding
Edited by Sarah Bigi and Maria Grazia Rossi
[Pragmatics & Beyond New Series 338] 2023
► pp. 43–74

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Chapter 2
Microanalysis of Clinical Interaction (MCI)

 | Akershus University Hospital
 | University of Victoria
 | University of Oslo
Published online: 17 November 2023
DOI logo with link
https://doi.org/10.1075/pbns.338.02ger
Abstract
A pragmatic agenda for clinical communication must derive sound practice recommendations based on investigations of actual clinical practice rather than idealized practice. While it is reasonable to recommend that clinicians foster the inclusion and active participation of their patients, if such recommendations are based on top-down ideals rather than a sound, bottom-up empirical base, they are vulnerable to implementation challenges.
This chapter introduces microanalysis of clinical interaction (MCI), which uses videorecorded consultations between clinicians and patients to reveal authentic communicative practice in interaction. We will briefly describe its history, unique features and affordances, and examples from studies that have applied it. We then focus on its potential utility for explicating how to accomplish patients’ inclusion and active participation in interaction.
Article outline
  • 1.Introduction
    • Value of doing video analysis in clinical practice
    • Short precis of Microanalysis of Clinical Interaction (MCI)
    • Positioning Microanalysis of Clinical Interaction with other methodological approaches
    • Chapter outline
  • 2.Historical background of Microanalysis of Clinical Interaction
    • Early roots of pragmatics of human communication
    • Pragmatics of human communication to microanalysis of face-to-face dialogue
      • Microanalysis of face-to-face dialogue to microanalysis of clinical interaction
    • Comparing MFD and MCI
    • Essential elements of MCI
  • 3.Method
    • Data
    • Data preparation
    • Preparation
      • Creating an inventory of material
      • Transcribing speech, noting initial impressions
      • Keeping the analysis traceable
    • Analytical activities
    • Beginning the coding manual with rationale and research questions
    • Doing the microanalysis
    • Deciding whether an entry point is useful
    • Identifying the phenomenon in specific behaviours
    • Characterizing the specific behaviours
    • An example of a moment of analysis using ELAN
    • Dissemination: Transforming analysis into meaningful results
    • Reporting definitions and examples
    • Summarizing frequencies of the phenomena
    • Summarizing qualitative characteristics of the phenomena
    • Follow up analyses
  • 4.A research agenda for fostering inclusion and active patient participation
  • 5.Discussion
  • Notes
  • References
References (59)
References
Ashby, W. Ross. 1957. An Introduction to Cybernetics. London: Chapman & Hall Ltd.Google Scholar logo with link to Google Scholar
Bavelas, Janet Beavin. 1987. “Permitting Creativity in Science.” In Scientific Excellence: Origins and Assessment, edited by Douglas N. Jackson and J. Phillipe Rushton, 307–327. Sage Publications Inc.Google Scholar logo with link to Google Scholar
. 1995. “Quantitative versus Qualitative.” In Social Approaches to Communication, edited by Wendy Leeds-Hurwitz, 49–62. The Guilford Press.Google Scholar logo with link to Google Scholar
. 2007. “Writing with Paul.” Journal of Marital and Family Therapy 33 (3): 295–297. Google Scholar logo with link to Google Scholar
. 2011. “Connecting the Lab to the Therapy Room: Microanalysis, Co-construction, and Solution-Focused Brief Therapy.” In Solution-Focused Brief Therapy: From Practice to Evidence-Informed Practice, edited by Cynthia Franklin, Terry S. Trepper, Eric E. McCollum and Wallace J. Gingerich, 144–162. Oxford, UK: Oxford University Press. Google Scholar logo with link to Google Scholar
. 2022. Face-to-face Dialogue: Theory, Research, and Applications. New York: Oxford University Press. Google Scholar logo with link to Google Scholar
Bavelas, Janet Beavin, and Nicole Chovil. 2006. “Hand Gestures and Facial Displays as Part of Language use in Face-to-face Dialogue.” In The SAGE Handbook of Nonverbal Communication, edited by Valerie Manusov and Miles L. Patterson, 97–115. Thousand Oaks, CA: Sage. Google Scholar logo with link to Google Scholar
. 2000. “Visible Acts of Meaning: An Integrated Message Model of Language in Face-to-face Dialogue.” Journal of Language and Social Psychology 19 (2): 163–194. Google Scholar logo with link to Google Scholar
Bavelas, Janet Beavin, Dan McGee, Bruce Phillips, and Robin Routledge. 2000. “Microanalysis of Communication in Psychotherapy.” Human Systems 11 (1): 47–66.Google Scholar logo with link to Google Scholar
Bavelas, Janet Beavin, Jennifer Gerwing, and Sara Healing. 2014. “Hand Gestures and Facial Displays in Conversational Interaction.” In Oxford Handbook of Language and Social Psychology, edited by Thomas Holtgraves, 111–130. New York: Oxford University Press.Google Scholar logo with link to Google Scholar
. 2017. “Doing Mutual Understanding. Calibrating with Micro-sequences in Face-to-face Dialogue.” Journal of Pragmatics 121: 91–112. Google Scholar logo with link to Google Scholar
Bavelas, Janet Beavin, Jennifer Gerwing, Sara Healing, and Christine Tomori. 2016. “Microanalysis of Face-to-face Dialogue: An Inductive Approach.” In Researching Communication Interaction Behavior: A Sourcebook of Methods and Measures, edited by C. Arthur Van Lear and Daniel J. Canary, 129–157. Thousand Oaks, CA: SAGE.Google Scholar logo with link to Google Scholar
. 2017. “Profile 41: Microanalysis of Face-to-face Dialogue (MFD).” Sourcebook of Listening Methodology and Measurement, edited by Debra L. Worthington and Graham D. Bodie, 445–452. Hoboken, NJ: Wiley Blackwell. Google Scholar logo with link to Google Scholar
Bavelas, Janet Beavin, Jennifer Gerwing, Chantelle Sutton, and Danielle Prevost. 2008. “Gesturing on the Telephone: Independent Effects of Dialogue and Visibility.” Journal of Memory and Language 58 (2): 495–520. Google Scholar logo with link to Google Scholar
Caronia, Letizia, Federica Ranzani, and Vittoria Colla. (this volume). “Pursuing Understanding or Engaging the Patient? ‘Making the body speak’ as a Dilemma-Overcoming Practice in Triadic Primary Care Visits with Unaccompanied Foreign Minors.” In A Pragmatic Agenda for Healthcare: Inclusion and Active Participation Through Shared Understanding, edited by Maria Grazia Rossi, and Sarah Bigi. Amsterdam: John Benjamins.
Cicourel, Aaron V. 1987. “The Interpenetration of Communicative Contexts: Examples from Medical Encounters.” Social Psychology Quarterly 50 (2): 217–226. Google Scholar logo with link to Google Scholar
Cox, Antoon. 2017. “The Dynamics of (Mis)communication in Language-Discordant Multi-Party Consultations in the Emergency Department.” PhD diss., Vrije Universiteit Brussel.
Davis, Martha. 2001. “Film Projectors as Microscopes: Ray L. Birdwhistell and Microanalysis of Interaction (1955–1975).” Visual Anthropology Review 17 (2): 39–49. Google Scholar logo with link to Google Scholar
De Jong, Peter, Janet Beavin Bavelas, and Harry Korman. 2013. “An introduction to using microanalysis to observe co-construction in psychotherapy.” Journal of Systemic Therapies 32 (3): 18–31. Google Scholar logo with link to Google Scholar
Del Vento, Agustin, Janet Bavelas, Sara Healing, Grant MacLean, and Peter Kirk. 2009. “An Experimental Investigation of the Dilemma of Delivering Bad News.” Patient Education and Counseling 77 (3): 443–449. Google Scholar logo with link to Google Scholar
Donabedian, Avedis. 1988. “The Quality of Care: How Can it be Assessed?.” Journal of the American Medical Association 260 (12): 1743–1748. Google Scholar logo with link to Google Scholar
ELAN (Version 6.0) [Computer software]. (2020). Nijmegen: Max Planck Institute for Psycholinguistics, The Language Archive. Retrieved from [URL]
Elwyn, Glyn, Hayley Hutchings, Adrian Edwards, Frances Rapport, Michel Wensing, Wai-Yee Cheung, and Richard Grol. 2005. “The OPTION Scale: Measuring the Extent that Clinicians Involve Patients in Decision-Making Tasks.” Health Expectations 8 (1): 34–42. Google Scholar logo with link to Google Scholar
Gerwing, Jennifer. 2008. “Quantifying Infant Social Responsiveness: Microanalysis of Home Videos of a Set of Triplets for Early Indications of Autism.” PhD diss, University of Victoria, Canada.
. 2017. “Introducing Body-Directed Gestures as a Semiotic Resource in Patient-Physician Dialogues.” In Proceedings of the 4th European and 7th Nordic Symposium on Multimodal Communication (MMSYM 2016), Copenhagen, 29–30 September 2016, edited by Patrizia Paggio and Costanza Navarretta, 85–93. Linköping: Linköping University Electronic Press.
. 2021. “A Case for Videorecording Practice.” Journal of Solution Focused Practice 5 (1): 31–35. Google Scholar logo with link to Google Scholar
Gerwing, Jennifer, and Anne Marie Landmark Dalby. 2014. “Gestures Convey Content: An Exploration of the Semantic Functions of Physicians’ Gestures.” Patient Education and Counseling 96 (3): 308–314. Google Scholar logo with link to Google Scholar
Gerwing, Jennifer, and Thor Indseth. 2010. Communication with Non-Native Callers in Medical Emergency Calls: Recommendations for AMK Operators and Leadership. Technical report prepared for NAKMI; Oslo University Hospital, Ullevål. Google Scholar logo with link to Google Scholar
. 2016. “Enhancing Caller Comprehensibility in Emergency Calls with a Language Barrier: Operators in the Role of Addressee.” International Journal of Listening 30 (3): 163–179. Google Scholar logo with link to Google Scholar
Gerwing, Jennifer, Thor Indseth, and Pål Gulbrandsen. 2016. “A Microanalysis of the Clarity of Information in Physicians’ and Patients’ Discussions of Treatment Plans with and without Language Barriers.” Patient Education and Counseling 99 (4): 522–529. Google Scholar logo with link to Google Scholar
Gerwing, Jennifer, and Pål Gulbrandsen. 2017. “The Perils of Information Giving: What an Accidental Incident Taught us about Messages and Roles.” Patient Education and Counseling 100 (11): 2109–2115. Google Scholar logo with link to Google Scholar
Gerwing, Jennifer, and Shuangyu Li. 2019. “Body-Oriented Gestures as a Practitioner’s Window into Interpreted Communication.” Social Science & Medicine 233: 171–180. Google Scholar logo with link to Google Scholar
Gerwing, Jennifer, Jon Erik Steen-Hansen, Trond Mjaaland, Bård Fossli Jensen, Olav Eielsen, Owen Matthew Truscott Thomas, and Pål Gulbrandsen. 2021. “Evaluating a Training Intervention for Improving Alignment between Emergency Medical Telephone Operators and Callers: A Pilot Study of Communication Behaviours.” Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 29 (1): 1–8. Google Scholar logo with link to Google Scholar
Healing, Sara. 2013. “Development of a Method of Analysis for Identifying an Individual Patient’s Perspective in Video-Recorded Oncology Consultations.” MSc thesis, University of Victoria, Canada.
Henry, Stephen G., Anne Elizabeth Clark White, Elizabeth M. Magnan, Eve Angeline Hood-Medland, Melissa Gosdin, Richard L. Kravitz, Peter Joseph Torres, and Jennifer Gerwing. 2020. “Making the Most of Video Recorded Clinical Encounters: Optimizing Impact and Productivity through Interdisciplinary Teamwork.” Patient Education and Counseling 103 (1): 2178–2184. Google Scholar logo with link to Google Scholar
Kendon, Adam. 1990. Conducting Interaction: Patterns of Behavior in Focused Encounters. Cambridge: Cambridge University Press.Google Scholar logo with link to Google Scholar
Korman, Harry, Janet Beavin Bavelas, and Peter De Jong. 2013. “Microanalysis of Formulations in Solution-Focused Brief Therapy, Cognitive Behavioral Therapy, and Motivational Interviewing.” Journal of Systemic Therapies 32 (3): 31. Google Scholar logo with link to Google Scholar
Larsen, Berit Hofset, Tonje Lundeby, Jennifer Gerwing, Pål Gulbrandsen, and Reidun Førde. 2022. “Eh – What Type of Cells are these – Flourishing in the Liver?” Cancer Patients’ Disclosure of Existential Concerns in Routine Hospital Consultations. Patient Education and Counseling 105 (7): 2019–2026. Google Scholar logo with link to Google Scholar
Larsen, Berit Hofset, Tonje Lundeby, Pål Gulbrandsen, Reidun Førde, and Jennifer Gerwing. 2022. “Physicians’ Responses to Advanced Cancer Patients’ Existential Concerns: A Video-Based Analysis.” Patient Education and Counseling 105 (10): 3062–3070. Google Scholar logo with link to Google Scholar
Leeds-Hurwitz, Wendy. 1987. “The Social History of the Natural History of an Interview: A Multidisciplinary Investigation of Social Communication.” Research on Language and Social Interaction, 20 (1–4): 1–51. Google Scholar logo with link to Google Scholar
Leeds-Hurwitz, Wendy, and Adam Kendon. 2021. “The Natural History of an Interview and the Microanalysis of Behavior in Social Interaction: A Critical Moment in Research Practice.” In Holisms of Communication: The Early History of Audio-Visual Sequence Analysis edited by James McElvenny and Andrea Plodner, 145–200. Berlin.Google Scholar logo with link to Google Scholar
Lie, Hanne C., Jennifer Gerwing, Hilde Bondevik, Inga Bostad, Dan-Mikael Ellingsen, Sasha Frühholz, Pål Gulbrandsen, Magnus Hontvedt, Thomas de Lange, Anne Marie Landmark Dalby, Berit Hofset Larsen, and Julia Menichetti. 2022. “Studying Clinical Communication through Multiple Lenses: The Underused Potential of Inter-Disciplinary Collaborations.” Patient Education and Counseling, 105 (6): 1673–1675. Google Scholar logo with link to Google Scholar
McNeill, David. 1992. Hand and Mind: What Gestures Reveal about Thought. Chicago: University of Chicago Press.Google Scholar logo with link to Google Scholar
Menichetti, Julia, Jennifer Gerwing, Lidia Borghi, Pål Gulbrandsen, and Elena Vegni. 2021. “Saying “I Don’t Know”: A Video-Based Study on Physicians’ Claims of No-Knowledge in Assisted Reproductive Technology Consultations.” Frontiers in Psychology 11: 3912. Google Scholar logo with link to Google Scholar
Menichetti, Julia, Inge Henselmans, Janneke Noordman, Anne Marie Landmark, Jennifer Gerwing, Marij Hillen, and Arwen Pieterse. 2021. “Methods for Analyzing Actual Communication: A Shared Decision Making Consultation under Multiple Methodological Lenses.” Patient Education and Counseling 104 (10): 2598–2600. Google Scholar logo with link to Google Scholar
Nordfalk, Jenny Maria, Julia Menichetti, Owen Matthew Truscott Thomas, Pål Gulbrandsen, and Jennifer Gerwing. 2022. “Three Strategies when Physicians Provide Complex Information in Interactions with Patients: How to Recognize and Measure Them.” Patient Education and Counseling 105 (6): 1552–1560. Google Scholar logo with link to Google Scholar
Ranzani, Federica. this volume). The Pediatrician’s Normalizing Practice in Well-Child Visits: Reassuring Parents and Ratifying Medical Knowledge in Infants’ Growth Assessment Sequences. In A Pragmatic Agenda for Healthcare: Inclusion and Active Participation through Shared Understanding edited by Maria Grazia Rossi and Sarah F. M. Bigi. Amsterdam: John Benjamins.
Roter, Debra, and Susan Larson. 2002 “The Roter Interaction Analysis System (RIAS): Utility and Flexibility for Analysis of Medical Interactions.” Patient Education and Counseling 46 (4): 243–251. Google Scholar logo with link to Google Scholar
Sacks, Harvey. 1985. “Notes on Methodology.” In Structures of Social Action: Studies in Conversation Analysis, edited by Maxwell Atkinson and John Heritage, 21–27. Cambridge University Press. Google Scholar logo with link to Google Scholar
Siddiqui, Tahreem Ghazal, Socheat Cheng, Marte Mellingsæter, Ramune Grambaite, Pål Gulbrandsen, Christofer Lundqvist, and Jennifer Gerwing. 2020. ““What Should I Do When I Get Home?” Treatment Plan Discussion at Discharge between Specialist Physicians and Older In-Patients: Mixed Method Study.” BMC Health Services Research 20 (1): 1–11. Google Scholar logo with link to Google Scholar
Smock Jordan, Sara. 2011. “Evidence-Based Supervision: Identifying Successful Moments of Solution-Focused Brief Therapy.” In Doing Something Different, edited by Thorana S. Nelson, 197–200. Taylor & Francis.Google Scholar logo with link to Google Scholar
Smock Jordan, Sara, Adam Froerer, and Janet Beavin Bavelas. 2013. “Microanalysis of Positive and Negative Content in Solution-Focused Brief Therapy and Cognitive Behavioral Therapy Expert Sessions.” Journal of Systemic Therapies 32 (3): 47–60.Google Scholar logo with link to Google Scholar
Svennevig, Jan, Jennifer Gerwing, Bård Uri Jensen, and Meredith Allison. 2019. “Pre-Empting Understanding Problems in L1/L2 Conversations: Evidence of Effectiveness from Simulated Emergency Calls.” Applied Linguistics 40 (2): 205–227. Google Scholar logo with link to Google Scholar
Taylor, Lance, and Joel Simon. 2014. “Opportunities: Organizing the Solution-Focused Interview.” Journal of Systemic Therapies 33 (4): 62–78. Google Scholar logo with link to Google Scholar
Thomson, Teresa L., and Wayne Beach (this volume). “Methodological Insights for the Study of Communication in Health.” In A Pragmatic Agenda for Healthcare: Inclusion and Active Participation through Shared Understanding edited by Maria Grazia Rossi and Sarah F. M. Bigi. Amsterdam: John Benjamins.
Tietbohl, Caroline K., and Anne E. C. White. 2022. “Making Conversation Analysis Accessible: A Conceptual Guide for Health Services Researchers.” Qualitative Health Research 32 (8–9:) 1246–1258. Google Scholar logo with link to Google Scholar
Tomori, Christine, and Janet Beavin Bavelas. 2007. “Using Microanalysis of Communication to Compare Solution-Focused and Client-Centered Therapies.” Journal of Family Psychotherapy 18 (3): 25–43. Google Scholar logo with link to Google Scholar
Watzlawick, Paul, Janet Beavin, and Don D. Jackson. 1967. Pragmatics of Human Communication: A Study of Interactional Patterns, Pathologies and Paradoxes. New York: WW Norton & Company.Google Scholar logo with link to Google Scholar
Zimmermann, Christa, Lidia Del Piccolo, Jozien Bensing, Svein Bergvik, Hanneke De Haes, Hilde Eide, Ian Fletcher, Claudia Goss, Cathy Heaven, Gerry Humphries, et al.. 2011. “Coding Patient Emotional Cues and Concerns in Medical Consultations: The Verona Coding Definitions of Emotional Sequences (VR-CoDES).” Patient Education and Counseling 82 (2): 141–148. Google Scholar logo with link to Google Scholar
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