Negotiation and the structure of discourse in medical consultation.

Using audio tape recordings of consultations between mid-level providers and patients in a health maintenance organization, a model of medical negotiation is presented. This model conceptualizes negotiation as a process in which mid-level providers and patients introduce their perspectives on the definition and treatment of medical problems by linking together units of discourse (acts, turns, sequences and phases). This model clearly locates negotiation in observable activities of interactants and demonstrates how the process changes over the course of an encounter as provider and patient participate in the taking of a medical history, the performance of a physical examination, and the discussion of the problem and treatment. Because of the formal yet flexible nature of this model, it lends itself for use in comparative studies of medical practitioner-patient negotiation.