Achieving multiple topic shifts in primary care medical consultations: a conversation analysis study in UK general practice.

The 'by the way' phenomenon, while commonly described in medical texts on the consultation, has not been systematically explored from an interactional perspective. Starting from a 'noticing' of an example of this phenomenon we studied a collection of over 200 recorded consultations in British general practice. New topics were introduced by both parties, but more commonly by patients, who used two sorts of device to change topic: an announcement, usually at the start of a consultation, but sometimes later, that they had multiple topics, which we have called a 'pre-announcement', and an apparently unexpected sudden change of topic, which we have called an 'in-situ announcement'. These phenomena occurred in about one third of our unselected collection of recorded consultations, drawn from nine doctors, and 27 surgery (office) sessions. We argue that this management of multiple topics is an important and normal part of the consultation, in contrast to its problematic status implied in some medical literature.