Eliciting Patients’ Health Concerns in Consulting Rooms and Wards in Vietnamese Public Hospitals

Huong Thi Linh Nguyen, Gavin Austin, Dung Duc Chau, Hien Quang Nguyen, Khanh Hoang Bao Nguyen, Manh The Duong


This article examines the doctor’s elicitation of the patient’s presenting health concern in two clinical settings in the Vietnamese public hospital system: the consulting room and the ward. The data were taken from 66 audio-recorded consultations. Our analysis shows that the elicitors used by the doctor in the consulting room often communicate a weak epistemic stance towards the patient’s health issue, while those used in the ward tend to signal a strong epistemic stance. In addition, this contrast between the elicitors employed in the consulting room and the ward is evident in our data regardless of whether the consultation is a first visit or a same follow-up (in which the doctor is the same one that treated the patient on their last visit), though the contrast is less clear for different follow-ups (in which the doctor has not treated the patient before). An additional finding is that the clinical setting has some bearing on the use of inappropriate elicitation formats (in which the doctor opens the visit with an elicitor which is more appropriate for another type of visit). The precise way in which each of the consulting room and the ward operates is, of course, a feature of the Vietnamese public hospital system itself. Hence, the overall contrast between the elicitors and elicitation formats used in these two settings illustrates how, on a more general level, the institutional context can have an impact on doctor-patient communication.


Vietnamese public hospital system, doctor-patient communication, problem elicitation, clinical setting, institutional context, Conversation Analysis  

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Athanasiadou, A. (1991). The discourse functions of questions. Pragmatics: Quarterly Publication of the International Pragmatics Association, 1(1), 107-122. doi: 10.1075/prag.1.1.02ath

Boyd, E., & Heritage, J. (2006). Taking the history: Questioning during comprehensive history-taking. In J. Heritage & D. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 151-184). Cambridge, England: Cambridge University Press.

Byrne, P. S., & Long, B. E. L. (1976). Doctors talking to patients: A study of the verbal behaviour of general practitioners consulting in their surgeries. London, England: Her Majesty’s Stationery Office.

Cordella, M. (2004). The dynamic consultation: A discourse analytical study of doctor-patient communication (Vol. 128.). Amsterdam, The Netherlands: John Benjamins.

Coupland, J., Robinson, J. D., & Coupland, N. (1994). Frame negotiation in doctor-elderly patient consultations. Discourse & Society, 5(1), 89-124. doi: 10.1177/0957926594005001005

Drew, P. (2013). Turn design. In J. Sidnell & T. Stivers (Eds.), The handbook of conversation analysis (pp. 131-149). Malden, MA: Wiley-Blackwell.

Dyche, L., & Swiderski, D. (2005). The effect of physician elicitation approaches on ability to identify patient concerns. Journal of General Internal Medicine, 20(3), 267-270. doi: 10.1111/j.1525-1497.2005.40266.x

Edwards, V., & Phan, A. (2013). Managers and management in Vietnam: 25 years of economic renovation (Doi moi). New York, NY: Routledge.

Fancher, T. L., Ton, H., Le Meyer, O., Ho, T., & Paterniti, D. A. (2010). Discussing depression with Vietnamese American patients. Journal of Immigrant and Minority Health, 12(2), 263-266. doi: 10.1007/s10903-009-9234-y

Gill, V. T., & Roberts, F. (2013). Conversation analysis in medicine. In J. Sidnell & T. Stivers (Eds.), The handbook of conversation analysis (pp. 575-592). Chichester, England: Wiley-Blackwell.

Heritage, J. (1984). A change-of-state token and aspects of its sequential placement. In J. M. Atkinson & J. Heritage (Eds.), Structures of social action: Studies in conversation analysis (pp. 299-345). Cambridge, England: Cambridge University Press.

Heritage, J., & Robinson, J. D. (2006). The structure of patients’ presenting concerns: Physicians’ opening questions. Health Communication, 19(2), 89-102. doi: 10.1207/s15327027hc1902_1

Ho, D. T. (1997). Vietnamese-English bilinguals in Melbourne: Social relationships in code-switching of personal pronouns. Monash University Linguistics Papers, 1(1), 41-51. Retrieved from http://search.informit.com.au/documentSummary;dn=322250958933600;res=IELHSS

Huynh, D. T. (1989). Introduction to Vietnamese culture. San Diego, CA: San Diego State University.

Jefferson, G. (1973). A case of precision timing in ordinary conversation: Overlapped tag-positioned address terms in closing sequences. Semiotica: Journal of the International Association for Semiotic Studies/Revue de l’Association Internationale, 9(1), 47-96. doi: 10.1515/semi.1973.9.1.47

Jefferson, G. (1984). Notes on some orderlinesses of overlap onset. In V. D’Urso & P. Leonardi (Eds.), Discourse analysis and natural rhetoric (pp. 11-38). Padua, Italy: Cleup Editore.

Jefferson, G. (1990). List construction as a task and resource. In G. Psathas (Ed.), Interaction competence (pp. 63-92). Washington, D.C.: University Press of America.

Jefferson, G. (2004). Glossary of transcript symbols with an introduction. In G. Lerner (Ed.), Conversation Analysis: Studies from the first generation (pp. 13-31). Philadelphia, PA: John Benjamins.

Labov, W., & Fanshel, D. (1977). Therapeutic discourse: Psychotherapy as conversation. New York, NY: Academic Press.

Lindström, A. (2009). Projecting nonalignment in conversation. In J. Sidnell (Ed.), Conversation analysis: Comparative perspectives (pp. 135-158). New York, NY: Cambridge University Press.

Luong, N. H., & Le, V. D. (2008). Nghiên cứu lời chào của người Việt và so sánh với lời chào của người Pháp [A study on Vietnamese greetings and a comparison with French]. Paper presented at Hội nghị sinh viên nghiên cứu khoa học, Da Nang University, Vietnam.

Luu, T. K. N. (2010). A brief comparison of Vietnamese intonation and English intonation and its implications for teaching English intonation to Vietnamese EFL learners. VNU Journal of Science, Foreign Languages, 26, 171-180. Retrieved from https://js.vnu.edu.vn/FS/article/view/2554

Ngo, N. B. (1999). Elementary Vietnamese. Boston, MA: Tuttle Publishing.

Nguyen, D. H. (2009). Vietnamese. In Comrie, B. (Ed). The world’s major languages (2nd ed.; pp. 677-692). London, England: Routledge.

Nguyen, D. T. (2012). Một số đặc điểm giao tiếp giữa bác sĩ và bệnh nhân trong quá trình khám và điều trị bệnh tại Trung tâm Y học hạt nhân và Ung bướu và các khoa lâm sàng tại Bệnh viện Bạch Mai [Some characteristics of communication between doctors and patients during consultations and treatment at The Nuclear Medicine and Oncology Centre and Clinic wards in Bach Mai hospital] (Unpublished master’s thesis). University of Social Sciences and Humanities, Hanoi, Vietnam.

Nguyen, G. T., Barg, F. K., Armstrong, K., Holmes, J. H., & Hornik, R. C. (2007). Cancer and communication in the health care setting: Experiences of older Vietnamese immigrants, a qualitative study. Journal of General Internal Medicine, 23(1), 45-50. doi: 10.1007/s11606-007-0455-2

Nishizaka, A. (2011). Response expansion as a practice for raising a concern during regular prenatal check-ups. Communication & Medicine, 8(3), 247-259. doi: 10.1558/cam.v8i3.247

Park, Y. (2009). Analyzing medical discourse: The organization of doctor-patient interaction in Korean primary care settings (Unpublished doctoral dissertation). University of California, Los Angeles, USA.

Pham, T. H. N. (2014). Linguistic and cultural constraints in Vietnamese general practitioners’ act of initiating clinical information-seeking process in first encounters with outpatients. Theory and Practice in Language Studies, 4(6), 1125-1131. Retrieved from http://www.academypublication.com/issues/past/tpls/


Pomerantz, A. (1984). Agreeing and disagreeing with assessments: Some features of preferred/dispreferred turn shaped. In J. M. Atkinson & J. Heritage (Eds.), Structures of social action: Studies in conversation analysis (pp. 57-101). Cambridge, England: Cambridge University Press.

Pomerantz, A. (2002). How patients handle lay diagnoses during medical consultations. Paper presented at the Tenth Annual Symposium about Language and Society Texas Linguistic Forum, Austin, TX.

Raymond, G. (2003). Grammar and social organization: Yes/no interrogatives and the structure of responding. American Sociological Review, 68(6), 939-967. doi: 10.2307/1519752

Robinson, J. D. (2006). Soliciting patients’ presenting concerns. In J. Heritage & D. W. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (Vol. 20., pp. 22-47). Cambridge, England: Cambridge University Press.

Robinson, J. D., & Heritage, J. (2005). The structure of patients’ presenting concerns: The completion relevance of current symptoms. Social Science & Medicine, 61(2), 481-493. doi: 10.1016/j.socscimed.2004.12.004

Sacks, H., Schegloff, E. A., & Jefferson, G. (1974). A simplest systematics for the organization of turn-taking for conversation. Language, 50(4), 696-735. doi: 10.17323/1728-192X-2015-1-142-202.

Schegloff, E. A. (1982). Discourse as an interactional achievement: Some uses of ‘uh-huh’ and other things that come between sentences. In D. Tannen (Ed.), Analyzing discourse: Text and talk (pp. 71-93). Washington, D.C.: Georgetown University Press.

Schegloff, E. A. (1997). Practices and actions: Boundary cases of other-initiated repair. Discourse Processes, 23(3), 499-545. doi:10.1080/01638539709545001

Schegloff, E. A., Jefferson, G., & Sacks, H. (1977). The preference for self-correction in the organization of repair in conversation. Language, 53(2), 361-382. doi: 10.1353/lan.1977.0041

Silverman, J., Kurtz, S. M., & Draper, J. (2013). Skills for communicating with patients. London, England: Radcliffe.

Stivers, T. (2011). Morality and question design: ‘Of course’ as contesting a presupposition of ask ability. In T. Stivers, L. Mondada, & J. Steensig (Eds.), The morality of knowledge in conversation (pp. 82-106). Cambridge, England: Cambridge University Press.

Stivers, T., & Hayashi, M. (2010). Transformative answers: One way to resist a question's constraints. Language in Society, 39(1), 1-25. doi: 10.1017/S0047404509990637

Terasaki, A. K. (2004). Pre-announcement sequences in conversation. In G. Lerner (Ed.), Conversation analysis: Studies from the first generation (pp. 171-223). Amsterdam, The Netherlands: John Benjamins.

Tran, K. (2009). Examining conversational constraints in Vietnamese patient-doctor communication: A case study. Xulanexus: Xavier University of Louisiana’s Undergraduate Research Journal, 6(1), 3-20. Retrieved from http://xulanexus.xula.edu/textpattern/index.php?s=file_download&id=20

Tran, N. T. (2006). Tìm về bản sắc văn hóa Việt Nam [Tracing Vietnamese cultural identity] (5th ed.). Hochiminh, Vietnam: Nhà Xuất Bản Tổng hợp thành phố Hồ Chí Minh.

Tran, Q. N. T. (2013). Refusal face-work strategies in intercultural communication: Refusals reported by Vietnamese speakers of EFL in intercultural workplaces (Unpublished doctoral dissertation). University of Queensland, Brisbane, Australia.

White, S. J. (2011). A structural analysis of surgeon-patient consultations in clinic settings in New Zealand (Unpublished doctoral dissertation). University of Otago, Wellington, New Zealand.

DOI: http://dx.doi.org/10.7575/aiac.ijalel.v.7n.2p.121


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