Three-party interactions between neurologists, patients and their companions in the seizure clinic

When patients attend seizure clinics, they are advised to bring along a companion (usually a family member or friend) who can help them to answer questions about their condition. Despite their role being officially sanctioned, there has been some debate over the usefulness of companions in this environment, with some seeing them as eating into the time that patients have to provide diagnostically-important information (Robson, Drew, & Reuber, 2013; Schwabe, Reuber, Schöndienst, & Gülich, 2008), whilst others suggest that companions contributions may actually help with diagnosis (Robson, Drew, & Reuber, 2016). Research from other medical contexts, meanwhile, suggests that companions can be helpful in ways that go beyond diagnosis, and that these other functions should be taken into account when considering their role in the consultation room (Ellingson, 2002; Laidsaar-Powell et al., 2013). This thesis aims to build upon this work by examining the companion s role at all stages (beyond just diagnosis and history-taking) in seizure clinic interactions. Based on 30 video-recorded initial visits in a seizure clinic in which a companion was present, my research used conversation analysis (CA) to examine, across four analytic chapters, several aspects of this topic. In chapter 3 I examine how it is that companions actually come to contribute to these interactions in the first place. My analysis shows that companions were explicitly invited to contribute in 20% of these cases (n=406), were implicitly invited to contribute in 27.6% of these cases (n=553), and that they volunteered themselves to contribute in the remaining 42.6% of cases (n=854). The second part of the chapter then analyses some of these instances in detail. It shows how companion participation is co-constructed between the participants and how companions are attuned to the relevance of their contributions for the ongoing interaction, as well as maintaining an orientation to the patient s rights as primary respondent. Having delineated the basic means of companion participation, the next two chapters consider how companions can contribute to the medical outcomes of the consultation, in their role as information-providers. Chapter 4 considers how companions can correct patients accounts of their illness. It shows, specifically how these corrections often upgrade the severity of the patient s own descriptions (e.g. provide a symptom, after the patient has given a no symptom answer, or upgrade the frequency of how many attacks the patient describes having). Chapter 5 then discusses companions contributions to talk, specifically about medication in both the history-taking and treatment-recommendation phases of the consultation. Based on the observation that companions contributed at least once to medication discussions in 67% of cases (n=20) in the data, the chapter shows that, during the history-taking phase, companions were used as an informational resource by both patient and doctor. In the treatment recommendation phase, meanwhile, companions showed initiative in asking questions, making suggestions, expressing concerns, and complaining about medication. In chapter 6 I demonstrate that companions contribute in a way that goes beyond simply providing medical information, by emotionally supporting patients. It shows that one important way in which they do so is by touching patients at points where they are displaying difficulty or emotional distress. This chapter will discuss how these touches appear to occur systematically in a sequential context where there is something delicate being discussed. This thesis provides an overview of companion participation in the seizure clinic. It shows how companions can, as expected, act as information-providers, thus supporting previous research (Ellingson, 2002; Laidsaar-Powell et al., 2013; Wolff et al., 2016). It also goes beyond this, though, to show how companions can provide a form of interpersonal emotional support which, while not necessarily part of their official role in the consultation, nonetheless serves an important function. Companions thus contribute at all points in seizure clinic interactions.