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Book: Understanding and Interaction in Clinical and Educational Settings

Chapter: 13. Culture, Authority, and Understanding--A Balance of Interpretive Contingencies

DOI: 10.1558/equinox.27845


Chapter Thirteen examines the interactional production of professional culture and its effects on patients’ and students’ understandings. The power of medical practitioners and teachers to expand or restrict understandings stems from their influence on patterns of interaction that produce or resolve interpretive contingencies. The biology classroom and radiology consultation examples show how a particular balance of participants’ interpretive contingencies affects the endurance or change of cultural conventions. During the biology classes, the teachers apply restrictive communication patterns, which functioned as a form of professional persistence overriding students’ digressions. In contrast, the radiology consultation examples show how a practitioner’s adaptations to patients’ responses to visual information produce a balance of interpretive contingencies that favors the patient. Examples show one patient expressing many comments and questions and another patient expressing infrequent and ambiguous comments and questions. In both cases, the patients affect the balance of interpretive contingencies as the nurse adapts her pattern of expression and use of explanatory images for each patient. The resulting expansive pattern of communication supplants the professional culture’s customary restrictive communication patterns. This increases the patients’ authority over the information presented during the consultation. The radiology patients' recall of the medical information correlated with the changes in the patterns of interaction prompted by the practitioner's increased interpretive contingencies. The immediate cognitive and interactional work that a practitioner faces in such circumstances overcomes some of the professional culture’s customary communication patterns--particularly the administrative patterns of deemphasizing or ignoring digressive questions.

Chapter Contributors

  • Barry Saferstein ([email protected] - book-auth-439) 'California State University, San Marcos'