Patients' Problem Presentation in China's Primary Care.

Abstract

Identifying patients' reasons for visiting is the central task at medical openings, the structure of which has been well studied in Western primary care, but much under-researched in China's mainland. Drawing on conversation analysis of 91 audio-recorded primary care consultations in China, this study explores interactional features of patients' problem presentation at medical openings in terms of sequential positions, forms, and contextual contingencies, which has implications for the model of medical service encounters in Chinese primary care openings. Although problem description is commonly solicited by doctors across cultures, Chinese patients' problem presentation often takes forms other than problem description. Nearly two thirds of problem presentation in our data are designed as a request-making action (57/91 cases), being more often self-initiated than solicited. This blurs the boundary between medical visits for new and non-new problems. The analysis of Chinese patients' problem presentation points to a high degree of patient agency in primary care in China, suggesting a strong orientation to the "provider-consumer" (vs. "professional-client") model of service encounters in the opening structure of doctor-patient interaction.