'I' and 'we': A concordancing analysis of how doctors and patients use first person pronouns in primary care consultations
Background. It is widely accepted that 'partnership' with patients is desirable, and that patients should be enabled to participate in decisions, but it is not clear to what extent doctor-patient interactions represent partnership in action. Objective. Our aim was to measure aspects of doctor-patient interaction through the deployment of the first person pronouns 'I', 'me', 'we' and 'us' in general practice consultations. Methods. The study design was a concordance-based language analysis of spoken data. Concordancing software was used to interrogate a database of 373 consultations with 40 doctors in UK general practice. The frequency and function of first person pronouns used in these consultations were scrutinized. Concordancing enables identification of strings of text with similar lexical properties and uses specialized statistics to assess relationships between words and phrases ('collocates' being words commonly found together) as well as their patterns of use (MI, mutual information, describes the likelihood of two words or phrases being associated). Analysis is therefore quantitative and qualitative. Results. Doctors use the word 'we' far more often than patients or companions do (doctors 23.5% and patients 2.9% of all personal pronoun occurrences). Doctors are far less likely to use 'I', after which a verb of thinking is usually selected (38 collocates with MI >3). However, after 'we', doctors select verbs of physical activity or auxiliary verbs. Three types of doctor use of 'we' were distinguished: to include patients ("you and I"), exclude them ("we doctors" or "we as a practice") or to mean "all of us as human beings". Conclusions. The findings suggest a prototypical pattern of interaction in primary care: Patient: I suffer. Doctor: I think. We will act. This, within the current paradigm which values partnership between doctor and patient, might seem encouraging; but there is evidence to suggest that power relationships in the consultation may still be unequal.