Conversation Analysis Example Including Coded Actions from a Segment of an Annual Wellness Visit
| Time Anchor (Time Stamp) | Characterization of Action (What Is Accomplished via Communication) | Packaging of Action (How Messages Are Communicated) | Potential Implications of Action (Impact on Decision Making or Goal Setting) | Talk Type |
|---|---|---|---|---|
| 10:00 | Doctor emphasizes that smoking cessation will give most health benefit for this patient | Professional authoritative statements invoking evidence | Patient may be more likely to take steps to quit smoking when the message comes from the doctor | Advice |
| 10:30 | Doctor asks how much patient is smoking a day | Respectful and tactful initiation of topic | Getting overall idea of patient's desire to quit, if any | |
| 11:00 | Patient says smoking cessation is not a goal for him currently; doctor asks him to elaborate | Doctor uses motivational interviewing techniques to elicit thinking about behavior | Patient reflects on why quitting smoking is not a current priority | Change talk |
| 11:30 | Patient inquires about benefits of switching to “healthier” cigarettes/vaping | “I am not ready yet to jump, but perhaps in steps…” | Patient education and moving patient along the continuum of change | Change talk |
| 12:00 | Doctor explains research findings, encourages patient to make that small change | Skillful guidance in synergy with authority | Patient education, encouragement to take small steps toward quitting smoking (toward a SMART goal) | Change talk |
| 12:30 | Doctor and patient talk about increasing the amount of sleep prompted by HRA recommendation | Doctor “negotiates” with patient about what a reasonable goal would be in terms of hours/night | Goal setting; doctor and patient agree on 6.5 hours/night | Goal setting |
| 13:00 | Doctor encourages patient to follow the links on the wellness portal to receive more education | Effective “time-saving” approach leveraging technology/info patient already has access to | Patient may use wellness portal resources to make more successful lifestyle changes | Advice |
| 13:30 | Doctor and patient talk about how to modify response to stress in patient's life | Empathy and personal reassurance of understanding | Patient is encouraged to change response to stress in an understanding environment | Change talk |
| 14:00 | Doctor makes recommendations on how to respond to stress | Coaching/facilitative tone | Patient receives specific strategies for coping with stress | Advice |
HRA, health risk assessment; SMART, Specific-Measurable-Achievable-Realistic-Time-Bound.