Table 1.

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
10:00Doctor emphasizes that smoking cessation will give most health benefit for this patientProfessional authoritative statements invoking evidencePatient may be more likely to take steps to quit smoking when the message comes from the doctorAdvice
10:30Doctor asks how much patient is smoking a dayRespectful and tactful initiation of topicGetting overall idea of patient's desire to quit, if any
11:00Patient says smoking cessation is not a goal for him currently; doctor asks him to elaborateDoctor uses motivational interviewing techniques to elicit thinking about behaviorPatient reflects on why quitting smoking is not a current priorityChange talk
11:30Patient 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 changeChange talk
12:00Doctor explains research findings, encourages patient to make that small changeSkillful guidance in synergy with authorityPatient education, encouragement to take small steps toward quitting smoking (toward a SMART goal)Change talk
12:30Doctor and patient talk about increasing the amount of sleep prompted by HRA recommendationDoctor “negotiates” with patient about what a reasonable goal would be in terms of hours/nightGoal setting; doctor and patient agree on 6.5 hours/nightGoal setting
13:00Doctor encourages patient to follow the links on the wellness portal to receive more educationEffective “time-saving” approach leveraging technology/info patient already has access toPatient may use wellness portal resources to make more successful lifestyle changesAdvice
13:30Doctor and patient talk about how to modify response to stress in patient's lifeEmpathy and personal reassurance of understandingPatient is encouraged to change response to stress in an understanding environmentChange talk
14:00Doctor makes recommendations on how to respond to stressCoaching/facilitative tonePatient receives specific strategies for coping with stressAdvice
  • HRA, health risk assessment; SMART, Specific-Measurable-Achievable-Realistic-Time-Bound.