The Structure of Patients’ Presenting Concerns: Opening Questions in Dentistry

Objective: This study uses Conversation Analysis (CA) to disclose the question types dental practitioners use to inquire about patient problems in the 'problem presentation' phase of consultations. This research addresses two questions: (1) Are similar opening question types evident across healthcare contexts and consultation types?; (2) How do linguistic and cultural contexts affect the formulation of opening questions? Methods: 42 review consultations of patients receiving routine, follow-up dental care were video recorded. Each consultation was conducted entirely in Cantonese, a Chinese dialect spoken in the Guangdong region. Research team members verified the recording transcriptions and English translations. Analysis adopted an established typology for opening questions in primary care medicine (Heritage & Robinson, 2006). Results: The 5 question types identified in the 'problem presentation' phase of primary care medicine were are also evident in review cases in dentistry. Requests for confirmation e.g. Are your teeth in pain? were the most commonly identified (40%); and general inquiries e.g. What brings you here today? were the second most frequent opening question (36%). When compared with medicine, requests for confirmation questions demonstrated a substantial increase in dental return visits. Two additional patterns were identified in the dental dataset due to a) the unique cultural context of this study and b) the specific demands of return visits. Conclusion: Opening question types appear to be similar across the two healthcare contexts of general dentistry and general medicine. Results from this study suggest that linguistic and cultural differences, along with the specific demands of return visit consultations, make a direct influence upon the formulation of opening questions.