Topic transitions in physician-patient interviews: Power, gender, and discourse change

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Abstract
This article examines the ways topic transitions are made in 12 physician-patient encounters between eight physicians (four men and four women) and eight patients, all women, in private practice settings. The data include visits by the same patient to more than one physician; these data are unique in the literature. I expand both the explicit theoretical frame in which topic transitions have been described and the types of these transitions that need consideration. The two major types of transitions arereciprocalandunilateralactivities. Reciprocal topic-transition activities are assumed to share power between physician and patient; unilateral topic transitions are assumed to allocate power to the speaker. Ratios of reciprocal to unilateral activities differ widely by gender of the physician. Change in discourse norms for this event may be in progress, due to increasing numbers of women physicians. (Medical discourse, topic, power, gender, sociolinguistic change, English)