Politeness Strategies and Doctor-Patient Communication. On the Social Choreography of Collaborative Thinking

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Abstract
Doctor-patient communication was studied in the light of Brown and Levinson's politeness model. Forms of address, different request and questioning strategies, and feedback patterns were analysed for their significance in the regulation of social distance; herein called the social choreography of medical discourse. Approaching and avoidance moves were explored with respect to sequencing as shown in the consultation phase structure, and in episodes of disagreement. It was demonstrated how doctors' ‘thinking-aloud sequences' require active patient collaboration. Patients' opposition, as revealed in avoidance strategies and minimal feedback, resulted in vague and ambiguous medical decisions. Likewise, doctors' indirectness (‘negative politeness strategies) would soften requests and questioning on the one hand, but ambiguate communication on the other.