Stroke and time : a discourse analysis of how patients, clinicians and scientists use talk as social action in the context of acute ischemic stroke
This discursive study explored the social interaction between patients with acute ischemic stroke (AIS) and their stroke team care providers in the Emergency Department of two local Certified Stroke Centers. The aim of the study was to understand how patient and provider participants use language, or talk, to manage the interactional business of AIS diagnosis and treatment during the earliest care phase after an AIS event. A primary aim was to explore how the concept of time and symptom descriptions figured into their conversations. AIS patients are often blamed for the persistently low treatment rates with approved therapies in the professional literatures. Several studies report patients do not always recognize stroke symptoms or respond to them immediately especially when the symptoms are mild. The intent of this study was to analyze talk during the initial AIS treatment phase to gain insights about their orientations to time and their own symptoms through an analysis of the participants’ own words. Five AIS patients and eight stroke team care providers consented for study participation. Interactions were recorded from the time the participants entered the ED up to the final decision regarding acute treatment. Verbatim transcripts were created for each case and analyzed for the interactive data points guided by Discursive Psychology (Potter & Wetherell, 1984), Conversation Analysis (Sacks, Schegloff & Jefferson, 1974), and the six dimensions of institutional talk described by Drew & Heritage (1992). The major findings included: 1). Patient participants’ own words and accounts were critical to participant providers as they made an AIS clinical diagnosis and when choosing optimal treatment, 2). The concept of time figured in to interactions in the form of “doing time” through temporal talk (e.g. clock time), using time-related spatial cues to link AIS events such as when the symptoms started and using conversational “short cuts” for the sake of time. 3). Participants revealed troubles in talk when describing sensory symptoms such as numbness and motor symptoms such as weakness, 4). Standard turns-at-talk and sequence preference revealed features such as knowledge asymmetry, diagnosis acceptance and resistance and, 5). Existing written texts made relevant in conversation included Standard AIS Care Guidelines and government-sponsored educational resources pertaining to the warning signs and symptoms of stroke.