WHY DIDNT YOU SAY JUST THAT - DEALING WITH ISSUES OF ASYMMETRY, KNOWLEDGE AND COMPETENCE IN THE PHARMACIST CLIENT ENCOUNTER/

The existence of asymmetry in medical encounters has been discussed ma ny times in previous research, beginning with Parsons' influential fun ctionalist view of socially prescribed roles for physician and patient . Both theory and research have undergone many transformations since, creating a general agreement amongst conversation analysts that asymme try is 'interactively achieved' rather than imposed (Maynard 1991). Ho wever, most of the 'micro' sociological literature dealing with asymme try in doctor/patient consultations is based on episodic encounters, a s opposed to long term relationships. Conversation analysts in particu lar have not tended to focus on long term interactional sequences. The data presented here are drawn from a paediatric oncology clinic, whic h deals with long term cancer and leukaemia patients. These patients m ake regular visits to the clinic, often over a period of several years , and as such are an unusual group with respect to their knowledge of their conditions and treatment. This paper considers the implications of this with respect to the 'knowledge-based asymmetry' which has been documented in a range of lay-professional encounters. In so doing, it examines to what extent pharmacists in the clinic constitute their cl ients as people with expertise and/or knowledge, what difficulties cli ent knowledgeability can create, and how this is managed or pre-empted within the interaction. In many cases, the knowledge of the patient d oes appear to 'diminish' the interactional symmetry commonly seen in l ay/professional encounters to some extent. However, there are still ob servable incidences of what is termed 'interactional submission' by ap parently knowledgeable patients or carers during the course of the enc ounters.