The interactional construction of asymmetry: The medical agenda as a resource for delaying response to patient questions

This study is based on transcriptions of twenty-one audiotaped encounters b etween patients with breast cancer and their oncologists. Using a conversat ion analytic approach, findings reveal how oncologists invoke a clinical ag enda to postpone response to certain patient questions or to mark them retr oactively as "out of order." These deferral actions take the shape of "pre- insert expansions" in which the physician mentions an activity to be perfor med (e.g. the physical exam) prior to actually initiating the activity. Onc e this clinical exigency has been invoked, patients do not pursue their que stions further. They thereby relinquish their request for information and " accept" that answers will be forthcoming. Thus, the oncologist uses the cli nical agenda as a resource for managing the direction of the talk, and pati ents orient collaboratively to that agenda.