The pattern of educator voice in clinical counseling in an educational hospital in Shiraz, Iran: a conversation analysis

Doctor-patient interaction (DPI) includes different voices, of which the educator voice is of considerable importance. Physicians employ this voice to educate patients and their caregivers by providing them with information in order to change the patients' behavior and improve their health status. The subject has not yet been fully understood, and therefore the present study was conducted to explore the pattern of educator voice. For this purpose, conversation analysis (CA) of 33 recorded clinical consultations was performed in outpatient educational clinics in Shiraz, Iran between April 2014 and September 2014. In this qualitative study, all utterances, repetitions, lexical forms, chuckles and speech particles were considered and interpreted as social actions. Interpretations were based on inductive data-driven analysis with the aim to find recurring patterns of educator voice. The results showed educator voice to have two general features: descriptive and prescriptive. However, the pattern of educator voice comprised characteristics such as superficiality, marginalization of patients, one-dimensional approach, ignoring a healthy lifestyle, and robotic nature. The findings of this study clearly demonstrated a deficiency in the educator voice and inadequacy in patient-centered dialogue. In this setting, the educator voice was related to a distortion of DPI through the physicians' dominance, leading them to ignore their professional obligation to educate patients. Therefore, policies in this regard should take more account of enriching the educator voice through training medical students and faculty members in communication skills.