In “The Medical Interview as Rhetorical Counterpart of the Case Presentation,” Dennis Cali and Carlos Estrada conduct a “macrocommunication analysis” reviewing then-recent genre-studies of case presentations and medical interviews. The authors suggest the macroanalytic approach for its ability to respond to three then-recent trends in rhetorically-situated health communication studies: 1) the emphasis on “individual factors within medical discourse over collective communication acts” 2) the confinement of “analysis of medical communication to the single context of either the case presentation…or the medical interview,” and 3) the neglect of “the implicit influences imposed during medical training on the way physicians communicate with patients” (p. 356).
In order to begin addressing these trends, Cali and Estrada synthesize generic studies in three areas of medical discourse: 1) the case presentation, 2) the (observed) medical interview, and 3) the (suggested) ideal medical interview. Distilling a list of generic and formal features and constraints on the case presentation qua genre, the authors identify “maintaining the floor, preempting questions, and interrupting” as key constituents of the case presentation. Cali and Estrada argue that these constituents tend to render case presentations exercises in professional dominance and monologism. The authors focus on these constituents because, as they argue, these cultural features of the case presentation are instantiated in medical interviews. Cali and Estrada cite several studies indicating the role of interruption and preemption during medical interviews in decreased patient outcomes and satisfaction.
In response to this identified problem, Cali and Estrada suggest an ideal medical interview also distilled from then-recent research and theorization. This interview would be dialogic in nature and perform the “four essential tasks of the medical interview: gather data, maintain a therapeutic relationship, educate the patient, and negotiate a treatment plan” (p. 368). Ultimately the authors suggest that if generic features of the medical interview can established distinct from the case presentation, as they are in the ideal form, then physicians will see improved patient satisfaction, outcomes, and fewer lawsuits (p. 370).