1 Introduction : Analyzing interaction between doctors and patients in primary care encounters

In 1976, Patrick Byrne and Barrie Long published a path-breaking study of the doctor–patient relationship. Based on some 2,500 taperecorded primary care encounters,Doctors Talking to Patients anatomized the medical visit into a series of stages, and developed an elaborate characterization of doctor behaviors in each of them. Drawing on Michael Balint’s (1957) proposal that the primary care visit has therapeutic value in its own right, Byrne and Long focused on the ways in which its therapeutic possibilities were attenuated by the prevalence of doctor-centered behaviors in the encounters they studied. The study was also conceived as an intervention: physicians were invited to use its coding framework to evaluate their own conduct, and to modify it in a more patient-centered direction. Not surprisingly, given these goals,Doctors Talking to Patients was itself somewhat doctor-centered. The authors had little to say about patients’ contributions to the encounter or the sociocultural context of social interaction in primary care. In the present volume we revisit Byrne and Long’s project of anatomizing the primary care visit, doing so from a primarily sociological and interactional perspective. We begin from the standpoint that physician and patient – with various levels of mutual understanding, conflict, cooperation, authority, and subordination – jointly construct the medical visit as a real-time interactional product. Within this orientation, we consider some of the social, moral, and technical dilemmas that physicians and patients face in primary care, and the resources that they deploy in solving them. Our objective is to open the study of doctor–patient relations to a wide range of social and interactional considerations.