Da impossibilidade de certezas na fala-em-interação em consultas de câncer de mama

Abstract

The present dissertation derives from doctoral research in Applied Linguistics that aims at understanding how interactions between oncologists and women with breast cancer play out in long-term treatment consultations and/or follow-up ones. The focus of the study was neither on consultations where bad news was delivered (since the patients had already been diagnosed with the illness) nor on those with terminally ill patients. Literature on the doctor-patient relationship in cancer has largely covered these issues. However, concern about verbal interaction in routine consultations during treatment and in periodic revisions, during which no diagnosis or negative prognosis is actually delivered by the doctor, has been scarce. The methodology used originates in the theoretical-methodological approach of Conversation Analysis or talk-in-interaction (SACKS, 1992; OSTERMANN; MENEGHEL, 2012). Its goal is the observation, audio (or video) recording and latter description of the interactions, the characteristics of the actions the participants produce therein and how one party’s actions affect the other, who will, in turn, produce his/her action in response. The data (24 audio recordings) were collected in a hospital in southern Brazil which is equipped with a cancer treatment center, then transcribed in accordance with conventions used in the field (JEFFERSON, 1984), then analyzed. From the analyses, recurring actions performed by doctors and their patients are described, such as requests for assessments; self-assessments of a patient’s emotional state; physical assessments; recommendations and prognostic evaluations with justifications and argumentation; accounts. These interactional actions show that the participants are dealing with a situation in which certainty is impossible in various aspects of the consultations, for instance: the impossibility of an absolutely certain prognostic evaluation, the impossibility of being sure about not having a relapse, the impossibility of certainty with regard to whether certain tests will actually serve as a basis for making necessary decisions, etc. Furthermore, some of these actions by the doctor (positive assessments, recommendations and prognostic assessments with justifications and argumentation, and accounts) have the potential to reassure the patient as they can reduce uncertainty by means of the construction of assertiveness. Ultimately, the contribution of this study may lie in the improvement of one of the basic axes of the relationship between doctors and their patients: how to humanize the oncologist-breast cancer patient relationship by means of a communicational apparatus – the interactional practices of certainty management.