Engagement of patients with psychosis in the consultation: conversation analytic study

Objective To investigate how doctors engage with patients with psychotic illness in routine consultations. Design Conversation analysis of 32 consultations between psychiatrists and patients with schizophrenia or schizoaffective disorder. Setting Two psychiatric outpatient clinics in east London and south west London. Participants 7 psychiatrists and 32 patients with schizophrenia or schizoaffective disorder. Main outcome measure Mutual engagement in communication during the consultation. Results Patients actively attempted to talk about the content of their psychotic symptoms in consultations by asking direct questions, repeating their questions and utterances, and producing these utterances in the concluding part of the consultation. In response, doctors hesitated, responded with a question rather than with an answer, and smiled or laughed (when informal carers were present), indicating that they were reluctant to engage with patients' concerns about their psychotic symptoms. Conclusions Patients repeatedly attempted to talk about the content of their psychotic symptoms, which was a source of noticeable interactional tension and difficulty. Addressing patients' concerns about their illness may lead to a more satisfactory outcome of the consultation and improve engagement of such patients in the health services.