Initiating physical examination in traditional-Chinese-medicine encounters: A multimodal conversation-analytic approach

Abstract

Based on video-recordings of 62 traditional Chinese medicine (TCM) encounters, this paper examines the initiation of an essential type of physical examination in TCM using multimodal conversation analysis. Focusing on the interactional patterns for initiating the pulse-taking activity, we observe a sequence made purely of embodied actions, unfolding linearly with a tripartite structure – ‘request for pulse-taking preparation, preparation enactment, and pulse palpation’. Instead of signaling a transition between medical activities as in Western medicine, the initiation of pulse-taking is often made amidst verbal interaction oriented to another medical task, featuring divergent orientations in parallel activities – a distinctive multiactivity type in TCM interaction. Meanwhile, the concurrence of verbal and embodied actions to initiate the pulse-taking activity is found only in three major interactional contingencies, indicating a selective and limited employment of coordinated verbal and nonverbal cues to initiate pulse taking. This study enriches our understanding of both under-researched multimodal interactions in medical contexts and differences in the initiation of physical examination across medical practices. It also has practical implications for improving consultation efficiency.