Christopher Elsey

Conversational assessment in memory clinic encounters: interactional profiling for differentiating dementia from functional memory disorders

Objectives: In the UK dementia is under-diagnosed, there is limited access to specialist memory clinics, and many of the patients referred to such clinics are ultimately found to have functional (non-progressive) memory disorders (FMD), rather than a neurodegenerative disorder. Government initiatives on ‘timely diagnosis’ aim to improve the rate and quality of diagnosis for those with dementia. This study seeks to improve the screening and diagnostic process by analysing communication between clinicians and patients during initial specialist clinic visits. Establishing differential conversational profiles could help the timely differential diagnosis of memory complaints. Method: This study is based on video- and audio recordings of 25 initial consultations between neurologists and patients referred to a UK memory clinic. Conversation analysis was used to explore recurrent communicative practices associated with each diagnostic group. Results: Two discrete conversational profiles began to emerge, to help differentiate between patients with dementia and functional memory complaints, based on (1) whether the patient is able to answer questions about personal information; (2) whether they can display working memory in interaction; (3) whether they are able to respond to compound questions; (4) the time taken to respond to questions; and (5) the level of detail they offer when providing an account of their memory failure experiences. Conclusion: The distinctive conversational profiles observed in patients with functional memory complaints on the one hand and neurodegenerative memory conditions on the other suggest that conversational profiling can support the differential diagnosis of functional and neurodegenerative memory disorders.

The Violence You Were/n’t Meant to See: Representations of Death in an Age of Digital Reproduction

Through the ongoing work of leak sites, public inquiries, criminal investigations, journalists, whistleblowers, researchers and others, the public has gained access to a growing number of videos of live military operations in recent years. Capturing such things as friendly fire attacks, civilian deaths and extrajudicial or illegal killings, these videos have attracted public and academic attention due to their ‘revelatory’ qualities. Through an analysis of two particular instances, WikiLeaks’ Collateral Murder and footage of a targeted assassination by the Israeli Defence Force, we argue it is important to analyse exactly how such deaths are digitally re-presented if we are to make use of videos as data in the study of episodes of military violence and the evidential politics they give rise to.

Violence as Work: Ethnomethodological Insights into Military Combat Operations

Objective: The objective of this article is to outline an ethnomethodological approach to the study of professionalized violence or violence as work. It focuses primarily on violence in the context of military combat operations and the “situational” analyses and assessments military personnel themselves undertake when engaging in violent action. Method: We use a video from one incident (WikiLeaks’ Collateral Murder release) as a demonstration case to set out the methodological bases of ethnomethodological studies of combat violence. As part of this study, we show how transcripts can be used to document the interactions in which situational analyses feature as part of coordinating and executing linked attacks. Results: Based on the video and our transcripts, we explicate how the military personnel involved collaboratively identified, assessed, and engaged a group of combatants. We show that the incident consisted of 2 attacks or engagements, a first and a follow-up, treated as connected rather than distinct by those involved on situational grounds. Conclusion: Moving beyond controversy, causal explanations, and remedies, the article describes how structures of practical military action can be investigated situationally from an ethnomethodological perspective using video data. By treating collaborative military methods and practices as a focus for inquiry, this article contributes to our understanding of violence as work more broadly.

CONVERSATION ANALYSIS IN THE MEMORY CLINIC

Introduction Conversation Analysis (CA) can help with the differential diagnosis of seizure disorders. We investigated if CA could be used in the memory clinic to distinguish neurodegenerative (NDD) from functional memory disorders (FMD). Methods We recruited consecutive, patients newly referred to the Neurology-led memory Clinic. Consultations were video & audio recorded. All participants underwent detailed Neuropsychology testing and MRI. Results 111 patients of 178 approached were recruited (20 ND, 24 FMD, 87 other). We identified profiles of 14 interactional features that can distinguish NDD from FMD consultations based on encounters with 15 patients with NDD and 15 with FMD. Features of NDD included an inability to answer compound questions fully, inability to give detailed examples of memory failures, shorter length of turn and reduced complexity of replies. Prospective analysis of an additional 10 encounters proved that Conversation Analysts could use these features to predict the diagnoses of FMD and ND with high sensitivity and specificity. Conclusions Simple differences in the communication behaviour of patients can help to distinguish between ND and FMD, suggesting that a targeted observation of interactional features could improve screening for ND in primary or secondary or care settings.

CONVERSATION ANALYSIS IN THE MEMORY CLINIC TO DISTINGUISH DEMENTIA FROM FUNCTIONAL MEMORY DISORDER

CLINIC TO DISTINGUISH DEMENTIA FROM FUNCTIONAL MEMORY DISORDER Daniel J. Blackburn, Chris Elsey, Sarah Wakefield, Kirsty Harkness, Annalena Venneri, Paul Drew, Markus Reuber, University of Sheffield, Sheffield, United Kingdom; University of Loughborough, Loughborough, United Kingdom; 3 Sheffield Teaching Hospitals, Sheffield, United Kingdom; IRCCS San Camillo Hospital Foundation, Venice, Italy. Contact e-mail: d. blackburn@sheffield.ac.uk

Interactional Activities of Patient-Centredness and Trust within Bedside Teaching Encounters

Abstract The present article reports upon the analytic progress of a video ethnographic study of bedside teaching encounters (BTEs). Of particular interest is the exploration of how doctor-patient interactions are fundamentally transformed by the presence of medical students. Analysis of a large corpus of video recordings has explored how the concepts of patient-centredness and trust are displayed and learned during real-time BTEs through interaction. A short exemplar from the video corpus is provided to illustrate how these concepts can be ‘found’ in actual medical encounters; for example, by providing spaces for patient questions during consultations.