Towards an interaction physiology: Unpacking the inferential property of language use.

Abstract

Dialogues between clinicians and patients constitute complex, dynamic systems comparable to human physiology. While human physiology focuses on the internal regulation of the body, interaction physiology focuses on the observable regulation between participants who are talking with each other. We draw attention to just one fundamental property of interaction physiology, namely that interaction is a continuous process of participants inferring meaning from what each other says and does. We unpack several sequences from authentic clinical dialogues to exemplify such inferential processes. Each contribution in a dialogue serves a function and meaning beyond its literal sense, indeed it has meaning potential, in that its meaning is dependent on the sense that interlocutors make of it, based on its immediate context (i.e., what has happened so far in the conversation and the broader context of time, purpose, and setting). Concrete, practical implications for clinicians are the following: to appreciate what is gained by paying close attention to what the patient says and does; to notice possible misalignments in understanding; to use opportunities that dialogue offers to bring the topic of understanding to the fore. For researchers, particularly ones who are not working within established analytical traditions, awareness of inferential processes entails developing the discipline (and humility) of differentiating between one's own inferences as an observer and the participants' displayed inferences while they respond to each other in real time. We suggest that clinicians need communication recommendations to help them make sense of their interactions with patients in situ, supporting their ability to pay attention to what each patient is saying and doing in the moment. Such advice depends on distilling and promoting practice from a solid foundation of basic research on language use.