Topic control and person control: A thorny problem for foreign physicians in interaction with American patients

Abstract

This paper examines the tension between physicians’ ability to control topics in interaction with patients and general American expectations that the asymmetry of power and status typical of such encounters be denied in favor of greater equality, manifested in shared topic control. Specifically, the paper focuses on the difficulties that foreign medical graduates, comfortable with power asymmetry, have in adapting their interactive style to American expectations. Finally, it proposes that the process of acquiring second‐culture communicative competence in this area is difficult not only because it involves learning to recognize patterns invisible to reflection in normal practice, but also because the encounter embodies a fundamental tension between authority (inequality) and equality in American society, which can be managed but not resolved.