“BUT IS THE NEEDLE VERY LONG?”: THE FEAR OF NEEDLES IN CONSULTATIONS ON INSULIN THERAPY

Purpose: The aim of this presentation is analyse the way the doctor elicits and manages the patient’s fears of needles in talk-in-interaction. 

Method: The sites for the collection of the primary data were hospital and clinics in Malaysia. Extracts from seven doctor-patient consultations were selected for examination.  Jefferson’s transcription conventions were used to transcribe the consultations to capture the linguistic and non-linguistic elements of interaction.  The consultations, which involved participants from different demographic groups, were conducted in English and Malay. We then analysed the selected samples  using the analytical tools derived from Conversation Analysis to discover the participants’ interactional conduct including language, tone, laughter and pauses.

Result: The findings are presented according to the following research questions: 1) Who initiated needle-related topics and how were they brought into the talk?  2) How did the doctor go about allaying the patient’s fear of needles? Our initial analysis shows that some patients were forthcoming about their fear of needles, but in most consultations, the topic was initiated by the doctor via a series of questions, including general or specific questions. We will illustrate in our presentation how a patient who denies being afraid of needles at the beginning eventually expresses very strong feelings of fear much later in the consultation.

Two important issues that we will highlight are how language proficiency inhibits communication and silence, pauses and nervous laughter are manifested as signs of fear in the interactions. It is also interesting to see how doctors attempted to reduce patients’ fears by providing some kind of assurance, e.g. downplaying the pain involved and the size of the needle, and providing suggestions on how to carry out the injection, which is designed to give confidence. 

Conclusion:

The fear of needles has been identified as a barrier to insulin therapy. However, patients may be reluctant to discuss these fears. As communicative practices differ among individuals and across socio-demographic groups, the analysis of naturally occurring doctor-patient interaction will illustrate how doctors can elicit and help patients manage these fears. Further data collection may inform training efforts to equip doctors with insight and strategies to better manage patients’ fears when making decisions about treatment options.