The components of reassurance for no-problem diagnoses: A conversation analytic study of physician-patient interactions

Reassuring patients who do not have serious illnesses is among the most common tasks for physicians, yet is a poorly understood clinical skill. In this study, we characterize how physicians reassure patients to communicate that their concern is not clinically problematic and does not require further medical attention. We take a conversation analytic approach to studying the social action of reassurance, examining video-recorded clinical visits across multiple contexts and health concerns. Across 30 cases, we identified three distinct components of successful reassurance: 1) establishing understanding of the concern by asking patients clarifying questions, gathering additional information, and/or eliciting the patient's underlying worry, 2) describing evidence by sharing information about their clinical rationale or decision-making process, and 3) communicating stance by sharing explicit no-problem statements, naming an unproblematic diagnosis, and/or offering a contingency plan. In cases where physicians successfully reassured patients using all three components, we found that patient concerns were resolved quickly and without resistance to topic closure. However, when physicians did not address all three components, we found that patients frequently pursued the concern and resisted transitioning to the next topic. We also found that physicians who did not initially address all three components sufficiently were able to correct course and successfully reassure patients by revisiting missed components. In conclusion, we argue that physicians can use reassurance as opportunities to transform no-problem diagnoses into good news.