Communication & Medicine, Vol 12, No 1 (2015)

Can conversation analytic findings help with differential diagnosis in routine seizure clinic interactions?

Katie Ekberg, Markus Reuber
Issued Date: 7 Jun 2016


There are many areas in medicine in which the diagnosis poses significant difficulties and depends essentially on the clinician’s ability to take and interpret the patient’s history. The differential diagnosis of transient loss of consciousness (TLOC) is one such example, in particular the distinction between epilepsy and ‘psychogenic’ non-epileptic seizures (NES) is often difficult. A correct diagnosis is crucial because it determines the choice of treatment. Diagnosis is typically reliant on patients’ (and witnesses’) descriptions; however, conventional methods of history-taking focusing on the factual content of these descriptions are associated with relatively high rates of diagnostic errors. The use of linguistic methods (particularly conversation analysis) in research settings has demonstrated that these approaches can provide hints likely to be useful in the differentiation of epileptic and non-epileptic seizures. This paper explores to what extent (and under which conditions) the findings of these previous studies could be transposed from a research into a routine clinical setting.

Download Media

PDF (Price: £17.50 )

DOI: 10.1558/cam.v12i1.26851


Antaki, C. (ed.) (2011) Applied Conversation Analysis. Basingstoke, UK: Palgrave-Macmillan.

Boyd, E. and Heritage, J. (2006) Taking the history: Questioning during comprehensive history-taking. In J. Heritage and D. W. Maynard (eds) Communication in Medical Care: Interaction between Primary Care Physicians and Patients, 151–184. Cambridge: Cambridge University Press.

Drew, P. and Heritage, J. (eds) (1992) Talk at Work: Interaction in Institutional Settings. Cambridge: Cambridge University Press.

Gülich, E. and Schöndienst, M. (1999) ‘Das ist unheimlich schwer zu beschreiben.’ Formulierungsmuster in Krankheitsbeschreibungen anfallskranker Patienten: differential diagnostische und therapeutische Aspekte. Psychother Sozialwissensch Zeitschr qualitat Forsch 1 (3): 199–227.

Gülich, E., Schöndienst, M. and Surmann, V. (eds) (2002) Themenheft: Wie Anfälle zur Sprache kommen. Special issue, Psychotherapie und Sozialwissenschaft: Zeitschrift fur qualitative Forschung 4 (4). Göttingen: Vandenhoeck and Ruprecht.

Heritage, J. (2010) Questioning in medicine. In A. F. Freed and S. Ehrlich (eds) ‘Why Do You Ask?’: The Function of Questions in Institutional Discourse, 42–68. New York: Oxford University Press.

Heritage, J. and Maynard, D. W. (eds) (2006) Communication in Medical Care: Interaction between Primary Care. Cambridge: Cambridge University Press.

Heritage, J. and Robinson, J. D. (2006) The structure of patients’ presenting concerns: Physicians’ opening questions. Health Communication 19 (2): 89–102.

Jefferson, G. (2004) Glossary of transcript symbols with an introduction. In G. Lerner (ed.) Conversation Analysis: Studies from the First Generation, 13–23. Philadelphia, PA: John Benjamins.

Jenkins, L., Cosgrove, J., Ekberg, K., Kheder, A., Sokhi, D. and Reuber, M. (2015) A brief conversation analytic communication intervention can change history-taking in the seizure clinic. Epilepsy and Behavior 52 (A): 62–67.

Jenkins, L. and Reuber, M. (2014) A conversation analytic intervention to help neurologists identify diagnostically relevant linguistic features in seizure patients’ talk. Research on Language and Social Interaction 47 (3): 266–279.

Malmgren, K., Reuber, M. and Appleton, R. (2012) Differential diagnosis of epilepsy. In S. Shorvon, M. Cook, R. Guerrini and S. Lhatoo (eds) Epilepsy, 81–94. Oxford: Oxford University Press.

Pilnick, A., Hindmarsh, J. and Gill, V. T. (2009) Beyond doctor and patient: Developments in the study of healthcare interactions. Sociology of Health and Illness 31 (6): 787–802.

Plug, L. and Reuber, M. (2009) Making the diagnosis in patients with blackouts: It’s all in the history. Practical Neurology 9: 4–15.

Plug, L., Sharrack, B. and Reuber, M. (2009a) Conversation analysis can help to distinguish between epilepsy and non-epileptic seizure disorders: A case comparison. Seizure 18 (1): 43–50.

Plug, L., Sharrack, B. and Reuber, M. (2009b) Seizure, fit or attack? The use of diagnostic labels by patients with epileptic or non-epileptic seizures. Applied Linguistics 31 (1): 1–21.

Plug, L., Sharrack, B. and Reuber, M. (2009c) Seizure metaphors differ in patients’ accounts of epileptic and psychogenic nonepileptic seizures. Epilepsia 50 (5): 994–1000.

Raymond, G. (2003) Grammar and social organization: Yes/no interrogatives and the structure of responding. American Sociological Review 68 (6): 939–967.

Reuber, M., Fernández, G., Bauer, J., Helmstaedter, C. and Elger, C. E. (2002) Diagnostic delay in psychogenic nonepileptic seizures. Neurology India 58 (3): 493–495.

Reuber, M., Howlett, S. and Kemp, S. (2005) Psychologic treatment for patients with psychogenic nonepileptic seizures. Expert Opinion in Neurotherapeutics 5 (6): 737–752.

Reuber, M., Monzoni, C., Sharrack, B. and Plug, L. (2009) Using interactional and linguistic analysis to distinguish between epileptic and psychogenic nonepileptic seizures: A prospective, blinded multirater study. Epilepsy and Behavior 16 (1): 139–144.

Robson, C., Drew, P., Walker, T. and Reuber, M. (2012) Catastrophising and normalising in patient’s accounts of their seizure experiences. Seizure 21 (10): 795–801.

Sacks, H. (1992) Lectures on Conversation. Oxford: Blackwell Publishing.

Sacks, H., Schegloff, E. and Jefferson, G. (1974) A simplest systematics for the organization of turn-taking for conversation. Language 50 (4): 696–735.

Schöndienst, M. (2001a) Konversationsanalytische Zugänge zu Gesprächen über Anfälle. In R.-M. Jacobi, P. Claussen and P. Wolf (eds) Die Wahrheit der Begegnung. Anthropologische Perspektiven der Neurologie. Festschrift für Dieter Janz, 73–84. Würzburg: Königshausen and Neumann.

Schöndienst, M. (2001b) Zur Differentialdiagnose nächtlicher anfallsartiger Störungen. Akt Neurol 28 (Suppl. 1): 33–36.

Schwabe, M., Howell, S. J. and Reuber, M. (2007) Differential diagnosis of seizure disorders: A conversation analytic approach. Social Science and Medicine 65 (4): 712–724.

Schwabe, M., Reuber, M., Schöndienst, M. and Gülich, E. (2008) Listening to people with seizures: how can linguistic analysis help in the differential diagnosis of seizure disorders? Communication and Medicine 5 (1): 59–72.

Sidnell, J. and Stivers, T. (eds) (2012) Handbook of Conversation Analysis. Boston, MA: Wiley-Blackwell.

Spranz-Fogasy, T. (2010) Verstehensdokumentation in der medizinischen Kommunikation: Fragen und Antworten im Arzt-Patient-Gespräch. In A. Deppermann, U. Reitemeier, R. Schmitt and T. Spranz-Fogasy (eds) Verstehen in professionellen Handlungsfeldern. Studien zur Deutschen Sprache 52: 27–116. Tübingen: Narr.

Surmann, V. (2005) Anfallsbilder: Metaphorische Konzepte im Sprechen anfallskranker Menschen. Wurzburg: Konigshausen and Neumann.

Tsai, M.-H., Lu, F.-H. and Frankel, R. M. (2013) Learning to listen: Effects of using conversational transcripts to help medical students improve their use of open questions in soliciting patient problems. Patient Education and Counseling 93 (1): 48–55.


  • There are currently no refbacks.

Equinox Publishing Ltd - 415 The Workstation 15 Paternoster Row, Sheffield, S1 2BX United Kingdom
Telephone: +44 (0)114 221-0285 - Email:

Privacy Policy