Front desk talk: A study of interaction between receptionists and patients in general practice surgeries

Receptionists who work in general practice surgeries in Great Britain are part of a large, state-funded organisation, the National Health Service. Their duties include registering patients with practices, arranging appointments for them and checking them in for consultations, as well as administration of the ordering and collection of repeat prescriptions. In this study the talk-in-interaction through which these activity types are accomplished at three general practice surgeries in Scotland is analysed and the discursive construction of roles and identities by receptionists and patients in the three separate, but related, institutional contexts explored. The discourse through which front desk activity types are accomplished at all three sites is found to consist of a maximum of four stages. These are present in varying combinations in different activity types but are always constructed through predictable combinations of moves, which, except in encounters in which problems are resolved or errors remedied, are realised through a limited range of speech acts and conversational routines. Different choices of act or routine encode differing levels and styles of face protection, which appear to be determined by factors such as the social environment of each practice, the preferred relational approach of individual participants and the perceived level of imposition which an activity type entails. In addition, participants are found to adopt varying stances towards personal agency. While some assume full responsibility for their actions, in others agency is either disguised, for example when receptionists attribute decisions to other practice sources, or downplayed, for example when patients present themselves as needy or inexpert. Although there are variations both in the discourse at different practices and the positioning of individual receptionists and patients, both groups of participants are found to orient strongly to their institutional roles, only rarely drawing on the wider identity resources available to them. Receptionists seem intent on task completion, while patients are focused on attaining service goals, in both cases at the expense of interpersonal communication. As a result, relative to service encounters in other contexts, levels of remedial action are low and there is very little small talk. Thus, paradoxically, although general practice surgeries provide intimate personal care for patients, at their front desks relational matters do not appear to be a primary concern. A narrow focus on transactional goals and a neglect of the relational function of discourse may give rise to negative perceptions among both receptionists and patients. It is therefore proposed that the findings from this study be used in receptionist training programmes to raise awareness of patterns of discourse behaviour at the front desk, with a view to improving both the professional experience of receptionists and the quality of service which patients receive