The Art of Conversation

The layout of the room when conducting an interview, I’m finding, is incredibly important. Not dissimilar to a medical consultation between doctor and patient, the space needs to put the interviewee at ease; it needs to promote trust and intimacy.

Talking to members of the community predominantly in their own homes on Hoy went a long way towards creating the right atmosphere; seeing peoples’ lives through photographs in sitting rooms and plants they’d chosen to grow in the garden (a limited selection on such an island!) not only gave me added insight into the people I was meeting but also provided a natural path into conversation. Crucially, it gave patients the chance to control the situation somewhat and for them to welcome me into their space instead of the other way around. As time went on I experienced how being in peoples’ homes could both increase and at other times alleviate feelings of vulnerability.

I remember seeing an elderly man on a medical home call in a house so smoke-filled many refused to visit. I’d been told before my visit that he was well known to the community, as many were on Hoy, but in recent years had become housebound with dementia. I’d arrived to find him sitting in a corner chair by the window, a position he now rarely left. His lunch was in front of him; a sandwich made by someone else. He didn’t say much as I introduced myself and I sensed what felt like embarrassment. It was one of the first times I’d felt really uncomfortable and intrusive. Whilst I wasn’t there to interview him specifically I was there with his doctor, an added extra, and I wasn’t sure he wanted me to be. After usual questions went unanswered, did he have family nearby, how long had he lived on the island etc., I searched for queues around the room and my eyes came across a certificate on the wall. In gold letters it outlined his many years of service as Lifeboat Coxswain, one of the subjects, as it turned out, he did want to talk about. I wouldn’t say conversation flowed easily after that, but it gave me an ‘in’ and for him, a chance to show me something more than what I was seeing. It’s a fairly long-winded example but hopefully illustrates how the smaller details of a person can make the understanding of them so much richer and how getting those details can be challenging.

Whilst I’d experienced the warmest of welcomes on Hoy, many of my interviews arising from meetings at social events, I’d experienced plenty of nerves when the tape recorder came out, not to mention the lip biting reluctance brought about by the camera. The effect of a tripod can be quite astounding; at knee height most seemed comfortable but as the legs extended so apparently did my interviewees sense of dread. In that environment, many patients wanted to oblige me I sensed out of a desire to tell their story to someone they’d begun to get to know rather than through a natural extrovert nature. Some were shy in the telling and quite disbelieving that I wanted to hear it.

You can perhaps then understand my apprehension at what I would find here in California. I knew, for the most part, that I would be recruiting patients through the medical centre and unlike on Hoy would not have met them before or had a chance to establish any kind of rapport. This would have benefits to it, I hoped people would not be biased by any previous conversation with me, but I worried about how I might best put people at ease whilst being a complete stranger to them. I also knew that I would be carrying out most of the interviews in an office at the practice opposed to peoples’ homes. Ironically, about to ask people questions on the subject of their relationship with their doctor, I was myself grappling with the best way to form an interview-interviewee relationship and what form it should take.

I am now a week into interviewing and am thrilled to report that I really needn’t have worried. It’s a well-known stereotype that our American friends may share our language but in contrast to many Brits, express it far more openly. I’ve sampled only a few so far admittedly, but I’d like to agree with that stereotype wholeheartedly and thank it very much for making my life a lot easier over the past week.

I hope in the coming blogs to recount sensitively some of the finer details of the conversations I’m having but for the moment will just say it’s been an incredible start. It’s not been without challenge; I am yet to keep up with any of the patients I’ve spoken to. Like many a GP in consultation, here rather than push through nervous pauses, I struggle to keep to time with stories spilling over the hour mark frequently. More than once a di

fficult story, accompanied by tears in one case, has begun before the camera started rolling.

I was worried that my perfectly lovely but anonymous space might intimidate people or hold them back somehow. On the contrary there has been a lot of laughter in my office over the last few days and a lot of kindness. I won’t forget the patient who spent ten minutes teaching me how to correctly use the zoom on my camera then the next ten positioning herself in the best light to ‘give my film the best chance’.

From one extreme to another, I’ve heard about the joys of living in a mobile home community where you can hear and rely on your neighbours at any time of day and I’ve listened to a patient’s fears that their community, with a large population of drug abusers is now an unsafe place to be.

I’ve explored the relationship each of them has with their doctor (or many doctors in some cases but that’s another story..) and how, on a larger scale, the American healthcare system affects their day to day experience. To some it represents something they are terrified of losing, appalled by the thought of not getting the most up to date treatments at the drop of a hat, to others it fuels constant worry and insecurity about the future.

It is a huge privilege to be having these conversations at all and I only hope they remain as colourful and, as my technique improves, a little more in my control! Keep watching this space...

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