A Discourse Analysis Study on Doctor-Patient Communication in Emergency Department Conflicts

Abstract

As a high-conflict setting for doctor-patient communication, the quality of communication in emergency departments directly impacts diagnostic and treatment orderliness and patient safety. This study employs discourse analysis and non-participatory observation within qualitative research to systematically collect doctor-patient interaction data from November 2024 to May 2025 across four Grade III Class A (the highest rank) hospitals in Nanchong City, Sichuan Province. Data collection focused on emergency departments (triage desk, resuscitation room, treatment area, and observation area), examining speech act characteristics and contextual associations during conflict-ridden doctor-patient communication. Findings reveal a significant spatial gradient in the distribution of conflict communication incidents: highest at triage desks (41.6%), followed by resuscitation rooms (30.7%), treatment areas (21.8%), and observation areas (5.9%), closely aligning with functional zone attributes. Conflict types were categorized into four major groups: disputes over process efficiency (48.51%), discrepancies in disease perception (24.75%), perceptions of service attitude (18.81%), and conflicts over resource allocation (7.92%). This study reveals the discursive triggers of emergency communication conflicts and their spatial-functional associations, providing clinical evidence for optimizing emergency department design, enhancing communication skills training for medical staff, and establishing conflict prevention systems.