Okay and Topic Changes
The Use of “Okay”
“Okay” is defined as “approval or endorsement” by Webster’s Dictionary (as cited in Beach, 1995, p. 264). Yet, in medical interviews the word “okay” does something different than it means (Beach, 1995). The use of “okay” is not random, and is used speakers, e.g. doctors and patients, to achieve “particular kinds of actions at specific moments of involvement” (Beach, 1995b, p. 154). The word “okay” is typically used in medical interviews to control and shape “topical progression” throughout the conversation between the doctor and patient (Beach, 1995, p. 286). The word “okay” is described as “remarkably repetitive”, according to Beach’s (1995) examination of “okays” in medical interviews (p. 264). The word “remarkable” refers to the finding that “okays” are “used and relied on almost exclusively by medical authorities and only in specific cases by patients” (Beach, 1995, p. 264). The word “repetitive” refers to how frequent the word “okay” is used “to achieve particular kinds of tasks” (Beach, 1995, p. 264).
A basic example of “okay” being used in a medical interview by a doctor is provided below in Example 4: “Well it seems uh um what is the word ambiguous”:
Example 4: “Well it seems uh um what is the word ambiguous”
1 Doctor: So hm how are you.
2 Patient: I’m fine.
3 Doctor: Okay. So Dr. Kim sent you over to discuss things.
4 Patient: He did I Dr. Kim has been my doctor for about four
5 years. I’ve gone in have for blood work.
In this opening of a medical interview, the doctor asks how the patient is in line one. The patient responds in line two with “I’m fine”. To progress to the next topic the doctor uses the word “okay” in line three followed by the next topic at hand, which is Dr. Kim. The patient responds in line four and five with speaking about the new topic. This topic progression attempt with the use of the word “okay” is successful by the doctor.
Unlike the dictionary definition of “okay”, the word can be used to achieve many different tasks. Most commonly “okay” is used as an introduction to the doctor’s next question (Beach, 1995). A doctor may use “okay” as an attempt to “close down some or all feature’s of prior turn” before moving onto the next topic (Beach, 1995, p. 266). The common use of a question, answer, and then an “okay” plus topic shift is demonstrated frequently in medical interviews (Beach, 1995, p. 274). An “okay” response from a doctor may work to “[condition] and [prepare] patients to wait for the doctor’s next question” (Beach, 1995, p. 267). An “okay” in a medical interview will primary be used to “acknowledge, close down, shift, and move to [the] next matter” (Beach, 1995, p. 273).
Example 1: “Well it seems uh um what is the word ambiguous” demonstrates the typical “okay” plus topic shift commonly found in medical interviews:
Example 1: “Well it seems uh um what is the word ambiguous”
1 Doctor: Okay. Um so let me kind of get some background
2 information then. You are how old.
3 Patient: Fifty.
4 Doctor: Okay. ( ) And any medical problems apart from
5 related to this.
6 Patient: No I don’t have anything.
Each question asked by the doctor in this excerpt has “okay” in front of the topic shift or the new question. The first line starts with “okay” and than asks for the first matter of background information, the patients age. The patient gives a quick response of “Fifty” in line three. The doctor responds in line four with “okay” and asks about other medical problems. The “okay’s” used in this conversation acknowledge the answer previously given and shift to the new matter. This pattern allows the conversation to flow with ease.
“Okay” is used by doctors to ultimately shift from “preliminary matters to official business” (Beach, 1995, p. 272). The patient explains what medical troubles they are experiencing and that will shape the “eventual focus” of the conversation (Beach, 1995, p. 272). Doctors will commonly use “okay” to attempt at bringing back the topic of the conversation to particular points that “are deemed relevant and worthy of pursuit en route to achieving professional goals and priorities” (Beach, 1995, p. 283).
Jefferson (1984) found “okay” can be used to transition to a new topic when the topic at hand is negative (as cited in Beach, 1995b, p. 138). Jefferson (1984) found the use of “okay” moves from troubling-tellings into closings or the completion of a topic (as cited in Beach, 1995b, p. 138).
Example 1: “Based on your presentation unfortunately is uh uh cancer” provides a demonstration of questions being asked by the doctor to ultimately arrive at the eventual focus as well as “okay” being used to move into troubling-tellings”
Example 1: “Based on your presentation unfortunately is uh uh cancer”
1 Patient: I smoked it until I was 25 but.
2 Doctor: Okay. And how about alcohol use.
3 Patient: No.
4 Doctor: Okay. Well the concern just based on your presentation
5 unfortunately is uh uh cancer.
The doctor asks a series of questions regarding the patients health, such as the
question in line two about the patients alcohol use. These questions are used to come to
the ultimate conclusion that the patient most likely has cancer. The word “okay” is used
in line four right before the ultimate topic of cancer is presented to the patient. The
“okay” in line four is used to transition from the question asking to speaking of a
troubling topic and ultimately completing the topic.
Schegloff and Sacks (1973) found “okay” may be used as a pre-closer to change topics (as cited in Beach, 1995b, p.146). That meaning “okay” may be used to set up the conversation for a change of topic, but may not end the topic at hand. There may be more conversation after the “okay” is stated about the topic, but that conversation will transition from the old topic into the new topic. The use of “okay” is frequently neither forward or back looking “in character” (Beach, 1995b, p. 142). Instead, “okay” is used as “a state of readiness”, as in ready to change to a new topic (Beach, 1995b, p. 142). “Okay” used as a pre-closing device can “close down a given interactant while eliciting comments from [the] next speaker” (Beach, 1995b p. 129).
Example 2: “So it’s a recurring thing” demonstrates an example of pre-closing in a medical interview:
Example 2: “So it’s a recurring thing”
1 Patient: And I have severe paramenopause that’s why I
2 wanted to do that that was the primary motivation for the
4 Doctor: Okay.
5 Patient: Because it was so severe. I was and I had two dollar
7 Doctor: ((sp?)) and taking your ovaries out is gonna make it
8 worse. You know that [right.]
In line one the patient is giving an extended response to a previous medical question. The doctor sees that information as sufficient and responds in line four with “okay” to mark the pre-closing of this topic. The patient gives a few more details in line five a six before the doctor changes the topic in line seven. The doctor uses “okay” in line four to prepare for the topic change and then proceeds to change the topic the next time she speaks in line seven and eight.
Utterance pairs that include advice and a response of “okay” are common to show the first speaker “seeks some form of agreement and/or alignment from [the] next speaker (Beach, 1995, p. 272). The “okay” responded by the second speaker shows he is willing to accept the first speakers advice and stops himself from giving further comment (Beach, 1995, p. 272). This type of “okay” is always seen at the end of the session.
Example 1: “So it’s a recurring thing” demonstrates an utterance pair of agreement at the end of an interview:
Example 1: “So it’s a recurring thing”
1 Patient: Okay great.
2 Doctor: Alright. [Thanks for coming in today.]
3 Patient: [Thank you so much. ]
4 Doctor: Okay.
In line one the patient says “okay great” to conclude the last topic of the interview. The doctor responds with “alright” in line two to show agreement that the last topic is complete and it is time to officially end the interview. Similar to “okay”, the word “alright” can function to stop the conversation topic and transition to a new topic (Beach, 1995). The use of the word “alright” suggests a stronger signal to shift topics than the word “okay” (Beach, 1995). In this case the “alright” in line two is a signal to stop all conversation. The patient picks up on this signal and says “Thank you so much” in line three to officially conclude her speaking in the interview. The doctor says one last “okay” in line four to indicate both speakers are at agreement that the conversation is complete and she will now refrain from giving further comments.
Other functions of “okay”
Patients may “reject doctors’ attempts to close down and shift topics” with the use of “okay” (Beach, 1995, p.280). A patient may continue their thought, story, or whatever they may be speaking of to finish their topic. Research has found that this resistance is only “momentary” and patients will eventually “adhere to [the] doctor’s attempts to shift topics toward what they prioritize as more important and relevant [to] ‘official’ matters” (Beach, 1995, p. 280).
Example 3: “Well it seems uh um what is the word ambiguous” demonstrates an instance where the patient rejects the doctors attempt to shift topics:
Example 3: “Well it seems uh um what is the word ambiguous”
1 Doctor: Any back pain.
2 Patient: I have back pain.
3 Doctor: Okay. So tell me about that.
4 Patient: I have back pain um in the area. I’ve been treated for
5 back pain for a long time through a chiropractor.
6 Doctor: Mmhm.
7 Patient: Um I also have a lot of back pain in the area where
8 they have taken the biopsies.
9 Doctor: Mmhm.
10 Patient: And then I have a pain right here. But I don’t know if
11 it’s a bone or a muscle pain. But it’s right here.
12 Doctor: Okay.
13 Patient: And sometimes it hurts to stretch. So it’s under my
14 mus rib.
15 Doctor: Okay. How long have you had that pain for.
16 Patient: About a month.
In this excerpt the patient speaks of pains in her body. The patient elaborates extensively for the purposes of answering the question about pains. The doctor tries to change topics in line twelve when she responds “okay”. Yet in line thirteen the patient still discusses the pain she is experiencing, resisting to the change of topic the doctor is pursuing. The doctor tries again to change the topic in line fifteen with “okay” plus the new topic of pain duration. In like sixteen the patient accepts the new topic by responding with “about a month” demonstrating her resistance was only momentary.
Enforces harmful behavior
“Okay” is supposed to be used to show approval, but in medical interviews the use of “okay” can be inappropriate because enforces the continuation of harmful behaviors (Beach, 1995). For example a patient may believe that behaviors like smoking or drinking are acceptable when a doctor follows the patients’ confessions of engaging in these activities with an “okay” (Beach, 1995).
Example 2: “Based on your presentation unfortunately is uh uh cancer”
demonstrates an instance where harmful behavior is enforced with the word “okay”:
Example 2: “Based on your presentation unfortunately is uh uh cancer”
1 Doctor: That are pretty concerning as well. And do you have
2 a a history of tobacco use.
3 Patient: No.
4 Doctor: Not really okay.
5 Patient: I smoked it until I was 25 but um
6 Doctor: Okay and
The topic being discussed in this excerpt is tobacco use. The patient admits to smoking tobacco when he was in his twenties in line five. The doctor responds to this with an “okay” in line six possibly indicating that smoking is an acceptable behavior. Since the dictionary definition of “okay” shows approval, the patient could conclude that it is acceptable to use tobacco. Clearly, in today’s times this is not the case, so “okay” is used inappropriately in this conversation.