Openings in follow-up cancer consultations: The 'How are you?' question revisited

The standard process for starting anamnesis in the follow-up cancer consultation is for the doctor to ask a ‘How are you?’ question. This question gives the patient the opportunity to give a gloss of their general condition and offer the first topic of discussion. Findings in earlier analyses of US and UK data in a broad array of medical contexts show that the question is ambiguous and hence patients may interpret it as social rather than medical. A discourse analysis of a corpus of 28 video-taped consultations shows that the ‘How are you?’ question in the context of Dutch follow-up cancer consultations is consistently interpreted by both doctor and patients as a holistic medical question, making relevant a – frequently complex and nuanced – medically oriented response. We suggest that this difference may have to do with the interactional norms of hospital visits in the Netherlands, and with the specific contextual parameters of return visits, more specifically with follow-up cancer consultations, which affect the way the HAY question is placed, intended and understood.