近年來，許多從事言談分析之研究已著手於觀察言談互動中的非語言行為。其中廣為討論，並視為談話時不可或缺的必備條件— 眼神注視— 更是各方學者專注的焦點。其中由其重視資訊傳遞過程的醫病互動更是廣為強調眼神使用的益處。許多醫學教科書與文獻都提及醫生適當的與病人保持眼神注視，可有效引出病人的病情資訊，因此教科書也多建議，醫生應與病人保持眼神注視。然而，此非語言行為卻與另一問診之必備行為相違背— 醫生讀/寫病歷；即醫生讀/寫病歷則無法與病人保持眼神注視，反之，若與病人保持眼神注視，便無法讀/寫病歷。有鑑於此，本研究旨為探討醫生在問診時眼神注視的模式，檢視是否醫生不同的眼神注視模式會引發不同醫病互動的效果。此外，在老年病人的門診中，多數病人通常有親友陪伴（即陪同），當陪同出現時，勢必影響醫生眼神注視的情形，因此，本研究旨在研究此三人行(即醫生、病人與陪同)的互動情形—醫生眼神注視的模式與其互動的效果。本研究提出以下三個研究問題：(1)當醫生注視病人、陪同或是病歷時，病人/陪同的回應率有何不同? (2)當醫生詢問第一個開放式問句時，醫生給予病人不同程度的眼神注視（即時間長短）是否會引起病人不同程度的回應情形(即回應時間長短與回應量多寡)? (3)又，醫生讀/寫病歷的行為與互動時的沉默是否相關? 為了探討這些問題，本研究於台灣南部某教學醫學院家庭醫學科，以錄影方式收錄了24 個實際問診的語料，每個病人皆為初診且有一位親友陪伴。結果顯示(1)醫生的眼神注視具有指派下一個發言者的作用，即當醫生向病方發問時，其眼神所注視的對象(如病人、陪同或是兩者)，此人通常便是問題的回應者(如病人接收到醫生眼神注視時，回應率達97.7%，陪同收到眼神時是100%，以及病人與陪同在一個問句中同時收到醫生眼神注視時可分別達87.2%與83%的回應率)；(2)當醫生投以病人更多的眼神注視可鼓勵病人提供更詳盡的描述，例如病人回應時，醫生注視病人的時間若能超過60%以上的回應時間(即在醫生進入下一個問題前，病方用於回答醫生第一個開放式問句的總計時間)，在此次問答，病人則花了最多的時間(19.4 秒)，提供最多的回應(46.1 音節)；(3)此外，若是互動時醫生專注於讀/寫病歷，則可能會造成言談互動暫停
而發生沉默，如研究所示，高達96.7%的沉默皆是發生在醫生讀/寫病歷的時候。根據以上結果，本研究提出以下三點建議：(1)醫生向病人詢問病情資訊時，眼神注視著病人有助於醫師收集病人的第一手資訊，特別是當有陪同在場時，醫生可使用眼神注視的方式指派病人提供資訊；(2)當病人描述時，醫生也應注視著病人，如此有助於病人提供更多的描述，有利於醫生收集病人病情的全面資訊；(3)由於醫生讀/寫病歷可能會造成互動暫停而沉默，故建議若醫生非得讀/寫病歷時，應盡量避免每次長時間的讀/寫（如21 秒以上），較可避免互動發生沉默。

In recent decades, research on discourse analysis has put emphasis on participants' nonverbal behavior. Eye contact, as one of the nonverbal channels, contributes an important and inevitable role during interaction and has received a lot of scholars' attention. Medical encounters, as one type of social interaction, being significant on information exchange widely emphasize the function of gaze. As a lot of medical textbooks and literatures (e.g., Billings & Stoeckle, 1999; Heath, 1986) have shown, using eye contact as an interviewing skill helps doctors to efficiently elicit patients' information. Doctors are encouraged to maintain their eye contact with patients when they interview them. However, such a facilitating behavior is in conflict with the doctors' act of reading/writing medical records. Doctors' reading/writing
records, as an important and inevitable activity in consultation, prevents doctors and patients from maintaining eye contact. Hence, the present study examines how doctors' different gaze patterns affect the verbal interaction. Moreover, the presence of a patient companion might complicate doctors' gaze patterns. Thus, the present study aims to examine doctors' gaze patterns and effects in triadic encounters. My three research questions include: (1) What is the patients' /companions' response rate when doctors gaze towards patients versus towards companions or records? (2) In what ways do doctors’ different degrees of gaze towards patients (i.e., gaze duration) affect patient responses (i.e. in terms of time length and participation amount) to doctors’first open-ended questions? (3) Is silence correlated with doctors’ reading/writing medical records? To examine these questions, the present study collects 24 videotaped
medical encounters in the family medicine department of a teaching hospital in southern Taiwan. Each patient accompanied by a family member was visiting their doctor for the first time. The results show that (1) doctors’ eye contact functions as an indicator of who the next speaker might be, as it is shown in my analysis that the party (i.e., the patient, the companion or both) the doctor directs his/her gaze towards while posing a question will be the most probable one to respond to the doctor (i.e., 97.7% by patients, 100% by companions, or 87.2% and 83% by patients and companions respectively); (2) doctors' eye contact is a nonverbal strategy in encouraging patients’elaboratio n. That is, when patients receive doctors' eye contact for more than 60% of
the response time (i.e., the time span between the doctor's first open-ended question and his/her second question), their response time and participation amount is larger (i.e., 19.4 seconds, 46.1 syllables) than those patients receiving relatively less eye contact from doctors (i.e., doctors’ eye contact with patients for less than 40% and for 0% of the response time); (3) the absence of doctors' eye contact with the patients (i.e., doctors' reading/writing records) is a potential cause for discontinuation of the conversation (i.e., silence). As the results have displayed that the majority (96.7%) of
silence occurs during the moments when doctors are reading/writing records. Based on the above findings, the present study suggests that (1) for doctors to elicit the
first-hand information from the patients, they should gaze towards patients when doctors initiate questions, especially in the triadic medical encounter; (2) doctors
should maintain their gaze towards patients so that patients will spend more time providing more utterances in reply, especially after doctors initiate their first
open-ended question (e.g., what brings you here today?) which aims to elicit a comprehensive perspective of patient problems ; (3) to avoid discontinuity of the
conversation flow (i.e., silence), intermittently reading/writing medical records in short periods of time works better than long periods of reading/writing records.

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