This research has analysed how student doctors and simulated patients from overseas communicate in primary care history-taking in English as a Lingua Franca. Special focuses are as follows; 1) how student doctors deliver the diagnosis and suggest the treatment and 2) how simulated patients disagree with or resist the diagnosis and suggestion. The conversation data were audio-visual recorded and transcribed for subsequent conversation analysis.

Conversation analysis has found three types of delivering diagnosis and suggestion by the student doctors and two types of disagreement or resistance by the simulated patients. In this data, the student doctors tend to deliver their decisions by using hedging expressions such as auxiliary verbs and stance markers when referring to the process of inference such as characteristics of the symptoms. Some however use more direct expressions when delivering strong need and necessity by clearly explaining the evidence of diagnosis. The former leads to immediate and smooth agreement of the treatment phase, while the latter invites more disagreement by the patients. For showing disagreement, the patients are found to use both question-formulation and repetition. The former facilitates immediate transition to the negotiation phase, while the latter requires multiple turns for the doctors to understand their disagreement.