When patients portray their conduct as normal and healthy: An interactional challenge for thorough substance use history taking
When patients portray their conduct as normal and healthy: An interactional challenge for thorough substance use history taking
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DOI：
10.1016/j.socscimed.2012.06.021
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发表时间：
2012-11-01
影响因子：
5.4
通讯作者：
Denvir, Paul M.
中科院分区：
文献类型：
--
作者：
Denvir, Paul M.
研究人员和医生认为，常规药物使用史的记录频率和彻底性都低于应有的水平。先前的研究已经确定了一系列有助于解释这种模式的结构、态度和社会文化障碍。本文使用对话分析（CA）方法，通过探索美国彻底记录药物使用史的潜在互动障碍来补充之前的工作。在回答常规药物使用问题（例如“你喝酒吗？”）时，患者所做的不仅仅是提供信息。他们还表达了对其行为的规范立场，本质上是为医生应如何理解其行为提供理由。患者可能采取的一种立场是他们的行为是正常且健康的。本文描述了患者用来采取这种立场的三种互动实践：1）在表明不使用某种物质时采用明显的词汇、语调或互动特征； 2) 自愿规范有关物质使用的类型、数量、频率或情况的详细信息； 3) 提供最小化物质使用的特征。本文探讨了为什么医生将这些视为适当且充分的反应，并且即使提供的信息非常肤浅，也没有寻求更多细节的一些原因。讨论了患者“正常/健康”立场的两种社会功能：1）将医生的病史重定向到其他主题；2）将自己呈现为具有健康意识的患者。 “正常/健康”的立场可以代表患者代理的表达，但也可能给医生带来困境，他们必须平衡对彻底性的关注和对融洽关系的关注。讨论了解决这一困境的建议。 (C) 2012 Elsevier Ltd. 保留所有权利。
Researchers and medical practitioners have argued that routine substance use histories are performed less frequently and less thoroughly than they should be. Previous research has identified a range of structural, attitudinal, and socio-cultural barriers that help to explain this pattern. Using conversation analytic (CA) methods, this paper complements previous work by exploring a potential interactional barrier to thorough substance use history taking in the USA. In response to routine substance use queries (e.g. "Do you drink alcohol?"), patients often do more than just providing information. They also convey normative stances toward their conduct, essentially making a case for how it should be understood by the physician. One stance that patients may take is that their conduct is normal and healthy. This paper describes three interactional practices that patients used to enact such a stance: 1) employing marked lexical, intonational, or interactional features when indicating no use of a substance; 2) volunteering normalizing details about the type, quantity, frequency, or circumstances of substance use; 3) providing minimizing characterizations of substance use. The paper explores some reasons why physicians treated these as appropriate and sufficient responses and did not seek additional details even when the information provided was quite superficial. Two social functions of patients' "normal/healthy" stances are discussed: 1) redirecting the physician's history taking to other topics and 2) presenting oneself as a health-conscious patient. "Normal/healthy" stances can represent an expression of patient agency, but can also present a dilemma for physicians, who must balance a concern for thoroughness with a concern for rapport. Recommendations for navigating this dilemma are discussed. (C) 2012 Elsevier Ltd. All rights reserved.