"How can I Put this?" Exaggerated Self-Disparagement as Alignment Strategy during Problematic Disclosures by Patients to Doctors

Abstract

This article explores how patients engage in problematic disclosures to their physician. Dialogue from medical encounters suggests that patients sometimes use exaggerated self-disparagement to bid for a physician's forgiveness and reassurance. Grounded in work on conversational framing and alignment, this study documents the conversational mechanism of overclaiming. Overclaims function like disclaimers or accounts, but rather than disclaiming responsibility for an action with potentially negative consequences, the speaker seems to claim disproportionate responsibility for it. In the conversations studied, such bids pay off with emphatic compliments and reassurance. Overclaiming facilitates a shift from the primary frame of a medical encounter to a secondary frame that focuses on the nature of the overclaim rather than the nature of the violation. It is suggested that overclaims are used to elicit more-than-usual reassurance, to save face, and to preserve conversational alignment.

The purpose and function of humour in health, health care and nursing: a narrative review

“…Du Pre and Beck (1997) suggest that exaggerated self‐disparagement is a way in which patients can respectfully challenge or pose questions of caregivers. An implicit power differential is evident and thus, even when patients are encouraged to participate in the consultation, they may still feel compelled to encode in a non‐threatening manner.…”

“…Is the patient attempting to encode without challenge (Du Pre & Beck 1997), demonstrating inequality and/or dissatisfaction (Sala et al. 2002) or simply sycophantic (Hanks 2001)?…”

“…Is the patient attempting to encode without challenge (Du Pre & Beck 1997), demonstrating inequality and/or dissatisfaction (Sala et al 2002) or simply sycophantic (Hanks 2001)? Is the patient lonely or lacking in social support (Hampes 2005), nervous (Granetk-Catarivas et al 2005), clinically depressed (Murphy et al 2002) or displaying use of humour which is possibly maladaptive (Kirsh & Kuiper 2003?…”

Negotiating knowledge and creating solidarity: Humour in antenatal counselling sessions at a rural hospital in Malawi

“…However, in spite of the considerable attention that humour and laughter have received by these scholars and practitioners, discourse analysts have largely overlooked these discursive strategies in their investigations of language use in medical settings. A few exceptions are Pizzini (1991) who analyses the occurrence of humour in obstetrical and gynaecological settings, Du Pré and Beck (1997), who look at the use of self-disparaging humour in consultations with a family physician, and Haakana (2001Haakana ( , 2002, Schnurr (2011, 2016) and Rees and Monrouxe (2010) who investigate the use of laughter by nurses and patients. Pizzini (1991) observes that physicians tend to use most humour before and after the critical phases of childbirth thus enabling them to relieve some stress and tension, while Du Pré and Beck (1997) find that patients who claim disproportionate responsibility for actions with potentially negative consequences -sometimes accompanied by humour and/or laughter -often receive emphatic compliments and reassurance from their family doctor, rather than criticism.…”

“…A few exceptions are Pizzini (1991) who analyses the occurrence of humour in obstetrical and gynaecological settings, Du Pré and Beck (1997), who look at the use of self-disparaging humour in consultations with a family physician, and Haakana (2001Haakana ( , 2002, Schnurr (2011, 2016) and Rees and Monrouxe (2010) who investigate the use of laughter by nurses and patients. Pizzini (1991) observes that physicians tend to use most humour before and after the critical phases of childbirth thus enabling them to relieve some stress and tension, while Du Pré and Beck (1997) find that patients who claim disproportionate responsibility for actions with potentially negative consequences -sometimes accompanied by humour and/or laughter -often receive emphatic compliments and reassurance from their family doctor, rather than criticism. Haakana (2001Haakana ( , 2002 argues that laughter is often used to mitigate embarrassing, sensitive or painful aspects and to create alignment between participants, and Zayts and Schnurr (2011) show that nurses frequently employ laughter to facilitate their clients' decision making and to assist them in making autonomous choices.…”