Pre-emptive resistance: patients’ participation in diagnostic sense-making activities

Abstract

In medical clinic visits, patients do more than convey information about their symptoms and problems so doctors can diagnose and treat them. Patients may also show how they have made sense of their health problems and may press doctors to interpret their problems in certain ways. Using conversation analysis, we analyse a practice patients use early in the medical visit to show that relatively benign or commonplace interpretations of their symptoms are implausible. In this practice, which we term pre-emptive resistance, patients raise candidate explanations for their symptoms and then report circumstances that undermine these explanations. By raising candidate explanations on their own and providing evidence against them, patients call for doctors to restrict the range of diagnostic hypotheses they might otherwise consider. However, the practice does not compel doctors to transparently indicate whether they will do so. Patients also display their ability to recognise and weigh the evidence for common, easily remedied causes of their symptoms. By presenting evidence against them, they show doctors the relevance of more serious diagnostic interpretations without pressing for them outright.

Medical Problems Where Talk is the Problem: Current Trends in Conversation Analytic Research on Aphasia, Autism Spectrum Disorder, Intellectual Disability, and Alzheimer’s

“…Some early conversation analytic studies of talk in medical settings focused on power and authority in the doctor/patient relationship (Frankel 1984, 1990, 1995; Frankel and Beckman 1989; Maynard 1991; West 1984). Since doctors’ diagnoses depend to a large extent on patient’s descriptions of their symptoms, a line of conversation analytic research addresses this important question (Gill 1998; Gill and Maynard 2006; Gill et al. 2010; Heath 1989; Roberts et al.…”

Systematically reviewing and synthesizing evidence from conversation analytic and related discursive research to inform healthcare communication practice and policy: an illustrated guide

“…Recordings are subjected to repeated listening and viewing, and collections of the phenomenon/a of interest are made. For instance, when investigating healthcare, collections might entail episodes where bad news is delivered [38]; where the topic of alcohol or smoking is raised [39]; where patients resist a treatment proposal [40]; or where consultations get brought to a close [41]. Collected episodes are closely scrutinized to generate descriptions of typical and atypical features of communication sequences.…”

The role of assessment packages for diagnostic consultations: A conversation analytic perspective

“…Whereas in consultations where the patients negotiated because of their need for a diagnosis, the patients put considerable effort into introducing their own perspective in the consultation, which was also reported by Gill et al (2010), Gill and Maynard (1995) and Robinson (2003). This suggests that the activities of the patients are influenced by the agenda they bring to the consultations.…”