Narratives of aging and social problems in medical encounters with older persons.

This study asks: How do older patients and their doctors deal with social problems in the discourse of routine medical encounters? Our research has been influenced by a growing recognition of narratives as an important analytic focus in the study of patient-doctor communication. We attempted to advance theoretical knowledge by emphasizing elements of sociocultural context, ideology, social control, underlying structure, and features of discourse that appear marginal to medicine's technical tasks. Based on a critical review of both quantitative and qualitative techniques in research on patient-doctor communication, we tried to move methodologically beyond prior work by developing a new interpretive method with systematic criteria to guide the sampling of encounters, transcription of recordings, interpretation of transcripts, and presentation of findings. We applied the interpretive method to 50 encounters selected randomly from a stratified random sample of 336 audiotaped encounters involving patients and primary care internists. As shown by illustrative encounters, a characteristic narrative structure and sequencing emerge, which tend to marginalize contextual problems, to leave them incompletely expressed, and to reinforce ideologies of stoicism and individualism.

[1]  A. Strauss,et al.  Basics of qualitative research: Grounded theory procedures and techniques. , 1992 .

[2]  H. Waitzkin,et al.  A Critical Theory of Medical Discourse: How Patients and Health Professionals Deal with Social Problems , 1989, International journal of health services : planning, administration, evaluation.

[3]  J. Cappella.  The method of proof by example in interaction analysis , 1990 .

[4]  J. Gee.  A Linguistic Approach to Narrative , 1991 .

[5]  K. Rost,et al.  Predictors of recall of medication regimens and recommendations for lifestyle change in elderly patients. , 1987, The Gerontologist.

[6]  K. Davis,et al.  Negotiating at the margins : the gendered discourses of power and resistance , 1995 .

[7]  Howard Brody,et al.  Stories of Sickness , 1987 .

[8]  R. Adelman,et al.  Issues in Physician—Elderly Patient Interaction , 1991, Ageing and Society.

[9]  R. Adelman,et al.  Concordance between physicians and their older and younger patients in the primary care medical encounter. , 1989, The Gerontologist.

[10]  Intimate Adversaries: Cultural Conflict Between Doctors and Women Patients , 1989 .

[11]  C. West.  Routine Complications: Troubles with Talk Between Doctors and Patients , 1984 .

[12]  Judith A. Hall,et al.  Studies of doctor-patient interaction. , 1989, Annual review of public health.

[13]  D. Polkinghorne.  Narrative Knowing and the Human Sciences , 2010 .

[14]  George C. Rosenwald,et al.  Storied lives : the cultural politics of self-understanding , 1993 .

[15]  L. Rubenstein,et al.  The Use of Targeting Criteria in Hospitalized HMO Patients: Results from the Demonstration Phase of the Hospitalized Older Persons Evaluation (HOPE) Study , 1992, Journal of the American Geriatrics Society.

[16]  S. Fisher.  In the Patient's Best Interest , 1986 .

[17]  R. Adelman,et al.  Ageism in the medical encounter: an exploratory study of the doctor-elderly patient relationship. , 1986, Language & communication.

[18]  R. Glynn,et al.  Correlates of Cognitive Function Scores in Elderly Outpatients , 1993, Journal of the American Geriatrics Society.

[19]  R. Arnold,et al.  Taking care of patients--does it matter whether the physician is a woman? , 1988, The Western journal of medicine.

[20]  M. Haug,et al.  Issues in Elderly Patient-Provider Interactions , 1987, Research on aging.

[21]  S. Jencks,et al.  Recognition of mental distress and diagnosis of mental disorder in primary care. , 1985, JAMA.

[22]  R. Adelman,et al.  Psychosocial concerns in the medical encounter: a comparison of the interactions of doctors with their old and young patients. , 1987, The Gerontologist.

[23]  E. Mishler,et al.  Discourse Of Medicine Dialectics Of Medical Interviews , 2017 .

[24]  E. Caine,et al.  Depressive symptoms, medical illness, and functional status in depressed psychiatric inpatients. , 1993, The American journal of psychiatry.

[25]  Richard Sennett,et al.  The Hidden Injuries of Class , 1973 .

[26]  R C Smith,et al.  The patient's story: integrating the patient- and physician-centered approaches to interviewing. , 1991, Annals of internal medicine.

[27]  L. Viney,et al.  Narrative analysis: a method of psychosocial research for AIDS-affected people. , 1991, Social science & medicine.

[28]  T. Delbanco,et al.  Enriching the Doctor-Patient Relationship by Inviting the Patient's Perspective , 1992, Annals of Internal Medicine.

[29]  K. Rost,et al.  Introduction of information during the initial medical visit: consequences for patient follow-through with physician recommendations for medication. , 1989, Social science & medicine.

[30]  J. Bensing,et al.  Gender Differences in Practice Style: A Dutch Study of General Practitioners , 1993, Medical care.

[31]  D. Silverman.  Interpreting Qualitative Data: Methods for Analysing Talk, Text and Interaction , 1994 .

[32]  I. K. Zola.  Bringing our bodies and ourselves back in: reflections on a past, present, and future "medical sociology". , 1991, Journal of health and social behavior.

[33]  H. Waitzkin,et al.  Physician stereotypes about female health and illness: a study of patient's sex and the informative process during medical interviews. , 1979, Women & health.

[34]  V. Voloshinov.  Marxism and the philosophy of language , 1973 .

[35]  Aaron V. Cicourel,et al.  Text and Discourse , 1985 .

[36]  Anthony Giddens,et al.  5. Action, Subjectivity, and the Constitution of Meaning , 1987 .

[37]  S. Woolgar,et al.  Representation in Scientific Practice , 1990 .

[38]  Kathy Davis,et al.  The process of problem (re)formulation in psychotherapy , 1986 .

[39]  The Second Sickness: Contradictions of Capitalist Health Care , 1983 .

[40]  C. Riessman.  Divorce Talk: Women and Men Make Sense of Personal Relationships , 1990 .

[41]  Kamerow Db.  Is screening for mental health problems worthwhile in family practice? An affirmative view. , 1987 .

[42]  Arthur Kleinman.  The Illness Narratives , 1988 .

[43]  J. Wertsch.  Voices of the Mind: A Sociocultural Approach to Mediated Action , 1992 .

[44]  R. Laing,et al.  Sanity, Madness and the Family , 1964 .