May 2, 2019
5:00pm to 6:30pm
Haines 279

The Conversation Analysis Working Group invites you to join us for:  

Amanda McArthur (UCLA, Sociology): "'Are we sure that's what I have?': Diagnosis resistance in US primary care"

The communication of diagnosis is a clinically and socially significant moment when patients may first come to understand what their symptoms mean. But clinical and social scientific research has suggested that, in primary care, physicians orient to the diagnosis of routine or self-limiting conditions as less important than, e.g., treating symptomatic discomfort. Conversation analytic studies showing minimal response or resistance to diagnosis in primary care suggest that patients generally align with this orientation. I argue that diagnosis resistance actually occurs more covertly and later in visits than previously supposed by these studies, and may thus be underreported in the literature. In this talk, I synthesize and expand on what we know so far about diagnosis resistance, and present a preliminary collection and operationalization of resistance meant to capture a wider and more nuanced range of patient actions that build toward and/or accomplish resistance. I suggest that, for patients who disagree with a physician’s diagnosis or characterization of their condition, there is a tension between eliciting reconsideration of the problem and maintaining an orientation to epistemic and interactional asymmetries. This tension may indeed shape the sometimes covert and delayed practices patients deploy to resist diagnoses. The practices identified in this study point to potential differences in physicians’ and patients’ orientations to the significance of diagnosis in primary care, and reveal some of the challenges these differences may present for communication in this context.