Physician-patient communication about patients' sexual activities and substance use: Information exchange on potentially delicate matters.

摘要

Previous interaction-based research has shown that physicians and patients collaboratively realize the routine character of comprehensive medical histories through their communicative behavior. A primary resource in this regard is the design of information seeking and reporting actions. Physicians seek information through closed-ended query formats and patients report information in fitted, minimal formats. This organization provides a relatively efficient way to address a wide range of health-related topics. One topical domain that has been described as sensitive and difficult is patient 'lifestyle,' which typically includes discussion of sexual activities and substance use. In these domains, patients engage in some special interactional work. They depart from the typical pattern of minimal, informational responses and instead provide responses that tacitly make a case for how their conduct should be understood. I argue that this special interactional work is designed, in part, to accomplish identity management. Specifically, I present evidence of two different identity management projects: the enactment of strong character and the restoration of character. Both projects involve patients' efforts to portray themselves as normatively and/or morally appropriate. The enactment of strong character was accomplished through three interactional practices: (1) employing a syntactically, intonationally, or interactionally marked 'no-type' response; (2) volunteering normalizing details about the type, quantity, frequency, or circumstances of conduct; (3) evaluating conduct as normal or unproblematic. The restoration of character was accomplished through four interactional practices: (1) displaying independent awareness that reported lifestyle conduct is problematic; (2) mitigating personal agency in problematic lifestyle conduct; (3) framing problematic conduct as 'in my past' or already resolved; (4) employing quantity or frequency formulations that downplay the magnitude of problematic conduct.