Illnesses such as upper respiratory tract infections (URTls(coughs and colds) are positioned within medical discourse as 'minor' and 'trivial', and consulting doctors with cough and cold symptoms is morally accountable. In this thesis I explore different methodological approaches to understanding doctor-patient consultations for URTls. I critically review quantitative and qualitative approaches to URTI consultation research, and explore qualitative discursive approaches through analyses of consultation data. Data comprise 33 video-taped consultations and post-consultation interviews with inner London general practitioners and patients with cough and cold symptoms, supplemented with ethnographic data. I draw from a range of discursive methodological approaches including conversation analysis, socio-Iinguistic analysis of institutional talk and discursive psychology. I show how discursive approaches can illuminate the complexity and meaning of doctor-patient interaction, exploring the way that coughing is used by patients as an interactional resource. In a detailed micro-analysis, I show that coughing is associated with interactional problems such as misunderstanding and disagreement, and how it also functions as a resource to assert patients' legitimacy. ,. In another detailed analysis, I show that the 'minor' status of coughs and colds (and consequent 'no problem' diagnosis) is associated with interactional difficulty for both doctors and patients: I show how doctors' and patients'legitimacy and 'face' are at stake in a contest to define the meaning of cough and cold symptoms (as significant and treatable, or alternatively, 'no problem'). I discuss conflicts between doctors' and patients' interests: for example, prescribing antibiotics may legitimise the patient but discredit the doctor. . I discuss the way that discourse analytic approaches can contribute richer understandings of doctor-patient interaction through detailed analysis of social transactions in consultation (such as the negotiation of identity and face). I contend that discursive approaches represent valuable and under-utilised resources for research and practice in primary care.
|Bailey, Julia Vivian
|King's College London (University of London)
|Electronic Thesis or Dissertation
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