Department of Sociology and Anthropology, Illinois State University, Normal, IL 61790, USA.
Sociol Health Illn. 2010 Jan;32(1):1-20. doi: 10.1111/j.1467-9566.2009.01208.x. Epub 2009 Dec 9.
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.
在医疗诊所就诊中，患者不仅要传达有关其症状和问题的信息，以便医生进行诊断和治疗，还可能会展示他们如何理解自己的健康问题，并可能促使医生以特定方式解释他们的问题。我们使用会话分析来分析患者在医疗就诊早期使用的一种做法，以表明对其症状相对良性或常见的解释是不可信的。在这种我们称之为先发制人的抵抗的做法中，患者提出了对其症状的候选解释，然后报告了破坏这些解释的情况。通过自行提出候选解释并提供反对这些解释的证据，患者呼吁医生限制他们可能考虑的诊断假设范围。但是，该做法并没有迫使医生明确表明他们是否会这样做。患者还展示了他们识别和权衡常见、易于纠正的症状原因的能力。通过提供反对这些原因的证据，他们向医生表明了更严重的诊断解释的相关性，而无需直接要求这些解释。
