UCLA, Los Angeles, CA 90095-1551, USA.
J Health Soc Behav. 2013 Jun;54(2):221-40. doi: 10.1177/0022146513487379.
Modern patients walk a tightrope between respecting medical authority and acting as knowledgeable advocates regarding health issues, with the agency and responsibilities that come with this. This article uses conversation analysis to explore this balance in relation to patient disclosures of medical misdeeds in video-recorded primary care medical visits (e.g., taking another's prescription medication or failing to adhere to a healthy lifestyle or prescription regimen). We focus on patient-initiated disclosures. We show that disclosures are used (1) where patients are seeking physician assessment of their behavior, (2) where patients are proposing the etiology of a health problem, and (3) where patients are lobbying for a particular treatment outcome. We argue that disclosures of medical misdeeds are an important but understudied domain of conduct in which patients show awareness of their own agency over, and responsibility for, their healthcare and respect for the physician's medical authority.
现代患者在尊重医疗权威和积极参与健康问题方面扮演着双重角色，他们需要承担相应的自主权和责任。本文运用会话分析的方法，探讨了患者在视频记录的初级保健医疗访问中披露医疗不当行为（例如，服用他人的处方药或不遵守健康的生活方式或处方方案）时的这种平衡。我们重点关注患者主动披露的情况。我们表明，披露行为可以用于：（1）患者寻求医生评估其行为；（2）患者提出健康问题的病因；（3）患者争取特定的治疗结果。我们认为，披露医疗不当行为是一个重要但研究不足的行为领域，患者在其中表现出对自己的医疗保健自主权和责任的认识，同时也对医生的医疗权威表示尊重。
