University of Washington School of Medicine, Department of Psychiatry & Behavioral Health, USA; Seattle Children's Hospital, Department of Pediatrics, 4800 Sandpoint Way M/S OA.5.154, PO Box 5371, Seattle, WA, 98145-5005, USA.
University of Massachuesetts, Amherst, Department of Communication, USA.
Soc Sci Med. 2020 May;253:112925. doi: 10.1016/j.socscimed.2020.112925. Epub 2020 Mar 17.
Diabetes is a chronic illness with individual, social, and structural-level factors that contribute to its successful management. This paper utilizes conversation analysis to analyze a corpus of 60 audiotaped adult doctor-patient interactions. We examine how patients with diabetes and their physicians discuss blood glucose level management, including how physicians present patients with their test results and how patients respond to these presentations given the possible moral orientation around these activities. We show that physicians are more likely to present "good" blood sugar levels using assessments that explicitly evaluate the patients' condition. Contrastingly, physicians present "bad" glucose levels using report formats of numerical values alone. Interactionally, this requires that patients respond to these numbers by making sense of or accounting for their glucose level. The different practices of discussing blood glucose levels suggests that physicians approach this topic cautiously. This sensitivity balances epistemic asymmetry and may help physicians avoid direct moral characterizations of their patients. Our analysis connects interactional practices to the continuous negotiation of both medical epistemic responsibility and morality between physicians and patients with diabetes as well as the implications this may have in the medical management of this illness.
糖尿病是一种慢性病，其成功管理涉及个体、社会和结构层面的因素。本文运用会话分析方法，对 60 段录音的成年医患互动语料进行了分析。我们探讨了糖尿病患者及其医生如何讨论血糖管理，包括医生如何向患者展示他们的测试结果，以及在这些活动可能涉及道德取向的情况下，患者如何对这些呈现做出反应。我们发现，医生更有可能使用明确评估患者病情的评估来呈现“良好”的血糖水平。相比之下，医生仅使用数值报告格式来呈现“不良”的血糖水平。在互动中，这要求患者通过理解或解释他们的血糖水平来对这些数字做出反应。讨论血糖水平的不同做法表明，医生谨慎地处理这个话题。这种敏感性平衡了认识不对称性，并可能有助于医生避免对患者进行直接的道德描述。我们的分析将互动实践与医生和糖尿病患者之间对医学认知责任和道德的持续协商联系起来，并探讨了这可能对这种疾病的医疗管理产生的影响。
