The conditional legitimacy of behavior change advice in primary care.

This study asks whether and when patients treat their doctors as having the right to give behavior change advice. Drawing on 171 primary care consultations video-recorded in the U.S. between 2014 and 2016, this study uses Conversation Analysis to examine physicians' behavior change advice following a patient's disclosure of medically problematic behavior such as physical inactivity. The basis on which the physician provides this advice is associated with clear regularities in patient response. Physicians may produce treatment-implicative advice that is unambiguously framed as a treatment plan for a specific health issue such as rising blood pressure. Alternatively, physicians may produce advice that is not overtly framed as treatment. This plain advice appeals to a model of care based in medical surveillance and prevention - a physician should not need to account for advising a patient to reduce risk factors. Though all advice is clinically relevant for preventing or controlling medical conditions, treatment-implicative advice is interactionally rooted in a physician's authority to treat illness. Patients show a strong social-interactional preference for treatment-implicative advice, even accepting 'behavior change' treatment recommendations at a higher rate than pharmaceutical treatment recommendations. In contrast, patients are highly resistant towards plain behavior change advice. This study explores the implications of advice formats for understanding modern orientations towards surveillance medicine in the age of preventive care.