Hawking Meredith K D, Robson John, Taylor Stephanie J C, Swinglehurst Deborah
Queen Mary University of London, London, United Kingdom.
Qual Health Res. 2020 Dec;30(14):2316-2330. doi: 10.1177/1049732320951772. Epub 2020 Aug 28.
In this article, we examine illness narratives to illuminate the discursive work that patients undertake to construct themselves as "good" and adherent. Biographical narrative interviews were undertaken with 17 patients receiving anticoagulation for stroke prevention in atrial fibrillation, from five English hospitals (May 2016-June 2017). Through pluralistic narrative analysis, we highlight the discursive tensions narrators face when sharing accounts of their medicine-taking. They undertake challenging linguistic and performative work to reconcile apparently paradoxical positions. We show how the adherent patient is co-constructed through dialogue at the intersection of discourses including authority of doctors, personal responsibility for health, scarcity of resources, and deservingness. We conclude that the notion of medication adherence places a hidden moral and discursive burden of treatment on patients which they must negotiate when invited into conversations about their medications. This discursive work reveals, constitutes, and upholds medicine-taking as a profoundly moral practice.
在本文中，我们审视疾病叙事，以阐明患者为将自己构建为“好”患者并坚持治疗所进行的话语工作。我们对来自英国五家医院（2016年5月至2017年6月）的17名接受抗凝治疗以预防房颤中风的患者进行了传记式叙事访谈。通过多元叙事分析，我们突出了叙述者在分享服药经历时所面临的话语张力。他们进行具有挑战性的语言和行为工作，以调和明显矛盾的立场。我们展示了依从性患者是如何在包括医生权威、个人健康责任、资源稀缺和应得性等话语交叉点上通过对话共同构建的。我们得出结论，服药依从性的概念给患者带来了隐藏的道德和话语治疗负担，当他们被邀请参与关于其用药的对话时，必须对此进行协商。这种话语工作揭示、构成并维护了服药作为一种深刻的道德实践。
