The expression of aversion to medicines in general practice consultations
Abstract
Although the relevance of patients' views about medicines for their medicine taking behaviour is now well established, little is known about the ways in which these views are discussed in primary care consultations. In particular, many studies have demonstrated patients' aversion to medicines. This paper examines the form that aversion talk takes in the consultation and how doctors respond to patients' expression of aversion to medicines. It is based on a dataset of 35 case studies of general practice consultations in England. In interviews with researchers, aversion to medicines was expressed in 34 of the 35 cases. In consultations with doctors, aversion was expressed in 10 cases. The interactional dimension of aversion talk in consultations was analysed using Conversation Analysis, and two general patterns were identified. Aversion could be used as an interactional resource, or it could be a topic in its own right. If used as an interactional resource, no real discussion of patients' views of medicines took place. When aversion was a conversational topic in its own right, two situations were observed. Firstly, the doctor elicited patients' views directly. Secondly, patients initiated aversive talk using a range of indirect strategies to do so. Even when patients managed to express their aversion to medicines, doctors did not engage them in any real discussion of their views. A scheme of interpretation is suggested to explain these findings. In this scheme patients perceive medicines to be an extension of the doctor and to be beneficial. In this view it is right for doctors to prescribe medicines and for patients to take medicines. The results of this paper suggest that using aversion as an interactional resource might be the only safe way for patients to express their aversion without seeming to breach the social contract.
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Patients can resist being referred and can resist offers of medication.
“Referral implies that a GP has identified particular features of candidacy and is seeking to match those to a service that deals with that form of candidacy, but patients can resist being referred [42,63] and can resist offers of medication [64,65].”
From Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups (2006) · cites this paper as [64]
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- Authors
- Britten, N., Stevenson, F., Gafaranga, J., Barry, C., & Bradley, C.
- Affiliations
- Peninsula College of Medicine and Dentistry (GB)
- Royal Free London NHS Foundation Trust (GB)
- University of Edinburgh (GB)
- Brunel University of London (GB)
- University College Cork (IE)
- Corresponding author
- Britten, Nicky
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2004-10
- Volume
- 59
- Issue
- 7
- Pages
- 1495-1503
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2114785584
- Cited by
- 74
- References
- 24
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 2 · 2021: 2 · 2020: 4 · 2019: 2 · 2018: 2 · 2017: 1 · 2016: 1 · 2015: 2 · 2014: 4 · 2013: 7 · 2012: 5
- FWCI
- 14.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Social Sciences › Arts and Humanities › Language and Linguistics › Language, Discourse, Communication Strategies
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- doctor-patient interaction, general practitioner visits, interactional resources, social contract
- MeSH terms
- Adult, Aged, Attitude to Health, Drug Therapy, England, Family Practice, Female, Humans, Male, Middle Aged, Physician-Patient Relations
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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