Doing Attributions in Medical Interaction: Patients' Explanations for Illness and Doctors' Responses

Abstract

This paper presents an analysis of the process of offering and responding to attributions in social interaction. Analyses of audio and video recordings of patients' visits to an outpatient general internal medicine clinic reveal the ways in which patients offer their own explanations for their health problems, and how doctors respond to these explanations. In these explanation-response sequences, patients and doctors collaboratively enact an asymmetrical social organization wherein patients are authorities about their experiences but not about why their health problems occur. Patients exhibit caution when they offer explanations; they downplay their knowledge and they avoid setting themselves up for disaffiliative responses. Patients do not compel doctors to interrupt information gathering to assess their explanations. Doctors take these opportunities to focus on patients' symptoms. Patients' authority is thus restricted to the empirical realm rather than encompassing the analysis of empirical facts.