Lian, Olaug S, Nettleton, Sarah, Wifstad, Åge and Dowrick, Christopher
(2021)
Negotiating uncertainty in clinical encounters: A narrative exploration of naturally occurring primary care consultations.
Social Science & Medicine, 291.
p. 114467.
Abstract
Based on a narrative analysis of 20 naturally occurring clinical consultations between general practitioners and patients in England, sourced from the One in a million data archive, we explore how they conceptualize and negotiate medical and existential uncertainty. To capture the interactional element, which is often overlooked, three consultations receive special attention. While exploring the ongoing dynamics of the moment-to-moment realization of negotiations, we relate their actions to the institutionalized positions of doctor and patient. Situating their negotiations in the sociocultural context in which their interaction is embedded reveals how consultations unfold as a result of communication between two different positions in a normatively structured system. When uncertainty prevails, both patients and GPs mainly conceptualize uncertainty indirectly. By conceptualizing uncertainty indirectly and in a depersonalized manner, GPs manage to safeguard against clinical errors without compromising their authority and credibility. Contrary to medical uncertainty, which is continuously discussed, existential uncertainty usually recedes in the background. However, as our consultations unfold it becomes evident that medical and existential dimensions of uncertainty are inextricably linked. By acknowledging that clinical uncertainty is not only an epistemic concern but also an existential one, existential aspects may usefully rise to the surface.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Uncertainty, Communication, Negotiating, Physician-Patient Relations, Referral and Consultation, Primary Health Care, General Practitioners, Clinical Decision-Making |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 22 Dec 2021 11:49 |
| Last Modified: | 18 Jan 2023 21:18 |
| DOI: | 10.1016/j.socscimed.2021.114467 |
| Open Access URL: | https://doi.org/10.1016/j.socscimed.2021.114467 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3145875 |
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