Negotiating the Pain Search in Primary Care Physical Exams

• In Event: 256 - Section on Ethnomethodology and Conversation Analysis Paper Session. Current Studies in Conversation Analysis

Abstract

In primary care clinical encounters, a physical exam investigating the nature and location of a patient’s new, undiagnosed pain is a unique institutional activity in which doctors and patients must collaborate to allow the doctor to re-locate that pain from a clinical, diagnostic perspective. Taking a conversation analytic approach to such exams, this paper challenges the notion that a physical exam activity can be de facto a search for pain by exploring the resources participants use to co-construct the doctor’s diagnostic actions as response relevant, and the ongoing activity as a recognizable search for pain – or not. By closely analyzing an exemplary case, this study finds that participants may sometimes “get it wrong,” i.e. misalign in their orientation to the nature of the ongoing pain-related physical exam activity. It is argued that such misalignments lead to interactional dilemmas for both doctors and patients, which may have implications for the quality of the clinical interaction, and by extension for patient satisfaction and health outcomes in general.

Author

• Amanda McArthur, University of California, Los Angeles