Extended Abstract: Who Can Be an “Engaged Patient”? Stratified Role Performances in Physician–Patient Communication

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 19. Patient Experiences

Abstract

This paper examines who can take up the role of an “engaged patient” and under which social conditions participation “on equal footing” becomes possible. Building on Timmermans’ concept of the engaged patient, we conceptualize physician–patient communication as a situated practice in which agency is relational and resource-dependent—shaped by stratified access to cultural and socioeconomic resources as well as by credibility relations. Empirically, we draw on 78 semi-structured, partly narrative interviews (in German) conducted in late 2025 with participants reflecting on experiences and expectations in physician–patient communication. Sampling was criteria-based and purposive to capture variation by occupational prestige, age, gender, and migration background; participants also completed a short post-interview questionnaire capturing sociodemographic indicators and selected items on communication. Analytically, we combine type-building qualitative content analysis with hermeneutic close readings of selected cases. Category development followed an iterative inductive–deductive logic, using the conceptual framework as sensitizing concepts and refining categories against the material. The analysis is organized along five emergent dimensions: locus of agency, stance toward medical authority, epistemic orientation (including symptom/body talk), participation repertoire (including agenda-setting), and affective framing. Preliminary interpretive analyses suggest that “patient engagement” takes multiple, sometimes contradictory forms that do not map neatly onto shared decision-making. Alongside cooperative participation, we observe institutionally distanced engagement in which patients mobilize knowledge outside professional medicine as a protective response to perceived opacity or overreach of medical authority. The paper contributes a typology of stratified patient role performances and, in an ongoing step, explores how these types cluster with social-position markers from the questionnaire.

Authors

• Anna K. Kosmuetzky

• Stephanie Beyer, Leibniz University Hanover