IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v228y2019icp262-271.html
   My bibliography  Save this article

The diagnostic moment: A study in US primary care

Author

Listed:
  • Heritage, John
  • McArthur, Amanda

Abstract

This paper conceptualizes the act of diagnosis in primary care as a 'diagnostic moment,’ comprising a diagnostic utterance in a 'diagnostic slot,' together with a patient response. Using a dataset of 201 treated conditions drawn from 255 video recorded medical visits with 71 physicians across 33 clinical practices in the Western United States, we investigate the incidence of diagnostic moments, aspects of their verbal design, and patient responsiveness. We find that only 53% of treated conditions in the dataset are associated with a diagnostic moment. Physicians present 66% of these diagnoses as hedged or otherwise doubtful, and deliver 30% of them without gazing at the patient. In the context of these diagnostic moments, patients are non- or minimally responsive 59% of the time. These findings underscore the different significance that may be accorded diagnosis in primary care in contrast to care in other medical contexts. The paper concludes that the analysis of sequences of action which empirically realize diagnosis are underrepresented in the sociology of diagnosis, and that better understanding of the diagnostic moment would enhance our understanding of diagnostic processes in primary care.

Suggested Citation

  • Heritage, John & McArthur, Amanda, 2019. "The diagnostic moment: A study in US primary care," Social Science & Medicine, Elsevier, vol. 228(C), pages 262-271.
    • Handle: RePEc:eee:socmed:v:228:y:2019:i:c:p:262-271
    DOI: 10.1016/j.socscimed.2019.03.022
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953619301649
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2019.03.022?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Robinson, Jeffrey D. & Heritage, John, 2005. "The structure of patients' presenting concerns: the completion relevance of current symptoms," Social Science & Medicine, Elsevier, vol. 61(2), pages 481-493, July.
    2. Armstrong, David, 2011. "Diagnosis and nosology in primary care," Social Science & Medicine, Elsevier, vol. 73(6), pages 801-807, September.
    3. Trundle, Catherine, 2011. "Biopolitical endpoints: Diagnosing a deserving British nuclear test veteran," Social Science & Medicine, Elsevier, vol. 73(6), pages 882-888, September.
    4. Armstrong, Natalie & Hilton, Paul, 2014. "Doing diagnosis: Whether and how clinicians use a diagnostic tool of uncertain clinical utility," Social Science & Medicine, Elsevier, vol. 120(C), pages 208-214.
    5. Schaepe, Karen Sue, 2011. "Bad news and first impressions: Patient and family caregiver accounts of learning the cancer diagnosis," Social Science & Medicine, Elsevier, vol. 73(6), pages 912-921, September.
    6. Koenig, Christopher J., 2011. "Patient resistance as agency in treatment decisions," Social Science & Medicine, Elsevier, vol. 72(7), pages 1105-1114, April.
    7. Nettleton, Sarah & Kitzinger, Jenny & Kitzinger, Celia, 2014. "A diagnostic illusory? The case of distinguishing between “vegetative” and “minimally conscious” states," Social Science & Medicine, Elsevier, vol. 116(C), pages 134-141.
    8. Gardner, John & Dew, Kevin & Stubbe, Maria & Dowell, Tony & Macdonald, Lindsay, 2011. "Patchwork diagnoses: The production of coherence, uncertainty, and manageable bodies," Social Science & Medicine, Elsevier, vol. 73(6), pages 843-850, September.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Gutin, Iliya, 2022. "Not ‘putting a name to it’: Managing uncertainty in the diagnosis of childhood obesity," Social Science & Medicine, Elsevier, vol. 294(C).
    2. Zhang, Shuai & Cheng, Meili & Ma, Wen & Liu, Huashui & Zhao, Chunjuan, 2023. "Companion responses to diagnosis in Chinese outpatient clinical interaction," Social Science & Medicine, Elsevier, vol. 338(C).
    3. Shachar, Leeor, 2022. "“You become a slightly better doctor”: Doctors adopting integrated medical expertise through interactions with E-patients," Social Science & Medicine, Elsevier, vol. 305(C).
    4. Zhao, Chunjuan & Ma, Wen, 2020. "Patient resistance towards clinicians’ diagnostic test-taking advice and its management in Chinese outpatient clinic interaction," Social Science & Medicine, Elsevier, vol. 258(C).
    5. Jin, Ying & Kim, Younhee, 2022. "Dietary advice in chronic care: Comparing traditional Chinese and western medicine practiced in mainland China," Social Science & Medicine, Elsevier, vol. 292(C).
    6. McCabe, Rose, 2021. "When patients and clinician (dis)agree about the nature of the problem: The role of displays of shared understanding in acceptance of treatment," Social Science & Medicine, Elsevier, vol. 290(C).
    7. Sideman, Alissa Bernstein & Razon, Na'amah, 2024. "Extra/ordinary medicine: Toward an anthropology of primary care," Social Science & Medicine, Elsevier, vol. 346(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Gøril Ursin, 2020. "Framing Dementia Care Practices: The Politics of Early Diagnosis in the Making of Care," SAGE Open, , vol. 10(3), pages 21582440209, July.
    2. Gutin, Iliya, 2022. "Not ‘putting a name to it’: Managing uncertainty in the diagnosis of childhood obesity," Social Science & Medicine, Elsevier, vol. 294(C).
    3. Wei, Wan, 2024. "Beyond the patient-doctor dyad: Examining “other” patient engagement in Traditional Chinese Medicine consultations," Social Science & Medicine, Elsevier, vol. 340(C).
    4. Locock, Louise & Nettleton, Sarah & Kirkpatrick, Susan & Ryan, Sara & Ziebland, Sue, 2016. "‘I knew before I was told’: Breaches, cues and clues in the diagnostic assemblage," Social Science & Medicine, Elsevier, vol. 154(C), pages 85-92.
    5. Phillips, Tarryn, 2012. "Repressive authenticity in the quest for legitimacy: Surveillance and the contested illness lawsuit," Social Science & Medicine, Elsevier, vol. 75(10), pages 1762-1768.
    6. Tate, Alexandra, 2020. "Invoking death: How oncologists discuss a deadly outcome," Social Science & Medicine, Elsevier, vol. 246(C).
    7. Dooley, Jemima & Barnes, Dr Rebecca, 2022. "Negotiating ‘the problem’ in GP home visits to people with dementia," Social Science & Medicine, Elsevier, vol. 298(C).
    8. Bernardi, Roberta & Wu, Philip F., 2022. "Online health communities and the patient-doctor relationship: An institutional logics perspective," Social Science & Medicine, Elsevier, vol. 314(C).
    9. Hawking, Meredith K.D. & Swinglehurst, Deborah, 2024. "Seeking help for atrial fibrillation: the role of the body in distributed decision making," Social Science & Medicine, Elsevier, vol. 350(C).
    10. Benwell, Bethan & Rhys, Catrin S., 2018. "Negotiating relevance in pre-operative assessments," Social Science & Medicine, Elsevier, vol. 200(C), pages 218-226.
    11. Murdoch, Jamie & Salter, Charlotte & Ford, John & Lenaghan, Elizabeth & Shiner, Alice & Steel, Nicholas, 2020. "The “unknown territory” of goal-setting: Negotiating a novel interactional activity within primary care doctor-patient consultations for patients with multiple chronic conditions," Social Science & Medicine, Elsevier, vol. 256(C).
    12. Landmark, Anne Marie Dalby & Svennevig, Jan & Gulbrandsen, Pål, 2016. "Negotiating treatment preferences: Physicians' formulations of patients' stance," Social Science & Medicine, Elsevier, vol. 149(C), pages 26-36.
    13. Zhao, Chunjuan & Ma, Wen, 2020. "Patient resistance towards clinicians’ diagnostic test-taking advice and its management in Chinese outpatient clinic interaction," Social Science & Medicine, Elsevier, vol. 258(C).
    14. Becky Alexis‐Martin & Matthew Breay Bolton & Dimity Hawkins & Sydney Tisch & Talei Luscia Mangioni, 2021. "Addressing the Humanitarian and Environmental Consequences of Atmospheric Nuclear Weapon Tests: A Case Study of UK and US Test Programs at Kiritimati (Christmas) and Malden Islands, Republic of Kiriba," Global Policy, London School of Economics and Political Science, vol. 12(1), pages 106-121, February.
    15. Daker-White, Gavin & Rogers, Anne & Kennedy, Anne & Blakeman, Thomas & Blickem, Christian & Chew-Graham, Carolyn, 2015. "Non-disclosure of chronic kidney disease in primary care and the limits of instrumental rationality in chronic illness self-management," Social Science & Medicine, Elsevier, vol. 131(C), pages 31-39.
    16. Schweda, Mark & Pfaller, Larissa, 2014. "Colonization of later life? Laypersons' and users' agency regarding anti-aging medicine in Germany," Social Science & Medicine, Elsevier, vol. 118(C), pages 159-165.
    17. Duran, Eduardo, 2021. "Diagnostic slippage: Medical uncertainty and engaged patienthood in the case of atypical disorders," Social Science & Medicine, Elsevier, vol. 280(C).
    18. Gaspar, Mark & Rosenes, Ron & Burchell, Ann N. & Grennan, Troy & Salit, Irving & Grace, Daniel, 2020. "Diagnosing uncertainty: The challenges of implementing medical screening programs for minority sub-populations in Canada," Social Science & Medicine, Elsevier, vol. 244(C).
    19. Toerien, Merran, 2021. "When do patients exercise their right to refuse treatment? A conversation analytic study of decision-making trajectories in UK neurology outpatient consultations," Social Science & Medicine, Elsevier, vol. 290(C).
    20. Turowetz, Jason, 2015. "Citing conduct, individualizing symptoms: Accomplishing autism diagnosis in clinical case conferences," Social Science & Medicine, Elsevier, vol. 142(C), pages 214-222.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:228:y:2019:i:c:p:262-271. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.