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The conditional legitimacy of behavior change advice in primary care

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  • Bergen, Clara

Abstract

This study asks whether and when patients treat their doctors as having the right to give behavior change advice. Drawing on 171 primary care consultations video-recorded in the U.S. between 2014 and 2016, this study uses Conversation Analysis to examine physicians' behavior change advice following a patient's disclosure of medically problematic behavior such as physical inactivity. The basis on which the physician provides this advice is associated with clear regularities in patient response. Physicians may produce treatment-implicative advice that is unambiguously framed as a treatment plan for a specific health issue such as rising blood pressure. Alternatively, physicians may produce advice that is not overtly framed as treatment. This plain advice appeals to a model of care based in medical surveillance and prevention - a physician should not need to account for advising a patient to reduce risk factors. Though all advice is clinically relevant for preventing or controlling medical conditions, treatment-implicative advice is interactionally rooted in a physician's authority to treat illness. Patients show a strong social-interactional preference for treatment-implicative advice, even accepting ‘behavior change’ treatment recommendations at a higher rate than pharmaceutical treatment recommendations. In contrast, patients are highly resistant towards plain behavior change advice. This study explores the implications of advice formats for understanding modern orientations towards surveillance medicine in the age of preventive care.

Suggested Citation

  • Bergen, Clara, 2020. "The conditional legitimacy of behavior change advice in primary care," Social Science & Medicine, Elsevier, vol. 255(C).
    • Handle: RePEc:eee:socmed:v:255:y:2020:i:c:s0277953620302045
    DOI: 10.1016/j.socscimed.2020.112985
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    References listed on IDEAS

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    1. 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.
    2. Pilnick, Alison & Coleman, Tim, 2003. ""I'll give up smoking when you get me better": patients' resistance to attempts to problematise smoking in general practice (GP) consultations," Social Science & Medicine, Elsevier, vol. 57(1), pages 135-145, July.
    3. Russell, N.K. & Roter, D.L., 1993. "Health promotion counseling of chronic-disease patients during primary care visits," American Journal of Public Health, American Public Health Association, vol. 83(7), pages 979-982.
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    Cited by:

    1. Paulus, Trena M. & Grubbs, Heather & Rice-Moran, Renee & Lester, Jessica N., 2023. "How student healthcare providers in a communication skills course respond to standardized patient resistance," Social Science & Medicine, Elsevier, vol. 337(C).
    2. 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).
    3. Bergen, Clara & McCabe, Rose, 2021. "Negative stance towards treatment in psychosocial assessments: The role of personalised recommendations in promoting acceptance," Social Science & Medicine, Elsevier, vol. 290(C).
    4. Wheat, H. & Barnes, R.K. & Aveyard, P. & Stevenson, F. & Begh, R., 2022. "Brief opportunistic interventions by general practitioners to promote smoking cessation: A conversation analytic study," Social Science & Medicine, Elsevier, vol. 314(C).

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