Health promotion talk in family practice encounters

The model of family medicine advocates a view of the patient as a psychosocially grounded person, and stresses the value of a preventive approach in maintaining health. Given such principles, it is expected that in the expression of this model--in actual family practice encounters--physicians will regularly introduce topics about health promoting behaviors in their interactions with patients. Examination of a sample of typical and unrehearsed encounters between family physicians and patients, however, reveals a striking absence of such topics. Where they do occur, there is conversational evidence that both parties find the topics troublesome, and employ conversational strategies which tend to distance these topics from the rest of the interview. The conversational features of these distancing strategies, as well as their possible sources and implications, are discussed. Physician participants in the research express no reluctance to introduce topics related to health promotion behavior, and in fact report that they do so regularly: the latter is contradicted by empirical conversational data. Difficulties that physicians evidence in managing these topics--in the absence of any conscious dispreference--suggest that shared interpretive frames operating for the remainder of the medical encounter do not work well for these topics. Physicians desiring to communicate effectively in this area may need to rethink health promotion talk as a special conversational task, which differs in key ways from more conventional topics introduced in medical encounters.