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“I was gonna ask you”: How patients use agency framing to display engagement in primary care

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  • Tietbohl, Caroline K.
  • Bergen, Clara

Abstract

The message that patients should be responsible for their health is pervasive. Health promotion campaigns encourage patients to “ask your doctor” about potential illnesses and treatments, preventive medicine guidelines call for patients to self-monitor to avoid future health problems, and models like shared decision-making advocate for greater patient involvement in medical decisions. Research shows that patients can participate in medical dialogue by asking questions, but that doing so is difficult due to the structure and social norms of medical visits. In this article, we ask: how can patients participate more actively in medical care? Drawing on video recordings of older patients (aged 65 and older) and primary care physicians, we use conversation analysis to describe one practice that patients use to demonstrate personal responsibility for their health; agency framing. This involves prefacing questions to the doctor with phrases that project a prior intended action, such as “I was gonna ask you”, “I was gonna tell you” or “I wanted to ask you”. Patients use agency framing to cast their questions as 1) independently motivated, 2) well-informed, and 3) personally responsible. Consequently, patients exert agency within the confines of the medical visit structure to resist the potential interpretation that their question was responsive to the doctor or to the local interactional context. Rather, agency framing allows patients to show that their question was considered independently. Questions designed with agency framing work to portray the speaker as a responsible patient who is not only meeting the bare minimum of expected health maintenance, but is staying ahead of medical problems. This article discusses the particular importance of this practice among older patients, for whom demonstrating a willingness and ability to cope with medical problems may be significant for maintaining independence.

Suggested Citation

  • Tietbohl, Caroline K. & Bergen, Clara, 2022. "“I was gonna ask you”: How patients use agency framing to display engagement in primary care," Social Science & Medicine, Elsevier, vol. 314(C).
  • Handle: RePEc:eee:socmed:v:314:y:2022:i:c:s0277953622008024
    DOI: 10.1016/j.socscimed.2022.115496
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    References listed on IDEAS

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    1. Street, Richard L., 1991. "Information-giving in medical consultations: The influence of patients' communicative styles and personal characteristics," Social Science & Medicine, Elsevier, vol. 32(5), pages 541-548, January.
    2. Fleming, Mark D. & Shim, Janet K. & Yen, Irene H. & Thompson-Lastad, Ariana & Rubin, Sara & Van Natta, Meredith & Burke, Nancy J., 2017. "Patient engagement at the margins: Health care providers' assessments of engagement and the structural determinants of health in the safety-net," Social Science & Medicine, Elsevier, vol. 183(C), pages 11-18.
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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).

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