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Death, depression and 'defensive expansion': Closing down smoking as an issue for discussion in GP consultations

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  • Pilnick, Alison
  • Coleman, Tim

Abstract

This paper examines routine primary care consultations in the UK where smoking is discussed using data from a larger study of the factors influencing discussion of smoking between general practitioners (GPs) and patients. In this study, consultations have been analysed with a focus on the termination of discussion about smoking, using an approach that is informed by the conversation analytic (CA) literature on professional/client interaction. In interviews from the previous larger study, GPs suggested two main reasons for not pursuing discussion of smoking in consultations. One reason was an overarching fear of damaging the GP/patient relationship. The second reason related to clinical judgement, where it was feared that an attempt to stop smoking might exacerbate a patient's existing condition, particularly their mental health. This paper suggests that, while this latter scenario of clinical judgement is borne out by the consultation data, there are two more subtle patient behaviours which are associated with GPs abandoning further discussion of smoking: patients' 'troubles telling', where the issue of smoking is de-emphasised in the face of other 'troubles', and 'defensive expansion', where the patient over-emphasises deficiencies to curtail discussion. Greater awareness of the situations in which doctors end discussion of smoking will help GPs to develop ideas for alternative approaches in these circumstances which could result in more meaningful, effective engagement between doctors and their patients who smoke when smoking is discussed.

Suggested Citation

  • Pilnick, Alison & Coleman, Tim, 2006. "Death, depression and 'defensive expansion': Closing down smoking as an issue for discussion in GP consultations," Social Science & Medicine, Elsevier, vol. 62(10), pages 2500-2512, May.
  • Handle: RePEc:eee:socmed:v:62:y:2006:i:10:p:2500-2512
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    References listed on IDEAS

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    1. Beach, W. A. & Dixson, C. N., 2001. "Revealing moments: formulating understandings of adverse experiences in a health appraisal interview," Social Science & Medicine, Elsevier, vol. 52(1), pages 25-44, January.
    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.
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    Cited by:

    1. Benwell, Bethan & Rhys, Catrin S., 2018. "Negotiating relevance in pre-operative assessments," Social Science & Medicine, Elsevier, vol. 200(C), pages 218-226.
    2. 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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