Item Details

Moral accounts and membership categorization in primary care medical interviews

Issue: Vol 8 No. 3 (2011)

Journal: Communication & Medicine

Subject Areas: Healthcare Communication Linguistics

DOI: 10.1558/cam.v8i3.211

Abstract:

Although the link between health and morality has been well established, few studies have examined how issues of morality emerge and are addressed in primary care medical encounters. This paper addresses the need to examine morality as it is (re)constructed in everyday health care interactions. A Membership Categorisation Analysis of 96 medical interviews reveals how patients orient to particular membership categories and distance themselves from others as a means of accounting (Buttny 1993; Scott and Lyman 1968) for morally questionable health behaviours. More specifically, this paper examines how patients use membership categorisations in order to achieve specific social identity(ies) (Schubert et al. 2009) through two primary strategies: defensive detailing and prioritizing alternative membership categories. Thus, this analysis tracks the emergence of cultural and moral knowledge about social life as it takes place in primary care medical encounters.

Author: Patrick J. Dillon

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References :

American Academy of Family Physicians. (2009). Primary care. Retrieved October 15, 2009 from: http://www.aafp.org/online/en/home/policy/policies/p/primarycare.html
Antaki, C. and Widdicombe, S. (1998). Identity as achievement and as a tool. In C. Antaki and S. Widdicombe (eds) Identities in Talk 1–14. London: Sage.
Aronsson, K. and Rundström, B. (1989). Cats, dogs, and sweets in the clinical negotiation of reality: On politeness and coherence in paediatric discourse. Language in Society 18: 483–504. http://dx.doi.org/10.1017/S0047404500013877
Aronsson, K. and Cederborg, A-C. (1997). A love story retold: Moral order and intergenerational negotiations. Semiotica 114: 83–110.
Baker, C. D. (1997a). Membership categorisation and interview accounts. In D. Silverman (ed.) Qualitative Research: Theory, Method and Practice 130–143. London: Sage.
Baker, C. D. (1997b). Ticketing rules: Categorisation and moral ordering in a school staff meeting. In S. Hester and P. Eglin (eds) Culture in Action: Studies in Membership Categorisation Analysis 78–98. Washington, DC: University Press of America.
Baker, C. D. (2000). Locating culture in action: Membership categorisation in texts and talk. In A. Lee and C. Poynton (eds) Culture and Text: Discourse and Methodology in Social Research and Cultural Studies 99–113. London: Routledge.
Baker, C.D. (2004). Membership categorization and interview accounts. In D. Silverman (ed.) Qualitative Research: Theory, Method and Practice (2nd Edition) 162–176. London: Sage.
Bartesaghi, M. and Bowen, S. P. (2009). The acquisition of memory by interview questioning: Holocaust re-membering as category-bound activity. Discourse Studies 11: 223–243. http://dx.doi.org/10.1177/1461445608100945
Baruch, G. (1981). Moral tales: Parents’ stories of encounters with health professions. Sociology of Health and Illness 3: 275–296. http://dx.doi.org/10.1111/1467-9566.ep10486851
Beckman, H. and Frankel, R. M. (1984). The effect of physician behaviour on the collection of data. Annals of Internal Medicine 101: 692–696.
Bergmann, J. (1992). Veiled morality: Notes on discretion in psychiatry. In P. Drew and J. Heritage (eds) Talk at work: Interaction in Institutional settings 137–162. Cambridge: Cambridge University Press.
Bergmann, J. R. (1998). Introduction: Morality in discourse. Research on Language and Social Interaction 31: 279–294.
Bolden, G. B. and Robinson, J. D. (2011). Soliciting accounts with why-interrogatives in conversation. Journal of Communication 61: 94–119. http://dx.doi.org/10.1111/j.1460-2466.2010.01528.x
Brody, H. (1987). Stories of Sickness. New Haven, CT: Yale University Press.
Brown, S. D. (1999). Stress as regimen: Critical readings of self-help literature. In C. Willig (ed.) Applied Discourse Analysis: Social and Psychological Interventions 22–43. Buckingham: Open University Press.
Buttny, R. (1993). Social Accountability in Communication. London: Sage.
Cegala, D. J. and Street Jr., R. L. (2010). Interpersonal dimensions of health communication. In C. R. Berger, M. E. Roloff and D. R. Roskos-Ewoldsen (eds) The Handbook of Communication Science 401–417. 2nd ed. Thousand Oaks, CA: Sage.
Clayman, S. E. and Maynard, D. W. (1995). Ethnomethodology and conversation analysis. In P. ten Have and G. Psathas (eds) Situated Order: Studies in the Social Organisation of Talk and Embodied Activities 1–30. London: University Press of America.
Crawford, R. (1977). You are dangerous to your health: The ideology and politics of victim blaming. International Journal of Health Services 7: 663–80. http://dx.doi.org/10.2190/YU77-T7B1-EN9X-G0PN
Dillon, P. J. (2012). Assessing the influence of patient participation in primary care medical interviews on recall of treatment recommendations. Health Communication 27: 58–65. http://dx.doi.org/10.1080/10410236.2011.569000
Drew, P. (1998). Complaints about transgressions and misconduct. Research on Language and Social Interaction 31: 295–325.
Edwards, D. and Potter, J. (2001). Discursive psychology. In A. McHoul and M. Rapley (eds) How to Analyse Talk in Institutional Settings: A Case Book of Methods 12–24. London: Continuum.
Edwards, D. and Potter, J. (2005). Discursive psychology, mental states and descriptions. In H. te Molder and J. Potter (eds) Conversation and Cognition 241–259. Cambridge: Cambridge University Press.
Evaldsson, A. (2007). Accounting for friendship: Moral ordering and category membership in preadolescent girls’ relational talk. Research on Language and Social Interaction 40 (4): 377–404. http://dx.doi.org/10.1080/08351810701471377
Garfinkel, H. (2002). Ethnomethodology’s Program : Working Out Durkeim’s Aphorism. Lanham, MD: Rowman & Littlefield Publishers.
Goffman, E. (1961). Encounters: Ten Studies in the Sociology of Interaction. Harmondsworth: Penguin.
Halkowski, T. (2006). Realizing the illness: Patients’ narratives of symptom discovery. In J. Heritage and D. W. Maynard (eds) Communication in Medical Care: Interaction Between Primary Care Physicians and Patients 48–85. Cambridge: Cambridge University Press.
Heritage, J. and Lindström, A. (1998). Motherhood, medicine, and morality: Scenes from a medical encounter. Research on Language and Social Interaction 31: 397–438.
Heritage, J. and Maynard, D. W. (eds) (2006). Communication in Medical Care: Interaction between Primary Care Physicians and Patients. Cambridge: Cambridge University Press.
Heritage, J., and Robinson, J. D. (2006). Accounting for the visit: Giving reasons for seeking medical care. In J. Heritage and D. W. Maynard (eds) Communication in Medical Care: Interaction between Primary Care Physicians and Patients 48–85. Cambridge: Cambridge University Press.
Hester, S. and Eglin, P. (1997). Membership categorisation analysis: An introduction. In S. Hester and P. Eglin (eds) Culture in Action: Studies in Membership Categorisation Analysis 1–24. Washington, DC: University Press of America.
Higgins, R. L., Snyder, C. R. and Berglas, S. (1991). Self-handicapping: The Paradox that Isn’t. New York: Plenum.
Housley, W. and Fitzgerald, R. (2009). Membership categorisation, culture and norms in action. Discourse & Society 20: 345–362. http://dx.doi.org/10.1177/0957926509102405
Jayyusi, L. (1984). Categorisation and the Moral Order. London: Routledge.
Jefferson, G. (1984). Transcript notation. In J. M. Atkinson and J. Heritage (eds) Structures of Social Action: Studies in Conversation Analysis ix–xvi. Cambridge: Cambridge University Press.
Jefferson, G. (1985). On the interactional unpackaging of a ‘gloss’. Language in Society 14: 435–466. http://dx.doi.org/10.1017/S0047404500011465
Lepper, G. (2000). Categories in Text and Talk. London: Sage.
Linell, P. and Bredmar, M. (1996). Reconstructing topical sensitivity: Aspects of face-work in talks between midwives and expectant mothers. Research on Language and Social Interaction 29: 347–379. http://dx.doi.org/10.1207/s15327973rlsi2904_3
Mäkitalo, A. (2003). Accounting practices as situated knowing: Dilemmas and dynamics in institutional categorisation. Discourse Studies 5: 495–516. http://dx.doi.org/10.1177/14614456030054003
Marvel, M. K., Epstein, R. M., Flowers, K. and Backman, H. B. (1999). Soliciting the patients’ agenda: Have we improved? Journal of the American Medical Association 281 (3): 283–287. http://dx.doi.org/10.1001/jama.281.3.283
Maynard, D. W. (2003). Bad News, Good News: Conversational Order in Everyday Talk and Clinical Settings. Chicago: University of Chicago Press.
Mechanic, D. (1972). Social psychological factors affecting the presentation of bodily complaints. New England Journal of Medicine 286: 1132–1139. http://dx.doi.org/10.1056/NEJM197205252862105
Parsons, T. (1951). The Social System. Glencoe, Illinois: Free Press.
Peräkylä, A. (1998). Authority and accountability. The delivery of diagnosis in primary health care. Social Psychology Quarterly 61 (4): 301–320. http://dx.doi.org/10.2307/2787032
Petersen, A. and Lupton, D. (1996). The New Public Health: Health and Self in The Age of Risk. London: Sage.
Roberts, C., Sarangi, S. and Moss, B. (2004). Presentation of self and symptoms in primary care consultations involving patients from non-English speaking backgrounds. Communication & Medicine 1 (2): 159–169. http://dx.doi.org/10.1515/come.2004.1.2.159
Robinson, J. D. and Bolden, G. B. (2010). Preference organization of sequence-initiating actions: The case of explicit account solicitations. Discourse Studies 12: 501–533. http://dx.doi.org/10.1177/1461445610371051
Sacks, H. (1972). On the analyzability of stories by children. In J. J. Gumperz and D. Hymes (eds) Directions in Sociolinguistics: The Ethnography of Communication. New York: Holt, Rinehart, and Winston.
Sacks, H. (1992). Lectures on Conversation. Cambridge, MA: Blackwell.
Schubert, S. J., Hansen, S., Dyer, K. R. and Rapley, M. (2009). ‘ADHD patient’ or ‘illicit drug user’? Managing medico-moral membership categories in drug dependence services. Discourse & Society 20: 499–516. http://dx.doi.org/10.1177/0957926509104025
Scott, M. B. and Lyman, S. M. (1968). Accounts. American Sociological Review 33: 46–62. http://dx.doi.org/10.2307/2092239
Silverman, D. (1987). Communication and Medical Practice: Social Relations in the Clinic. London: Sage.
Silverman, D. and Peräkylä, A. (1990). AIDS-counselling: The interactional organisation of talk about ‘delicate’ issues. Sociology of Health and Illness 12: 293–318. http://dx.doi.org/10.1111/1467-9566.ep11347251
Stephens, C. and Breheny, M. (2008). Menopause and the virtuous woman: The importance of the moral order in accounting for medical decision making. Health 12: 7–24. http://dx.doi.org/10.1177/1363459307083695
Stoeckle, J. D., Zola, I. K. and Davidson, G. E. (1963). On going to see the doctor: The contributions of the patient to the decision to seek medical aid, a selective review. Journal of Chronic Diseases 17: 959–970. http://dx.doi.org/10.1016/0021-9681(64)90165-1
Stokoe, E. H. (2003). Mothers, single women and sluts: Gender, morality and membership categorisation in neighbor disputes. Feminism and Psychology 13: 317–44. http://dx.doi.org/10.1177/0959353503013003006
Stokoe, E. and Smithson, J. (2001). Making gender relevant: Conversation analysis and gender categories in interaction. Discourse & Society 12: 217–244. http://dx.doi.org/10.1177/0957926501012002005
Sznitman, S. R., Horner, J. and Stanton, B. F. (2009). Condom failure: Examining the objective and cultural meanings expressed in interviews with African American adolescents. Journal of Sex Research 46 (4): 309–318. http://dx.doi.org/10.1080/00224490802684590
Tracy, K. and Robles, J. (2009). Questions, questioning, and institutional practices: An introduction. Discourse Studies 11: 131–152. http://dx.doi.org/10.1177/1461445608100941
United States National Center for Health Statistics. (2006). Ambulatory Care Visits: Physicians’ Offices and Hospital Outpatient and Emergency Departments (National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey). Washington, DC: United States Government Printing Office.
Waitzkin, H. (1991). The Politics of Medical Encounters: How Patients and Doctors Deal with Social Problems. New Haven, CT: Yale University Press.
Watson, D. R. (1978). Categorisation, authorization, and blame-negotiation in conversation. Sociology 2: 105–113. http://dx.doi.org/10.1177/003803857801200106
Watson, R. and Weinberg, T. (1982). Interviews and the interactional construction of accounts of homosexual identity. Social Analysis 11: 56–78.
Zimmerman, D.H. (1978). Ethnomethodology. American Sociologist 13: 6–15.
Zola, I. K. (1973). Pathways to the doctor: From person to patient. Social Science and Medicine 7: 677–689. http://dx.doi.org/10.1016/0037-7856(73)90002-4