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Article published In:
Narratives as Social Practice in Organisational Contexts
Edited by Dorien Van De Mieroop, Jonathan Clifton and Stephanie Schnurr
[Narrative Inquiry 32:1] 2022
► pp. 36–65

Narrative accounts and their influence on treatment recommendations in medical interviews

| Emory University
Previous research exploring the use of narratives in medical interviews has primarily examined the history-taking phase to illustrate the ways in which physicians and patients discursively collaborate to organize and interpret patients’ illness experiences (Eggly, 2002; Halkowski, 2006; Stivers & Heritage, 2001). In this paper, the scope will be expanded to demonstrate that narrative accounts are interwoven and unfold across various phases of the medical interview, not only the history-taking phase, and are utilized in a variety of ways to collaboratively accomplish specific social practices. A narrative as talk-in-interaction approach is used to examine narrative accounts using audio-recordings of naturally occurring medical interview data (US, American English). This paper examines the ways in which narratives are locally occasioned to do a variety of things (e.g., raise difficult topics, actively resist treatment, reinforce identities), including influencing the treatment decision making process.
Keywords: narratives, accounts, narrative as talk-in-interaction, physician-patient interactions, treatment recommendations, narrative medicine, healthcare communication 
Article outline
  • Introduction
  • Background
    • Narrative medicine
    • Narratives in physician-patient interactions
    • Intertextuality and repetition
  • Methodological approach
    • Narrative as talk-in-interaction
  • Data
  • Analysis
  • Discussion and conclusions
  • Notes
  • References
Published online: 27 October 2020
DOI logo
https://doi.org/10.1075/ni.20028.fio
References (76)
References
Agar, M. (1985). Institutional discourse. Text, 5(3), 147–168. DOI logoGoogle Scholar
Allen, G. (2000). Intertextuality: The new critical idiom. New York: Routledge. DOI logoGoogle Scholar
Antaki, C., & Widdicombe, S. (1998). Identity as an achievement and as a tool. In C. Antaki, & S. Widdicombe (Eds.), Identities in talk (pp. 1–14). London: Sage.Google Scholar
Bakhtin, M. (1981). The dialogic imagination: Four essays. (M. Holquist, Ed., C. Emerson & M. Holquist, Trans.). Austin, TX: University of Texas Press.Google Scholar
(1986). The problem of speech genres. In C. Emerson, & M. Holquist (Eds.), Speech genres and other late essays (V. W. McGee, Trans.) (pp. 60–102). Austin, TX: University of Texas Press.Google Scholar
Blakemore, D. (1989). Denial and contrast: A relevance theoretic analysis of “But”. Linguistics and Philosophy, 12(1), 15–37. DOI logoGoogle Scholar
Bortfeld, H. (2003). Comprehending idioms cross-linguistically. Experimental Psychology, 50(3), 217–230. DOI logoGoogle Scholar
Boyd, E., & Heritage, J. (2006). Taking the history: Questioning during comprehensive history-taking. In J. Heritage, & D. W. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 151–184). Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Charon, R. (2001). Narrative medicine: A model for empathy, reflection, profession, and trust. The Journal of the American Medical Association, 286(15), 1897–1902. DOI logoGoogle Scholar
(2006a). The self-telling body. Narrative Inquiry, 16(1), 191–200. DOI logoGoogle Scholar
(2006b). Narrative Medicine: Honoring the stories of illness. New York: Oxford University Press.Google Scholar
(2014). Why read and write in the clinic?: The contributions of narrative medicine to health care. In H. Hamilton, & W-Y. S. Chou (Eds.), The Routledge handbook of language and health communication (pp. 245–258). New York: Routledge.Google Scholar
Chen, P-J., Huang, C-D., & Yeh, S-J. (2017). Impact of narrative medicine programme on healthcare providers’ empathy scores over time. BMC Medical Education, 17(108), 1–8. DOI logoGoogle Scholar
Cieślicka, A. B. (2015). Idiom acquisition and processing by second/foreign language learners. In R. R. Heredia, & A. B. Cieślicka (Eds.), Bilingual Figurative Language Processing (pp. 208–244). Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Clark, J. A., & Mishler, E. G. (1992). Attending to patients’ stories: Reframing the clinical task. Sociology of Health & Illness, 14(3), 344–372. DOI logoGoogle Scholar
Curl, T. S. (2005). Practices in other-initiated repair resolution: The phonetic differentiation of ‘repetitions’. Discourse Processes, 39(1), 1–43. DOI logoGoogle Scholar
De Fina, A., & Johnstone, B. (2015). Discourse analysis and narrative. In D. Tannen, H. E. Hamilton, & D. Schiffrin (Eds.), Handbook of Discourse Analysis (pp. 152–167). Malden, MA: Wiley & Sons, Inc. DOI logoGoogle Scholar
Dunmire, P. (2009). “9/11 changed everything”: An intertextual analysis of the Bush doctrine. Discourse & Society, 20(2), 195–222. DOI logoGoogle Scholar
Eggly, S. (2002). Physician-patient co-construction of illness narratives in the medical interview. Health Communication, 14(3), 339–360. DOI logoGoogle Scholar
Fioramonte, A. (2014). A study of pragmatic competence: International medical graduates’ and patients’ negotiation of the treatment phase of medical encounters. (Doctoral dissertation). Retrieved from ProQuest Dissertations & Theses A&I.Google Scholar
Frankel, R. M. (1983). The laying on of hands: Aspects of the organization of gaze, touch, and talk in a medial encounter. In S. Fisher, & A. Todd (Eds.), The social organization of doctor-patient communication (pp. 19–49). Washington, DC: Center for Applied Linguistics.Google Scholar
(1984). From sentence to sequence: Understanding the medical encounter through microinteractional analysis. Discourse Processes, 7(2), 134–170. DOI logoGoogle Scholar
Galatolo, R., & Drew, P. (2006). Narrative expansions as defensive practices in courtroom testimony. Text & Talk, 26(6), 661–698. DOI logoGoogle Scholar
Georgakopoulou, A. (2007). Small stories, interaction and identities. Amsterdam: John Benjamins. DOI logoGoogle Scholar
Goffman, E. (1959). The presentation of self in everyday life. New York: Anchor Books, Doubleday.Google Scholar
Gordon, C. (2009). Making meanings, creating family: Intertextuality and framing in family interaction. New York: Oxford University Press. DOI logoGoogle Scholar
(2015). “I would suggest you tell this ^^^ to your doctor”: Online narrative problem-solving regarding face-to-face doctor-patient interaction about body weight. In F. Gygax, & M. A. Locher (Eds.), Narrative matters in medical contexts across disciplines (pp. 117–140). Amsterdam: John Benjamins. DOI logoGoogle Scholar
Gordon, C., Barton, E., Meert, K. L., Eggly, S., Pollack, M., Zimmerman, J., Anand, K. J. S., Carcillo, J., Newth, C., Dean, J. M., Willson, D., & Nicholson, C. (2009). Accounting for medical communication: Parents’ perceptions of communicative roles and responsibilities in the pediatric intensive care unit. Communication & Medicine, 6(2), 177–188.Google Scholar
Halkowski, T. (2006). Realizing the illness: Patients’ narratives of symptom discover. In J. Heritage, & D. W. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 86–114). Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Hamilton, H. E. (1996). Intratextuality, intertextuality, and the construction of identity as patient in Alzheimer’s disease. Text, 16(1), 61–90. DOI logoGoogle Scholar
(1998). Reported speech and survivor identity in on-line bone marrow transplantation narratives. Journal of Sociolinguistics, 2(1), 53–67. DOI logoGoogle Scholar
Heritage, J., & Clayman, S. (2010). Talk in action: Interactions, identities, and institutions. Retrieved from [URL]. DOI logo
Heritage, J., & Maynard, D. (2006). Communication in medical care: Interaction between primary care physicians and patients. Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Hodges, A. (2015). Intertextuality in discourse. In D. Tannen, H. E. Hamilton, & D. Schiffrin (Eds.), Handbook of Discourse Analysis (pp. 42–60). Malden, MA: Wiley & Sons, Inc. DOI logoGoogle Scholar
Hojat, M. (2009). Ten approaches for enhancing empathy in health and human services cultures. Journal of Health and Human Services Administration, 31(4), 412–450.Google Scholar
Holmes, J. (2005). Story-telling at work: A complex discursive resource for integrating personal, professional and social identities. Discourse Studies, 7(6), 671–700. DOI logoGoogle Scholar
Johnstone, B. (1994). Repetition in discourse: Interdisciplinary perspectives. Norwood, NJ: Ablex.Google Scholar
Jones, C. M. (2001). Missing assessments: Lay and professional orientations in medical interviews. Text, 21(1/2), 113–150.Google Scholar
Koenig, C. J. (2008). Interactional dynamic of treatment counseling in primary care. (Doctoral dissertation). Retrieved from ProQuest Dissertations & Theses A&I.Google Scholar
(2011). Patient resistance as agency in treatment decisions. Social Science & Medicine, 721, 1105–1114. DOI logoGoogle Scholar
Kristeva, M. (1980/1967). Word, dialogue and novel. In L. S. Roudiez (Ed.), Desire in language: A semiotic approach to literature and art (T. Gora, A. Jardine, & L. S. Roudiez, Trans.). (pp. 64–91). New York: Columbia University Press.Google Scholar
Labov, W. (1972). Language in the inner city. Philadelphia: University of Pennsylvania Press.Google Scholar
Labov, W., & Waletzky, J. (1967). Narrative analysis: Oral versions of personal experience. In J. Helm (Ed.), Essays on the verbal and visual arts (pp. 12–44). Seattle: University of Washington Press.Google Scholar
Landmark, A., Gulbrandsen, P., & Svennevig, J. (2015). Whose decision? Negotiating epistemic and deontic rights in medical treatment decisions. Journal of Pragmatics, 781, 54–69. DOI logoGoogle Scholar
Lin, S. Y., Mahoney, M. R., & Sinsky, C. A. (2019). Ten ways artificial intelligence will transform primary care. Journal of General Internal Medicine, 341, 1626–1630. DOI logoGoogle Scholar
Lindström, A., & Weatherall, A. (2015). Orientations to epistemics and deontics in treatment discussions.” Journal of Pragmatics, 781, 39–53. DOI logoGoogle Scholar
Maynard, D. W. (1991). Interaction and asymmetry in clinical discourse. American Journal of Sociology, 97(2), 448–495. DOI logoGoogle Scholar
Mishler, E. G. (1984). The Discourse of Medicine: Dialectics of Interviews. Norwood, NJ: Ablex.Google Scholar
Ong, L. M., de Haes, J. C., Hoos, A. M., & Lammes, F. B. (1995). Doctor-patient communication: A review of the literature. Social Science Medicine, 401, 903–918. DOI logoGoogle Scholar
Pilnick, A., & Coleman, T. (2003). ‘I’ll give up smoking when you get me better’: Patients’ resistance to attempts to problematize smoking in general practice (GP) consultations. Social Science and Medicine, 571, 135–145. DOI logoGoogle Scholar
Polanyi, L. (1981). Telling the same story twice. Text, 1(4), 315–336. DOI logoGoogle Scholar
(1985). Conversational storytelling. In T. A. Van Dijk (Ed.), Handbook of discourse analysis (pp. 183–201). London: Academic Press.Google Scholar
Ricoeur, P. (1988). Time and narrative, Vol. 31. Chicago: Chicago University Press.Google Scholar
Riessman, C. K. (1990). Strategic uses of narrative in the presentation of self and illness: A research note. Social Science & Medicine, 30(11), 1195–1200. DOI logoGoogle Scholar
Robinson, J. D. (2003). An interactional structure of medical activities during acute visits and its implications for patients’ participation. Health Communication, 15(1), 27–59. DOI logoGoogle Scholar
(2006). Soliciting patients’ presenting concerns. In J. Heritage, & D. W. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 22–47). Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Schiffrin, D. (1996). Narrative as self-portrait: Sociolinguistic constructions of identity. Language in Society, 25(2), 167–203. DOI logoGoogle Scholar
Scott, M., & Lyman, S. (1968). Accounts. American Sociological Review, 33(1), 46–62. DOI logoGoogle Scholar
Sharf, B. (1990). Physician-patient communication as interpersonal rhetoric: A narrative approach. Health Communication, 21, 217–231. DOI logoGoogle Scholar
Silverman, D. (1987). Communication and medical practice: Social relations in the clinic. London: Sage.Google Scholar
Stivers, T. (2002). Participating in decisions about treatment: Overt parent pressure for antibiotic medication in pediatric encounters. Social Science & Medicine, 54(7), 1111–1130. DOI logoGoogle Scholar
(2004). “No no no” and other types of multiple sayings in social interaction. Health Communication Research, 30(2), 260–293.Google Scholar
(2005a). Non-antibiotic Treatment Recommendations: Delivery Formats and Implications for Parent Resistance. Social Science & Medicine, 601, 949–964. DOI logoGoogle Scholar
(2005b). Parent resistance to physicians’ treatment recommendations: One resource for initiating a negotiation of the treatment decision. Health Communication, 18(1), 41–74. DOI logoGoogle Scholar
(2006). Treatment decisions: Negotiations between doctors and parents in acute care encounters. In J. Heritage, & D. W. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 279–312). Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Stivers, T., & Heritage, J. (2001). Breaking the sequential mold: Answering ‘more than the question’ during comprehensive history taking. Text, 21(1–2), 151–185.Google Scholar
Stivers, T., Heritage, J., Barnes, R., McCabe, R., Thompson, L., & Toerien, M. (2018). Treatment Recommendations as Actions. Health Communication, 33(11), 1335–1344. DOI logoGoogle Scholar
Tannen, D. (2006). Intertextuality in interaction: Reframing family arguments in public and private. Text & Talk, 26(4–5), 597–617. DOI logoGoogle Scholar
(2007/1989). Talking voices: Repetition, dialogue, and imagery in conversational discourse. (2nd edition). New York: Cambridge University Press. DOI logoGoogle Scholar
ten Have, P. (1991). Talk and institution: A reconsideration of the ‘asymmetry’ of doctor-patient interaction. In D. Boden, & D. H. Zimmerman (Eds.), Talk and Social Structure: Studies in Ethnomethodology and Conversation Analysis (pp. 138–163). Berkeley: University of California Press.Google Scholar
Todd, A. (1983). A diagnosis of doctor-patient discourse in the prescription of contraception. In S. Fisher, & A. Todd (Eds.), The social organization of doctor-patient communication (pp. 159–188). Washington, DC: Center for Applied Linguistics.Google Scholar
Waitzkin, H. (1990). On studying the discourse of medical encounters: A critique of quantitative and qualitative methods and a proposal for reasonable compromise. Medical Care, 28(6), 473–488. DOI logoGoogle Scholar
Webb, H. (2009). ‘I’ve put weight on cos I’ve bin inactive, cos I’ve ‘ad me knee done’: Moral work in the obesity clinic. Sociology of Health & Illness, 31(6), 854–871. DOI logoGoogle Scholar
Whalen, M. R., & Zimmerman, D. H. (1990). Describing trouble: Practical epistemology in citizen calls to the police. Language in Society, 19(4), 465–492. DOI logoGoogle Scholar
Wong, J. (2000). Repetition in conversation: A look at “first and second sayings”. Research on Language and Social Interaction, 33(4), 407–424. DOI logoGoogle Scholar
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