Talking at cross purposes: Negotiation of the sick role with a MUS patient as a real time social process
ResuméMedically unexplained symptoms (MUS) challenge our perception of illness. As a consequence, a MUS-patient’s legitimised entry into the sick role, as defined by Parsons, poses a problem for physicians and patients alike. The encounter between patients with MUS and physicians therefore can be frustrating for both parties. The present study is a single case analysis of such an encounter in primary care. Using the microanalytical method of conversation analysis, this study aims to provide a contextualised description of both the patient’s and the physician’s different orientations to the purpose of the encounter. This approach locates the source of the frustration in the participants’ incompatible interactional projects. The patient is oriented towards the emotional and life world aspects of her situation. She is pursuing recognition, not only of the destructive effect that the symptoms have on all aspects of her life, but also of herself as a morally sound person. The physician, on the contrary, is oriented towards avoiding to psychologise the patient and keeping the focus on reaching an agreement about future clinical action. The physician uses ancillary questions to refocus the emotionally loaded contributions from the patient and maintain structured progression. Consequently, physician and patient are talking at cross purposes, and it is argued that this is a structurally facilitated pitfall of the conventional format of primary care visits that physicians are trained to adhere to.
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