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Title: Patient expertise and agency : interactional construction of patient identities in type 2 diabetic consultations
Author: Knight, Patricia Pamela
ISNI:       0000 0004 2735 7296
Awarding Body: University of Essex
Current Institution: University of Essex
Date of Award: 2010
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This thesis reports on an empirical study of interaction in medical consultations, and in interviews with doctors and patients who are involved in the management of the long-term illness type 2 diabetes. These interactions (i.e., expert patients; long-term illness consultations) reside firmly in the arena of gate-keeping encounters in which cultural 'unsharedness' might impact on the talk of interactions, and on outcomes for those in subordinate positions. However, these contexts predict movement away from the power disparity between doctors and patients familiar in the literature: subordinated patients, domineering doctors and interactional asymmetry (e.g., Beckman & Frankel 1984; Marvel et al 1999; West 1984). Ultimately, the analysis demonstrates a degree of sharedness, articulated as partnership, in the discourses of long-term illness management. The data sources comprise 15 doctor-patient consultations involving 13 patient participants and 10 healthcare professionals (8 doctors and 2 nurses), and 7 Expert Patients' Programme sessions, giving in total 15 consultations, 21 patient participant interviews, and 8 health professional interviews, and approximately 147 hours of recordings of EPP sessions. The study follows the theoretical perspectives of patient centred healthcare and the methods of interactional sociolinguistics, and draws on linguistic and discourse analysis, Goffmanian and interaction analysis, conversational analysis, and ethnography. Microanalytic focus involves the examination of interactive processes including evaluation, perspective display, the functions of tag questions in indexing shared epistemic rights in consultations, interruptions and topic transitions in case analyses. Thematic and micro-analyses of interview data involve contextualisation cues, frames and footing, and greeting exchanges (in examination of phase structure), and address an ethnographic focus of the study. Evaluative constructions associated with the delivery of the HbAlc test result index an agentive identity of diabetic patients, encompassing collaboration and expertise. Yet collaboration interactionally is limited to co-impl'ication in decision making. Co-operation, collaboration and the expert patient concept exist on a continuum of agentivity, with co-operation at the lower end of the continuum, involving passive action, and expert patient at the higher end, involving autonomous practices. Expert patient is not a harmonious concept, but may involve conflict and resolution of conflict reminiscent of expert to expert interactions.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available