Legerollen

Modes of interaction in clinical encounters: a contextual narrative exploration of 212 naturally occurring GP consultations. 

Clinical interaction between patients and doctors is embedded within, positioned and inseparable from social context. In this study, we explore how illness narratives are co-constructed within naturally occurring clinical consultations between doctors and patients. Clinical uncertainty and shared decision-making are emphasised. Although our empirical exploration focuses on in situ consultations between patients and GPs as they unfold, we situate their interaction in the sociocultural context in which it is embedded and explore their negotiations in relation to their institutionalized positions and roles. The study is based on 212 naturally occurring GP consultations in England, sourced from the One in a Million data archive in the UK. Consultations involve musculoskeletal, psychological, digestive, cardiovascular, neurological, endocrine/metabolic and general conditions. By exploring complete naturally occurring consultations with a heterogenous sample of patients, we capture the interactional dynamics of negotiations in relation to a wide range of consultation aspects and clinical conditions. Contextualising these negotiations enables us to see how the actions of both patients and GPs are tied to their different institutionalised positions. Through data-grounded coding of all 212 consultations in NVivo, we are able to relate our in-depth cases to the wider dataset. Although we use a mix of analytical methods, our main approach is qualitative interpretive methods, particularly narrative and thematic analysis. The researchgroup is international and interdiciplinary.

Most recent publication from the project:

• Lian, OS Nettleton, S, Wifstad, Å and Dowrick, C (2021) Negotiating Uncertainty in Clinical Encounters: A Narrative Exploration of Naturally Occurring Primary Care Consultations. Social Science & Medicine 291 (114467). https://doi.org/10.1016/j.socscimed.2021.114467. Social media response.
• Lian OS, Nettleton, S, Wifstad, Å and Dowrick, C (2021) Modes of Interaction in Naturally Occurring Medical Encounters with General Practitioners: The ´One in a Million´ Study. Qualitative Health Research 31(6): 1129-1143. https://doi.org/10.1177/1049732321993790.

Complete list of research interests:

• Patient-doctor interaction 
• Shared decision-making
• Medical uncertainty
• Illness narratives
• Contested Chronic Conditions: experiential perspectives
• Sociology of diagnosis
• Social constructions of health and illness
• Cultural, historical and gendered perspectives on medical knowledge and practice
• Medicalisation as a modern phenomena
• Qualitative research and narrative theory
• The role of theory in qualitative research
• Photography and visual research

I am involved in several research projects in medical education, clinical decision-making and clinical practice. My primary research perspective is from medical anthropology and the methodology of ethnographic fieldwork.