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U.S. Primary Care Providers’ ‘Narrative Mind Reading’ of Patients: Examples from Hypertension and Asthma (Mis)management.

Solomon J, Cohn ES, Cortes DE, Haidet P, Fix GM, Bokhour BG. U.S. Primary Care Providers’ ‘Narrative Mind Reading’ of Patients: Examples from Hypertension and Asthma (Mis)management. Presented at: American Anthropological Association Society for Medical Anthropology International Conference; 2009 Sep 24; New Haven, CT.


Abstract Text A robust body of literature has shown that health care providers often overlook the views-or "lifeworlds"-of patients during clinical encounters. Utilizing conversation and discourse analytic techniques, scholars have documented how providers dominate interactions with patients by pursuing a standard algorithmic approach to communication that marginalizes patients' perspectives and agendas. However, there is little understanding of how providers' interpretations of patients' illness-related behaviors-the presumed underlying motives and intentions shaping patient actions-are related to the communication strategies providers use during clinical encounters. We seek to fill this gap by drawing on narrative theory to analyze how primary care providers in the U.S. attribute motives and intentions to patients who have difficulties managing chronic conditions. Such attributions-whereby a narrator infers the mental states of others-is called "narrative mind reading" (Mattingly, 2008). Based on analysis of interviews with 27 providers from diverse settings in the Northeast and Southwest, we first describe how providers employ narrative mind reading to depict patients' motives and intentions, especially regarding medication-taking. We then examine the communication strategies providers report using in response to their narrative mind readings of patients.

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