NARRATIVES OF AGING AND SOCIAL-PROBLEMS IN MEDICAL ENCOUNTERS WITH OLDER PERSONS

This study asks: How do older patients and their doctors deal with soc ial problems in the discourse of routine medical encounters? Our resea rch has been influenced by a growing recognition of narratives as an i mportant analytic focus in the study of patient-doctor communication. We attempted to advance theoretical knowledge by emphasizing elements of sociocultural context, ideology, social control, underlying structu re, and features of discourse that appear marginal to medicine's techn ical tasks. Based on a critical review of both quantitative and qualit ative techniques in research on patient-doctor communication, we tried to move methodologically beyond prior work by developing a new interp retive method with systematic criteria to guide the sampling of encoun ters, transcription of recordings, interpretation of transcripts, and presentation of findings. We applied the interpretive method to 50 enc ounters selected randomly from a stratified random sample of 336 audio taped encounters involving patients and primary care internists. As sh own by illustrative encounters, a characteristic narrative structure a nd sequencing emerge, which tend to marginalize contextual problems, t o leave them incompletely expressed, and to reinforce ideologies of st oicism and individualism.