Online commentary in acute medical visits: a method of shaping patient expectations

This paper conceptualizes a type of physician communication, termed 'online commentary'. Online commentary is talk that describes what the physician i s seeing, feeling or hearing during physical examination of the patient. So me dimensions of online commentary are described, and its functions in rout ine and acute medical consultations are distinguished. Using a case study m ethod, the paper focuses on the role of online commentary in pre-empting pa tient resistance to upcoming 'no problem' diagnostic evaluations which coul d delegitimize patients' decisions to seek medical assistance, or deprive t hem of anticipated medical benefits. It is hypothesized that this role for online commentary may be associated with successful physician resistance to implicit or explicit patient demands for inappropriate antibiotic medicati on. (C) 1999 Elsevier Science Ltd. All rights reserved.