Maynard2006c

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Maynard2006c
BibType ARTICLE
Key Maynard2006c
Author(s) Douglas W. Maynard
Title “Does it mean i'm gonna die?”: on meaning assessment in the delivery of diagnostic news
Editor(s)
Tag(s) EMCA, Medical EMCA, Assessments, Diagnosis, News
Publisher
Year 2006
Language
City
Month
Journal Social Science & Medicine
Volume 62
Number 8
Pages 1902–1916
URL Link
DOI 10.1016/j.socscimed.2005.09.011
ISBN
Organization
Institution
School
Type
Edition
Series
Howpublished
Book title
Chapter

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Abstract

This paper investigates how, in the delivery of diagnostic news, participants to the delivery may engage in meaning assessment or interpreting the news. It draws on data from 24 conversations in developmental disabilities clinics, internal medicine clinics and HIV counselling and testing clinics in the USA. The analysis shows that participants initiate meaning assessment sequences whereby one participant proposes what the news means and the other aligns or disaligns with the proposal. When meaning assessment occurs, the preferred way for this to happen is that the clinician initiates and proposes an interpretation. Following the interpretive proposal, a patient or family member aligns or disaligns with the interpretation, with alignment being sought over disalignment. Further practices of meaning assessment are "affirming the positive" and "disconfirming the negative," which work to provide relatively benign interpretations of news. Analysis of a collection of meaning assessment sequences in clinical settings is brought to bear on a single case in which an internist tells a patient that he has stomach cancer. After delivering the diagnosis, this doctor neither affirms the positive nor disconfirms the negative, and the patient ends up asking, "Does it mean I'm gonna die?" At this point, the interview gets disrupted as the patient withdraws. Asking what the news means is a structurally dispreferred way of handling problems of meaning, and as such this patient's exhibition of difficulty is an outcome of orderly social practices. A clinician's withholding of auspicious meaning assessment may undermine the relationship with patients and/or family members and disrupt the encounter.

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