Heritage2019

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Heritage2019
BibType ARTICLE
Key Heritage2019
Author(s) John Heritage, Amanda McArthur
Title The diagnostic moment: A study in US primary care
Editor(s)
Tag(s) EMCA, DIagnosis, Primary Care, Uncertainty, Verbal Design, Patient Response, United States
Publisher
Year 2019
Language English
City
Month
Journal Social Science & Medicine
Volume 228
Number
Pages 262-271
URL Link
DOI 10.1016/j.socscimed.2019.03.022
ISBN
Organization
Institution
School
Type
Edition
Series
Howpublished
Book title
Chapter

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Abstract

This paper conceptualizes the act of diagnosis in primary care as a 'diagnostic moment,’ comprising a diagnostic utterance in a 'diagnostic slot,' together with a patient response. Using a dataset of 201 treated conditions drawn from 255 video recorded medical visits with 71 physicians across 33 clinical practices in the Western United States, we investigate the incidence of diagnostic moments, aspects of their verbal design, and patient responsiveness. We find that only 53% of treated conditions in the dataset are associated with a diagnostic moment. Physicians present 66% of these diagnoses as hedged or otherwise doubtful, and deliver 30% of them without gazing at the patient. In the context of these diagnostic moments, patients are nonor minimally responsive 59% of the time. These findings underscore the different significance that may be accorded diagnosis in primary care in contrast to care in other medical contexts. The paper concludes that the analysis of sequences of action which empirically realize diagnosis are underrepresented in the sociology of diagnosis, and that better understanding of the diagnostic moment would enhance our understanding of diagnostic processes in primary care.

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