Patients’ use of the internet to negotiate about treatment

The internet provides access to a huge variety of information, including health information. There is, however, a dearth of evidence as to how, and to what ends, patients raise prior use of the internet during medical visits. Analysis is based on the Harnessing Resources from the Internet study. Drawing on data from 281 video-recorded primary care consultations, we use conversation analysis (CA) to systematically inspect the data for instances in which patients reveal that they have accessed publicly available online resources regarding their illness, symptoms, or treatment concerns. Patients invoke the internet to support three types of action: to (i) justify concerns about a serious illness; (ii) provide a warrant for treatment where they have been unable to find a solution; and (iii) advocate in relation to treatment. Although invoking the internet risks potential encroachment into the doctor's domain of authority, patients carefully design their turns when raising the internet so as to orientate to the final decision about treatment as residing firmly within the doctor's domain of authority. The work demonstrates how detailed interactional analysis can be used to illuminate the local work that patients and doctors engage in to manage the rise in availability of information from the internet.

Conversation analysis, Doctor-patient interaction, Internet, Primary care, UK, Video-recorded consultations

10.1016/j.socscimed.2021.114262

0277-9536

Stevenson, Fiona A.

68366278-ef64-41e6-a7b2-099f1971ba8e

Leydon-Hudson, Geraldine

c5cdaff5-0fa1-4d38-b575-b97c2892ec40

Murray, Elizabeth

cb300780-9041-44af-9ae5-e13531eb23b8

Seguin, Maureen

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Barnes, Rebecca

5f2ab8e7-129c-4ca2-8022-dc371e740597

December 2021

Stevenson, Fiona A.

68366278-ef64-41e6-a7b2-099f1971ba8e

Leydon-Hudson, Geraldine

c5cdaff5-0fa1-4d38-b575-b97c2892ec40

Murray, Elizabeth

cb300780-9041-44af-9ae5-e13531eb23b8

Seguin, Maureen

51582489-e9d0-4e32-a72c-b0fa6a0bd4f8

Barnes, Rebecca

5f2ab8e7-129c-4ca2-8022-dc371e740597

Stevenson, Fiona A., Leydon-Hudson, Geraldine, Murray, Elizabeth, Seguin, Maureen and Barnes, Rebecca (2021) Patients’ use of the internet to negotiate about treatment. Social Science and Medicine, 290, [114262]. (doi:10.1016/j.socscimed.2021.114262).

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Accepted/In Press date: 22 July 2021

e-pub ahead of print date: 27 July 2021

Published date: December 2021

Additional Information: Funding Information: The authors would like to acknowledge the patients, GPs and practice staff who supported data collection. Laura Hall, who was one of the two researchers on the project. Sue Ziebland, Catherine Pope, Helen Atherton and Trish Greenhalgh who were co-applicants on the original grant, the patient and public involvement representatives, Jon Benford and Charles Prince. The authors are also grateful for the helpful comments of Tanya Stivers and Rose McCabe, the other contributing authors to the Special Issue and the reviewers. The Harnessing Resources from the Internet (HaRI) project was funded by the National Institute for Health ResearchSchool for Primary Care Research. The views expressed are those of the authors and not necessarily those of the NIHR, the NHS or the Department of Health. NHS costs were covered via the Local Clinical Research Network. Funding Information: The authors would like to acknowledge the patients, GPs and practice staff who supported data collection. Laura Hall, who was one of the two researchers on the project. Sue Ziebland, Catherine Pope, Helen Atherton and Trish Greenhalgh who were co-applicants on the original grant, the patient and public involvement representatives, Jon Benford and Charles Prince. The authors are also grateful for the helpful comments of Tanya Stivers and Rose McCabe, the other contributing authors to the Special Issue and the reviewers. The Harnessing Resources from the Internet (HaRI) project was funded by the National Institute for Health Research School for Primary Care Research. The views expressed are those of the authors and not necessarily those of the NIHR, the NHS or the Department of Health. NHS costs were covered via the Local Clinical Research Network. Publisher Copyright: © 2021 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

Keywords: Conversation analysis, Doctor-patient interaction, Internet, Primary care, UK, Video-recorded consultations