Abstract
In this article, we examine illness narratives to illuminate the discursive work that patients undertake to construct themselves as “good” and adherent. Biographical narrative interviews were undertaken with 17 patients receiving anticoagulation for stroke prevention in atrial fibrillation, from five English hospitals (May 2016–June 2017). Through pluralistic narrative analysis, we highlight the discursive tensions narrators face when sharing accounts of their medicine-taking. They undertake challenging linguistic and performative work to reconcile apparently paradoxical positions. We show how the adherent patient is co-constructed through dialogue at the intersection of discourses including authority of doctors, personal responsibility for health, scarcity of resources, and deservingness. We conclude that the notion of medication adherence places a hidden moral and discursive burden of treatment on patients which they must negotiate when invited into conversations about their medications. This discursive work reveals, constitutes, and upholds medicine-taking as a profoundly moral practice.
Highlights
Pharmaceuticals play an increasing role in the daily life of patients, driven by the combination of prescribing for chronic disease management and prescribing to reduce risk of disease, and partly by a burgeoning market in medications for longterm conditions (Bell & Figert, 2012; Hardon & Sanabria, 2017)
We have shown how circulating discourses around medication adherence shape and are shaped by moral talk about medicines
We have illustrated the ways in which a “good” adherent self was constructed and maintained in moral narratives in the face of tensions that arise from concerns about being a pill-taker, and have shown how language offers flexible resources that patients can draw on when reporting skipping, missing or stopping medicines, or indulging in drinking and eating prohibited foods
Summary
Pharmaceuticals play an increasing role in the daily life of patients, driven by the combination of prescribing for chronic disease management and prescribing to reduce risk of disease (and associated health care costs), and partly by a burgeoning market in medications for longterm conditions (Bell & Figert, 2012; Hardon & Sanabria, 2017). We delineate how medication adherence manifests and is (re)produced in patient narratives about medicine-taking, as they work to construct and manage adherent selves despite conflicting positions and tensions.
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