Patients' Efforts to Justify Wellness in a Comprehensive Cancer Clinic

Abstract

Conversation analysis (CA) is employed to examine oncology interviews within a comprehensive cancer clinic. Data are drawn from a sampling of 75 video-recorded and transcribed encounters involving 30 oncologists. During history-taking, by expanding answers to doctor's questions designed to solicit “yes/no” responses, patients manage constraints on interaction by initiating and pursuing distinct courses of action. One prominent set of nonconforming actions involves how cancer patients “justify wellness” and contest doctors' orientations to sickness. In response, doctors treat patients' expansions as dispreferred (e.g., through lack of acknowledgment or topic shift) because they do not conform with questions designed to solicit minimal answers. Patients initiate “justifying wellness” by invoking epistemic knowledge, using extreme language to optimize medical histories, emphasizing and bolstering wellness claims, and reporting healthy lifestyles. As a resource for managing vulnerability in the face of cancer, and for advancing resilient stances toward health and healing, patients attempt to counter the likelihood, severity, and overall threat of cancer. These and related actions ward off otherwise troubling diagnoses and, directly or indirectly, make the case for minimal or even dismissing the need for ongoing cancer care. Implications are raised for recalibrating “sick role” and “well role” activities as practical achievements, distributions of yes/no questions and expanded answers, a benign theory of social order in cancer clinics, the importance of responding to patients' wellness efforts, and the need for a more refined understanding of moments when hurting patients report, demonstrate, and seek treatment for various cancer-related problems.