Disclosure of mental health problems in general practice: The gradual emergence of latent topics and resources for achieving their consideration

Abstract

Common mental disorders often go undetected in primary care. Sharpening general practitioners’ (GPs’) attention to potential signs thereof is therefore crucial. This conversation-analytic study arises from the observation that the consideration of psychological problems in new-concern visits can be achieved by way of ‘gradual topic emergence’. This entails that the problem is not presented directly, but adjunct to somatic symptoms, and is hinted at by way of generic, ambiguous complaints, and furthermore by expressions of frustration and uncertainty and talk about lifeworld problems. It is argued that these materials are ‘trouble-premonitory’, alerting the GP to the presence of an underlying problem that can then be addressed through further inquiry. The patient logic behind this approach is to assure the GP’s recipiency and thus ratification of the problem’s medical legitimacy. It allows the patient to introduce a potentially delicate problem ‘off the record’, thus guarding the patient against the loss of face that could result from no uptake by the GP. The results of the study point to the importance of GPs being receptive to such interactional clues to psychological problems provided by patients.