Saving face during routine lifestyle history taking: How patients report and remediate potentially problematic conduct

Abstract

Previous research has shown that lifestyle discussions (e.g. substance use, sexuality, diet, exercise) tend to be challenging for physicians and patients, in part because of the moral and normative concerns that these topics can engender. Patients who have problematic lifestyle information to disclose to their physicians may experience a dilemma: on the one hand, they may be motivated to disclose the problematic information so that their physicians can treat them appropriately; on the other hand, they may be motivated to withhold or misrepresent information that could serve as a basis for unflattering identity attributions. Drawing on video recordings of primary care consultations in the northeastern United States, I describe and illustrate three remedial strategies that patients employed in order to navigate this dilemma: (1) displaying independent awareness of the problem; (2) framing the problem as ‘in my past’ or as already resolved; and (3) downplaying the role of personal agency in the problem. Implications for patient participation in lifestyle history taking are provided.