“My Mom Had a Stroke”: Understanding How Patients Raise and Providers Respond to Psychosocial Concerns

In the following transcribed excerpts, drawn from a routine medical interview, a patient repeatedly discloses that “My mom had a stroke.” On three different occasions, over the course of a single medical encounter, the patient invokes his mom’s illness as a significant factor influencing key health behaviors that are eventually discussed: excessive drinking, inadequate exercise and diet, and sleeplessness. However, he does so in the midst of producing other actions: (a) explaining his drinking, (b) offering mild disagreement with the interviewer, a physician’s assistant (PA), and (c) explaining why he does not exercise. In response, despite patient’s repeatedly invoking the serious impact that his mother’s stroke has had on his life and his health, interviewer does not take up these psychosocial matters, nor even minimally acknowledge them. Because the patient presents these serious lifeworld experiences three times, at times quite dramatically, it seems anomalous that the PA does not address them in some way. This chapter focuses on how patients present and interviewers respond to psychosocial problems during medical encounters. We reveal how it comes about that the interviewer pursues a biomedical agenda