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In this paper, we explore the ways in which patients invoke third parties to gain decision-making influence in clinical consultations. The patients' role in decision-making processes is often overlooked, and this interactional practice has rarely been systematically studied. Through a contextual narrative exploration of 42 naturally occurring consultations between patients (aged 22–84) and general practitioners (GPs) in England, we seek to fill this gap. By exploring how and why patients invoke third parties during discussions about medical treatments, who they refer to, what kind of knowledge their referents possess, and how GPs respond, our main aim is to capture the functions and implications of this interactional practice in relation to decision-making processes. Patients refer to third parties during decision-making processes in most of the consultations, usually to argue for and against certain treatment options, and the GPs recognise these utterances as pro-and-contra arguments. This enables patients to counter the GPs' professional knowledge through various knowledge-sources and encourage the GPs to target their specific concerns. By attributing arguments to third parties, patients claim decision-making influence without threatening the GPs' authority and expertise, which their disadvantaged epistemic position demands. Thereby, patients become able to negotiate their role and their epistemic position, to influence the agenda-setting, and to take part in the decision-making process, without being directly confrontational. Invoking third parties is a non-confrontational way of proposing and opposing treatment options that might facilitate successful patient participation in decision-making processes, and so limit the risk of patients being wronged in their capacity as knowers. [ABSTRACT FROM AUTHOR]

In this commentary, we critically review the contribution of the sociologist Erving Goffman (1922-1982) to understanding recovery from problem drug use. Previous research has indicated that drug users have a "spoiled identity" and must restore a "normal" or "unspoiled" identity in order to recover. This argument has been linked to Goffman's classic work "Stigma: Notes on the management of a spoiled identity" [1963, Harmondsworth: Penguin]. Despite its evident appeal, linking recovery to repairing a spoiled identity has a number of problems. These include the derogatory connotations of "spoiled", and the fact that the "momentary" spoiled identity that Goffman likely intended is easily lost to a more "totalizing" spoiled identity, from which it can be difficult for individuals to escape. Given such shortcomings, we consider how Goffman's broader dramaturgical work might contribute to our understanding of recovery processes. Dramaturgy, which focuses on the performative aspects of selfhood and the relational and situational nature of identity, suggests ways that individuals can work on their identity (and recovery) projects without over-prioritizing abstinence. We suggest that dramaturgy is more useful than the notion of repairing a spoiled identity for understanding and facilitating recovery. Nonetheless, it has limitations and other sociological perspectives provide fertile ground for future debate. (Contains 3 notes.)

Introduction: Our aim is to explore the ways in which a patient and a general practitioner (GP) negotiate knowledge claims stemming from different epistemic domains while dealing with a mismatch between experiential and biomedical knowledge during the clinical consultation. We interpret their interaction in relation to the sociocultural context in which their negotiation is embedded and identify factors facilitating their successful negotiation (a medical error is avoided). Methods: Based on a narrative analysis of a verbatim transcript of a complete naturally occurring primary care consultation, we explore the moment‐to‐moment unfolding of talk between the patient and the GP (two women). Findings: The patient experiences symptoms of what she interprets as a thyroid condition, and indirectly asks for medication. She presents her case by drawing on experiential knowledge ('it feels like my metabolism has shut down') and biomedical knowledge (while suggesting a diagnosis and a diagnostic test). The GP informs her that her thyroid blood tests are normal and uses biomedical knowledge to explain why she turns down the patient's request. This stages a potential conflict between the patient's embodied experiential knowledge and the doctor's biomedical knowledge. However, during their encounter, the patient and the GP manage to co‐construct the patient's illness story and make shared decisions about further actions. Conclusion: The transition from potential conflict to consensus is a result of the mutual efforts of two parties: a patient who persistently claims experiential as well as biomedical knowledge while at the same time deferring to the GP's professional knowledge, and a GP who maintains her epistemic authority while also acknowledging the patient's experiential and biomedical knowledge. Patient and Public Contribution: Our empirical data are sourced from a data archive and patients were not involved in the design or conduct of the study, but our study is based on a naturally occurring clinical consultation with a patient. [ABSTRACT FROM AUTHOR]

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2007.01057.x Byline: Sarah Nettleton (1), Roger Burrows (1), Ian Watt (2) Keywords: doctors; embodiment; regulation; NHS; tacit knowledge Abstract: Abstract The aim of this paper is to explore the consequences of modernisation and regulatory processes for the everyday lives of doctors working the UK National Health Service. We do this by reporting on interview data generated as part of a qualitative investigation into the working lives of 47 doctors. The analysis of the empirical findings is informed by two literatures: that which has sought to theorise the contemporary thrust of regulation and audit and that which has developed a sociology of embodiment. Doctors' views are presented in relation to four areas of work which have - in the loosest sense of the word - been subject to regulation. Drawing on work from the sociology of embodiment we argue that changes in the institutional and cultural context of medical work could be altering both the 'field' and the 'habitus'- to use Bourdieu's terms - of medicine, with a consequence that medical knowledge is becoming less embodied. Author Affiliation: (1)Department of Sociology, University of York (2)Department of Health Sciences, University of York Article note: Address for correspondence: Sarah Nettleton, Department of Sociology, University of York, Heslington, York YO10 5DD, e-mail: sjn2@york.ac.uk