“It Looks Like You’re Making Very Healthy Choices”: Attending to the Lifeworld and Medicine in Photo-Based Talk in Primary Care

ABSTRACT

Addressing patient-clinician communication barriers to improve multiple chronic disease care is a public health priority. While significant research exists about the patient-clinician encounter, less is known about how to support patient-clinician communication about lifestyle changes that includes the context of people’s lives. Data come from a larger photo-based primary care study collected from 13 participants who were adults 60 or older with at least two chronic conditions, in English, Chinese (Cantonese or Mandarin), or Spanish. We use discourse analysis of three examples as anchor points demonstrating different interactional pathways for the photo-based communication. Patients and clinicians can move smoothly through a pathway in which photos are shared, clinicians acknowledge and align with the patient’s explanation, and clinicians frame their medical evaluations of food choices, nutrition suggestions, and shared goal-setting by invoking the voice of lifeworld (VOL). On the other hand, when clinicians solely press the voice of medicine (VOM) in their evaluations of patients’ pictures with little attention to patients’ presentations, it can lead to patient resistance and difficulty moving to the next activity. Because photo-sharing is still relatively novel, it offers unique interactional spaces for both clinicians and patients. Photo-sharing offers a sanctioned moment for a primary care visit to operate in the VOL and promote goal-setting that both parties can agree upon, even if clinicians and patients framed the activity as one in which patients’ lifeworld choices should be assessed as medically healthy or unhealthy based on the ultimate judgment of clinicians operating from the VOM.

Acknowledgements

We would like to thank the study participants, as well as research assistants Liliana Del Carmen Chacón, Jennifer Fung, Joselvin Galeas, and Ying Wang.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Because these data are HIPAA protected, readers can contact senior author with questions.

Additional information

Funding

This work was supported by the National Institute on Aging of the National Institutes of Health (award numbers R03 AG050880 and P30 AG044281) and received additional support from the National Center for Advancing Translational Sciences of the National Institutes of Health (award number KL2 TR001870) and the University of California San Francisco Hellman Fellows Fund. Dr. Jih is supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health (award number K23 MD015089). The funding sources had no role or involvement in the design and conduct of the study; the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript. Contents are solely the responsibility of the authors and do not necessarily represent the official views of the funders.