Patient "Demand" for Medical Interventions: Exerting Pressure for an Offer in a Primary Care Clinic Visit

Abstract

Contemporary medical decision making has been characterized as a struggle between patients who are reportedly making more demands for medical interventions such as diagnostic tests and prescription drugs and physicians who are encouraged to partner with patients and satisfy them while simultaneously keeping medical costs down. Understanding this dynamic requires attention to the interactional strategies whereby patients indicate what they desire, how physicians respond, and how the participants apply and react to pressure for particular outcomes. This investigation is a single case analysis of a primary care visit recorded in a general internal medicine outpatient clinic. Using conversation analysis, it reveals how a patient exerts subtle but persistent pressure for a diagnostic test and how the physician responds to her persuasive efforts.