ATTENDING TO PATIENTS STORIES - REFRAMING THE CLINICAL TASK

Communication between patients and physicians is currently a significant topic in medical training programmes and in research on clinical practice. Physicians are encouraged, for example, to attend to patients' stories as ways of providing their concerns and understandings of their illnesses. However, there is little research on how storytelling is actually accomplished in the context of clinical encounters. Drawing on studies of medical discourse, conversational storytelling, and narrative, we present a comparative analysis of two encounters. Both revolve around the same clinical tasks, but in one the patient's story is prominent and in the other it is unheard. We follow the course of successful storytelling in one and its interruption in the other, showing how the encounters unfold through patients' attempts to negotiate a story topic, set the scene, and clarify the action and its consequences. The physicians adopt distinctive alignments with respect to the emerging story. These differences appear to be related to the outcomes of the encounters, including the framing of clinical decisions and the maintenance of cooperative patient-physician relationships. Focusing on the patients' attempts to tell a story illuminates the exercise of authority in clinical encounters, and the way in which clinical tasks are embedded in the social process of authoring the accounts of patients' illnesses.