Raising Issues of Risk Behavior in Medical Treatment Consultations

Medical interventions evaluate and deal with uncertainty and risk in relation to individual patients’ health. In addition, they may also include measures to protect the general public against consequences of individuals’ conditions. Such measures may be inoculation, anti-smoking campaigns, or assessments of patients’ risk behavior. The present study explores how the double agenda of helping individuals and assessing their risk behavior plays out in medical interactions.

The empirical case of this presentation, video-recorded treatment consultations between Obstructive Sleep Apnea (OSA) patients and nurses in Sweden, takes place after a diagnosis is established and doctors and patients have agreed to try a specific treatment. The aim of the encounter is therefore to personalize the treatment and provide a basis for follow-up rather than gaining new information about the patient’s problems. In addition, the consultations include the less patient-focused goal of assessing patients’ risk of falling asleep. OSA is the world’s most common sleep disorder and involves patients’ respiratory airways collapsing during sleep. This often results in recurrent episodes of excessive daytime sleepiness. Consequently, the Swedish Transport Administration states that untreated OSA patients should have their driver’s license confiscated.

The study uses conversation analysis to examine how nurses and patients manage the implications of questions concerning the risk to fall asleep involuntarily. The analysis shows nurses conducting a balancing act between risk work on different scales: gaining information as agents for the state and promoting social solidarity with the patient in front of them. It further shows how the participants raise and attend to expertise and experience as different epistemic domains with accompanying rights and responsibilities. I argue that an understanding of risk work benefits from taking into account how different agendas, epistemic responsibilities, and statuses are negotiated in social interaction.