Initiation and Discussion of Information from the Internet in GP Consultations: Managing and Negotiating the Boundary between inside and Outside the Clinic

In an increasingly connected world exchange of information about health can occur at any time. Yet patients express concerns that referring to information from the internet in consultations may be perceived as a challenge to medical authority and as such a potential source of interactional ‘trouble’. We consider the ways in which patients manage the boundary between patient research about health and the presentation of medical concerns in the clinic, and how this is jointly negotiated in consultations.

Data consist of 300 video-recorded routine patient consultations with 10 GPs from the UK, a baseline survey determining information sources accessed prior to the consultation and 40 semi-structured post-consultation interviews detailing accounts of discussion of the internet in consultations. Conversation analysis is used to consider the ways patients and GPs manage and negotiate interactions in relation to prior, present and future use of the internet. Thematic analysis of Interview data provides patients’ and GPs’ accounts of use of the internet both in and outside of the consultation.

Comparison of pre-consultation survey responses and consultation data indicates patients do not always discuss their use of the internet prior to consultations. Conversation analysis of when and how patients raise the topic of the internet indicates discussion of the internet as interactionally problematic. There is also evidence of ranking by patients relating to legitimacy of sources of information when discussing medical problems in consultations.

This work contributes to research on the management of the potentially interactionally-fraught area of the permeability of boundaries between inside and outside of the clinic relating to discussion of use of the internet. Observations are based primarily on video recorded interactions from everyday practice allowing us to comment on practices as opposed to accounts of practice, providing an additional dimension to existing research in this area.