How Do Patients Compromise Diagnosis?: Practices of Making a Diagnosis

Friday, 20 July 2018: 16:15
Oral Presentation
Yuki KAWAMURA, Hitotsubashi University, Japan
This presentation shows how “diagnosis” itself makes diagnostic culture possible.

 Previous studies have focused on lay expertise instead of the normative culture of diagnosis, which involves the exclusive use of knowledge by physicians. Some patients actively participate in diagnosis and treatment. This requires them to rewrite their past experiences with the process of diagnosis and treatment, thus participating in the process. However, describing past experiences involves rewriting from the current viewpoint.

 So, the following question emerges: “How do patients correlate past experiences with diseases and make compromises?” To answer this question, I analyzed interview data from the viewpoint of ethnomethodology. The interviewee was a patient who was re-diagnosed with bipolar disorder after having been diagnosed with depression previously. Results of the analysis reveal the following. First, the meaning of past actions has changed, and the logical conditions that enabled the action have also changed. For example, the past experience of “ups and downs of drive” was reinterpreted as an episode of bipolar disorder. Second, reorganizing past experiences also enables the creation of a new reality. Finally, a change in the positioning of expert knowledge occurs while rewriting. In other words, these analyses clarify how expert knowledge is embedded in everyday life.

 This phenomenon shows a 'looping effect' (Hacking 1996), which indicates the interaction between the professional concept, such as doctors' diagnosis, and the ordinary concept of the understanding experiences and behaviors of people; the current report presents the looping process in detail. As described above, patients rewrite their past experiences according to the diagnosis and create a new reality. By making a compromise with the diagnosis, patients have a way to manage diagnosis well without refusing diagnosis. Such practices make diagnosis meaningful and enable a diagnostic culture.