Women's Narratives in Primary Care Medical Encounters

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Abstract
Objective: This study asked how women's narratives of social and emotional problems are dealt with in primary care encounters. Our conceptual work extended perspectives from narrative analysis to focus on elements of ideology, social control, underlying structure, and features of discourse that appear marginal to medicine's technical tasks. Method: Based on a critical review of both quantitative and qualitative techniques in research on patientdoctor communication, we developed an interpretive method with criteria to guide sampling, transcription, interpretation, and presentation of findings. We applied the method to encounters which were selected randomly from a data base derived from a stratified random sample of 336 audiotaped encounters involving patients and primary care internists. Findinns: As shown by illustrative encounters, women's narratives in primary care often express emotional troubles related to gender roles. Medical discourse in these encounters tends to marginalize contextual issues that contribute to women's distress. Such discourse conveys acceptance of reproductive commitments, medical management of psychic distress, and a lack of criticism regarding social problems that affect women. Conclusions: Narrative analysis clarifies the medical processing of women's emotional problems that derive in large part from the social context of medicine. Women patients and medical practitioners often deal with these issues in primary care encounters rather than in psychiatric settings. These findings suggest directions for improving the discourse of primary care encounters.

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