Bio-Psycho-Social Reasoning in GPs’ Case Narratives: The Discursive Construction of ME Patients’ Identities

Abstract

This article takes a discursive psychology approach to the analysis of medical case narratives. An analysis of interview extracts on the topic of ME (CFS) shows how GPs use bio-psycho-social reasoning to construct the patient’s identity and to define their illness as mental or physical. Patients’ identities are ‘talked up’ using bio-psycho-social ‘evidence’; they are constructed in the process of explaining the origins of an illness as mental or physical. This has much in common with identity construction in the illness narratives of ME patients. The analysis also shows how identity construction can function as a justification for defining an illness as psychosomatic and effectively ‘shifting the blame’ for what might otherwise be treated as medical failure or uncertainty. These processes show how a discursive analysis can shed more light on how bio-psycho-social reasoning functions in doctors’ case constructions.

Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)—A case study

“…Nevertheless, the reported events correspond well with the sceptical viewpoints towards the diagnosis presented by doctors in other studies [10,12,31]. Previous research has described similar uncreative negotiations as 'the shame-blame-game', where all interaction concentrates on body-mind arguments about whether CFS is 'really' a psychological or a physical condition [24].…”

“…However, many doctors are not yet even prepared to acknowledge the CFS entity itself, but regards it as a dubious category [31]. Doctors' reluctancy towards giving this diagnosis is known from before [11,36], and confidence with making a diagnosis and management is low [37].…”

“…They demonstrate specific areas where quality of care can be improved by implementing evidence and guidelines among healthcare professionals. Special efforts would yet be needed to develop adherence to guidelines within a field where GPs seem to have strong opinions about the 'real' nature of the disorder [30,10,31].…”

Factors facilitating patient satisfaction among women with medically unexplained long-term fatigue: A relational perspective

“…For doctors, their credibility as competent partners is at stake (Horton-Salway, 2002). For patients, it is important to receive acceptance for having an actually existing disease (Nettleton, 2006).…”

Patient School as a Way of Creating Meaning in a Contested Illness: The Case of CFS

“…In the same vein, Horton-Salway (2001: 247) has shown how 'attributional stories and identity formulations', told in interviews with sufferers, are linked together to construct a diagnosis of CFS/ME 'as a physical disease while countering potential accusations of malingering or psychological vulnerability'. However, another part of her study shows that General Practitioners´ case narratives about patients suffering from CFS/ME also were constructed to justify the diagnosis as either physical or psychosocial (Horton-Salway, 2002).…”