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Health-Promoting Behaviors or Preventive Health Behaviors: Patient Disclosures and Physician Lifestyle Advice in the Primary Care Consultation


People perform hundreds of health-relevant actions each day. These actions accumulate to form behavioral patterns which are the primary predictor of mortality in the United States. With studies establishing significant links between lifestyle and health outcomes, communities are in debate about where to draw the line between promoting population health and recognizing individual autonomy over lifestyle. These lines are negotiated daily in the routine clinical encounter. This line is drawn each time a medical professional makes a bid to supervise or direct a patient’s lifestyle decisions. The line is erased and redrawn each time a patient resists a physician’s lifestyle directive and accounts for that resistance. This dissertation examines a large and diverse sample of video-recorded routine primary care consultations, presenting a detailed analysis of patient reports of ‘medically problematic’ behavior and physician responses to these reports. Following a disclosure of a medically problematic behavior (e.g., admitting to smoking or not exercising), a doctor may advise a patient to change their behavior. Chapter 2 asks whether and when individuals treat doctors as having the right to supervise and enforce a lifestyle change. Self-presentation and framing of behavior are an inevitable part of the social reality of disclosure. Chapter 3 asks whether patients in low-income communities of color and high-income white communities frame medically problematic behavior in systematically different ways. The reporting of routine medical test results (e.g., blood pressure) is systematically coupled with discussions of lifestyle. In Chapter 4, I examine the etiology and treatment discussions that follow reports of problematic lab results, and I explore how physicians and patients manage explicit and implicit attributions of fault in this context.

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