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Moral issues in interactions between doctors and patients during consultations about obesity

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  1. Moral issues in interactions between doctors and patients during consultations about obesity Helena Webb, King’s College London

  2. Overview of presentation • Background to project • General points – moral issues in the consultations • Describing progress between appointments: ‘success’ vs lack of ‘success’ • Discussion

  3. Background to project • PhD on doctor-patient interactions during medical consultations about obesity. • Two outpatient obesity clinics - routine appointments to encourage weight loss. • Observations over a period of 2 years. • 39 video recorded consultations, analysed according to the principles of conversation analysis (CA).

  4. Moral issues in healthcare consultations • Fatness/obesity as a moral condition (Bordo, 1993; Sobal 1995; Rich and Evans, 2005; Saguy and Riley, 2005). • Healthcare as inherently moral (Parsons, 1956 and 75; Heritage, 2009). • Patients ‘obliged’ to seek expert help and make an effort to become well. • Moral concerns have a particular resonance when fatness is treated as a healthcare issue.

  5. Moral issues in the clinic consultations • Doctor ‘acceptance’ of patient reports. • Use of praise and avoidance of blame. • Overtly neutral questions. • Patients display knowledge of their condition and willingness to follow advice. • Patients describe their progress between appointments in terms of success and lack of success. In doing so they take credit for successes and mitigate lack of success.

  6. ‘Success’ at weight loss

  7. ‘Lack of success’ at weight loss

  8. ‘Lack of success’... cont’d

  9. Discussion • Moral issues become visible in the talk between doctor and patient. • Normative concerns about fatness/obesity. • Normative concerns about patienthood. • Implications for medical practice.

  10. Webb, H. (2009) I’ve put weight on cos I’ve been inactive, cos I’ve 'ad me knee done’: moral work in the obesity clinicSociology of Health & IllnessVolume 31 Issue 6, Pages 854 - 871 helena.webb@kcl.ac.uk