Patients must prove both problem authenticity and change motivation. Too much inability questions treatment potential. Too much ability questions need for specialist care. This creates a precarious balancing act in self-presentation.

State University of New York at Binghamton

- Doctorability Dilemma
- Agency-Accountability Link
- Chronic Pain Context
- Interactional Fix

Interactional Tensions: Conflicts and dilemmas arising in pain consultations

Rhetorical requirement to present the issue in a way that aligns with institutional business. Must establish that the problem warrants clinical intervention and legitimation.

Doctorable Problem

- Doctorability Dilemma
- Interactional Fix

Clinical Implications: Understanding patterns to improve communication practices

Lester, J. N. (Ed.). (2021). Discursive Psychology and Disability. Palgrave Studies in Discursive Psychology. Springer Nature Switzerland AG.

Reference For: Discursive Psychology and Disability

Doctorability Dilemma in Chronic Pain Treatment Eligibility

Chronic pain lacks clear biomedical causes, lasting 3+ months. Treatment uses biopsychosocial approaches targeting functioning despite pain. Patients seek biomedical explanations while practitioners target psychosocial factors. This mismatch creates interactional tension.

Chronic Pain Context

Attributing agency makes past actions accountable. If you choose to lie down, why did you choose inactivity? This provokes defensive responses from patients. Conversations spiral into frustrating circular patterns.

Agency-Accountability Link

Negotiations get stuck in repetitive patterns. Patient asserts inability, practitioner suggests agency, patient defends harder. Neither party achieves their communicative goals. Understanding these patterns helps explain consultation frustrations.

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