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.

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.

Interactional Fix

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

State University of New York at Binghamton

- Patient Authenticity Management: How patients construct credible disability claims
- Practitioner Challenge Strategies: Techniques for encouraging behavioral change without direct confrontation
- Interactional Tensions: Conflicts and dilemmas arising in pain consultations

Patient-Practitioner Dynamics: The interactional dance between competing goals and perspectives

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

Reference For: Discursive Psychology and Disability

- Willing But Unable Identity
- Script Formulations
- Extreme Case Formulations
- Factual Language
- Breach Narratives

Patient Authenticity Management: How patients construct credible disability claims

- Normalization Devices
- Hypothetical Treatment Directions
- Insufficient Explanation Framing
- Agency Attribution
- Hedging and Distancing

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