Feber i interaktion : Kropp, kunskap och legitimitet i svenska primärvårdssamtal

Sammanfattning: This thesis explores the social and interactional dimensions of fever and body temperature. Using the theoretical and methodological framework of Conversation Analysis, this thesis investigates how patients and healthcare professionals talk about fever, measure body temperature and negotiate the significance of temperature measurements in acute primary care encounters. The analysis pays close attention to verbal, embodied, and material interactional resources. Data are drawn from a larger corpus of video-recorded Swedish acute primary care consultation (Uppsala University Interaction Corpus (UUIC): Primary Care) and consist of 97 encounters between healthcare professionals and adult patients presenting with respiratory tract symptoms. The main focus is on patients’ interactions with registered nurses and healthcare assistants. The three analytical chapters deal with different aspects of body temperature during the consultation. First, talk about fever in patients’ problem presentations is investigated. The analysis suggests that patients and nurses treat fever as an urgent matter when establishing patients’ reasons for seeking care. Patients reference fever when they present their condition as worthy of medical attention and treatment, and fever may be posed as a component of a candidate diagnosis. Second, a multimodal analysis of temperature measurement shows how participants jointly accomplish a transition from the patient-as-subject to the patient-as-object for investigation. The analysis illustrates how patients and nurses rely on changes in body orientation and gaze when initiating, attending, and accomplishing such activity shifts as well as how visible manipulation of the thermometer constitutes a crucial resource in the rearrangement of activity-appropriate participation frameworks. Third, talk about expected and reported results of temperature measurement are investigated. Here, it is demonstrated that patients can both claim and be offered an epistemic position of independent expertise regarding body temperature. The corpus also includes cases where patients challenge the nurse's interpretation of a numerical measurement by suggesting an alternative way of understanding the measurement. Such cases expose how seemingly "objective" references for establishing normality can be invoked and contested.By describing and shedding light on the linguistic and social dimensions of a routine clinical task, this study contributes to the field of medical interaction as well as to broader topics in language and social interaction such as self-presentation, epistemic orientation and negotiation, and the multimodal organization of jointly achieved activities.