In this study, I investigated naturally occurring medical interaction in commercial medicine. Drawing on 30+ hours of videotaped data and 9 months of fieldwork in a cosmetic surgery clinic, this analysis focuses on how plastic surgeons interact with patients who seek to alter their bodily appearance. The ethnographically informed discourse analysis reveals how plastic surgeons manage multiple and competing interactive demands. Specifically, I describe plastic surgeons’ key strategies for meeting both health-related and institutional goals. In the conclusion, I reflect on the communication challenges that medical professionals and patients face when consumerism and medicine meet.
ABIM Foundation. (2002). Medical professionalism in the new millennium: A physician charter. Annals of Internal Medicine, 136, 243-246.
2.
Agne, R., & Tracy, K. ( 2001). "Bible babble": Naming the interactional trouble at Waco . Discourse Studies, 3, 269-294.
3.
Agne, R.R. ( 2007). Reframing practices in moral conflict: Interaction problems in the negotiation standoff at Waco. Discourse & Society , 18, 549-578.
4.
American Society of Plastic Surgeons. (2008 a). 2008 report of the 2007 statistics: National clearinghouse of plastic surgery statistics. Retrieved February 19, 2009, from http://www.plasticsurgery.org/d.xml?comp=x3309
5.
American Society of Plastic Surgeons. (2008 b). Plastic surgery procedures. Retrieved November 14, 2008, from http://www.plasticsurgery.org/Patients_and_Consumers/Procedures.html
6.
Andreassen, H.K., Trondsen, M., Kummervold, P.E., Gammon, D., & Hjortdahl, P. ( 2006). Patients who use e-mediated communication with their doctor: New constructions of trust in the patient-doctor relationship. Qualitative Health Research, 16, 238-248.
7.
Angell, M. ( 2004). The truth about drug companies: How they deceive us and what to do about it. New York: Random House.
8.
Arber, A. ( 2008). Team meetings in specialist palliative care: Asking questions as a strategy within professional interaction. Qualitative Health Research, 18, 1336-1344.
9.
Askegaard, S., Gertsen, M.C., & Langer, R. ( 2002). The body consumed: Reflexivity and cosmetic surgery. Psychology & Marketing, 19, 793-812.
10.
Atkinson, J. M., & Heritage, J. (Eds.). (1984). Structures of social action: Studies in conversation analysis. New York: Cambridge University Press.
11.
Audi, R. (Ed.). (1999). The Cambridge dictionary of philosophy (2nd ed.). Cambridge, MA: Cambridge University Press.
12.
Barrett, B. M., Jr. (Ed.). (1996). Patient care in plastic surgery (2nd ed.). St. Louis, MO: Mosby.
13.
Beach, W.A., Easter, D.W., Good, J.S., & Pigeron, E. ( 2005). Disclosing and responding to cancer "fears" during oncology interviews. Social Science & Medicine, 60, 893-910.
14.
Beisecker, A.E., & Beisecker, T.D. (1993). Using metaphors to characterize doctor-patient relationships: Paternalism versus consumerism. Health Communication, 5, 41-58.
15.
Blum, V.L. ( 2003). Flesh wounds: The culture of cosmetic surgery. Berkeley, CA: University of California Press.
16.
Bordo, S. ( 1993). Unbearable weight: Feminism, Western culture, and the body. Berkeley, CA: University of California Press.
17.
Brooks, A. ( 2004). "Under the knife and proud of it": An analysis of the normalization of cosmetic surgery. Critical Sociology, 30, 207-240.
18.
Brown, J.B., Stewart, M., & Ryan, B.L. ( 2003). Outcomes of patient-provider interaction. In T. L. Thompson, A. M. Dorsey, K. I. Miller, & R. Parrott (Eds.), Handbook of health communication (pp. 141-162). Mahwah, NJ: Lawrence Erlbaum.
19.
Buttny, R. ( 1987). Sequence and practical reasoning in accounts episodes . Communication Quarterly, 35, 67-83.
20.
Cameron, D. ( 2001). Working with spoken discourse. Thousand Oaks, CA: Sage.
21.
Candlin, C.N., & Candlin, S. ( 2002). Discourse, expertise, and the management of risk in health care settings. Research on Language and Social Interaction , 35, 115-137.
22.
Carl, W.J. ( 2004). The interactional business of doing business: Managing legitimacy and co-constructing entrepreneurial identities in e-commerce multilevel marketing discourse. Western Journal of Communication, 68, 92-119.
Clark, C., Drew, P., & Pinch, T. ( 2003). Managing prospect affiliation and rapport in real-life sales encounters. Discourse Studies, 5, 5-32.
25.
Coupland, J. (Ed.). (2000). Small talk. New York: Longman.
26.
Coupland, J. ( 2003). Small talk: Social functions. Research on Language and Social Interaction, 36, 1-6.
27.
Davis, K. ( 1995). Reshaping the female body: The dilemma of cosmetic surgery . New York: Routledge.
28.
Fitch, K. L., & Sanders, R. E. (Eds.). (2005). Handbook of language and social interaction. Mahwah, NJ: Lawrence Erlbaum.
29.
Gee, J.P. ( 1999). An introduction to discourse analysis: Theory and method . New York: Routledge.
30.
Gilman, S.L. ( 1999). Making the body beautiful: A cultural history of aesthetic surgery. Princeton, NJ: Princeton University Press.
31.
Goodwin, C. ( 1994). Professional vision. American Anthropologist , 96, 606-633.
32.
Goodwin, C. ( 1996). Transparent vision. In E. Ochs, E. A. Schegloff, & S. A. Thompson (Eds.), Interaction and grammar (pp. 370-404). New York: Cambridge University Press.
33.
Goodwin, C. ( 2000). Vision and inscription in practice. Mind, Culture, and Activity, 7, 1-3.
34.
Goodwin, C., & Goodwin, M.H. ( 1992). Context, activity and participation. In P. Auer & A. Di Luzio (Eds.), The contextualization of language (pp. 77-99). Philadelphia : John Benjamins.
35.
Goodwin, C., & Goodwin, M.H. ( 1997). Contested vision: The discursive constitution of Rodney King. In B.-L. Gunnarsson, P. Linell, & B. Nordberg (Eds.), The construction of professional discourse (pp. 292-316). New York: Longman.
36.
Haiken, E. ( 1997). Venus envy: A history of cosmetic surgery. Baltimore, MD: John Hopkins University Press.
37.
Holmes, J. ( 2003). Small talk at work: Potential problems for workers with an intellectual disability. Research on Language and Social Interaction, 36, 65-84.
38.
Holmes, J., & Stubbe, M. ( 2003). Power and politeness in the workplace: A sociolinguistic analysis of talk at work. London: Longman.
39.
James, I., Andershed, B., & Ternestedt, B. (2009). The encounter between informal and professional care at the end of life. Qualitative Health Research, 19, 258-271.
40.
Jauhar, S. ( 2009, July 7). A doctor by choice, a businessman by necessity . New York Times, p. D5.
41.
Johannesen, R.L., Valde, K.S., & Whedbee, K.E. ( 2008). Ethics in human communication (6th ed.). Long Grove, IL: Waveland Press.
42.
Jordan, J.W. ( 2004). The rhetorical limits of the "plastic body." Quarterly Journal of Speech, 90, 327-358.
43.
Kitzinger, C., & Frith, H. ( 1999). Just say no? The use of conversation analysis in developing a feminist perspective on sexual refusal. Discourse & Society, 10, 293-316.
44.
Lam, S.M. ( 2002). Digital imaging in the plastic surgical practice. International Journal of Cosmetic Surgery and Aesthetic Dermatology, 4, 199-212.
45.
Lammers, J.C., & Geist, P. ( 1997). The transformation of caring in the light and shadow of ‘managed care.’ Health Communication, 9, 45-60.
46.
Levy, J.L., Trelles, M.A., Levy, A., & Besson, R. ( 2004). Photography in dermatology: Comparison between slides and digital imaging. Journal of Cosmetic Dermatology, 2, 131-134.
47.
Lupton, D. ( 1997a). Consumerism, reflexivity and the medical encounter. Social Science & Medicine, 45, 373-382.
48.
Lupton, D. ( 1997b). Doctors on the medical profession. Sociology of Health & Illness, 19, 480-497.
49.
Mattson, M., & Roberts, F. ( 2001). Overcoming truth telling as an obstacle to initiating safer sex: Clients and health practitioners planning deception during HIV test counseling. Health Communication, 13, 343-362.
50.
Mechanic, D. ( 1996). Changing medical organization and the erosion of trust . Milbank Quarterly, 74, 171-189.
51.
Mechanic, D., & Meyer, S. ( 2000). Concepts of trust among patients with serious illness . Social Science & Medicine, 51, 657-668.
Mirivel, J.C. ( 2007). Managing poor surgical candidacy: Communication problems for plastic surgeons. Discourse & Communication, 1, 267-293.
54.
Mirivel, J.C. ( 2008). The physical examination in cosmetic surgery: Embodied persuasion in medical interaction. Health Communication, 23, 153-170.
55.
Moerman, M. ( 1988). Talking culture: Ethnography and conversation analysis . Philadelphia: University of Pennsylvania Press.
56.
Moi, A.L., & Gjengedal, E. ( 2008). Life after burn injury: Striving for regained freedom . Qualitative Health Research, 18, 1621-1630.
57.
Nabi, R.L. ( 2009). Cosmetic surgery makeover programs and intentions to undergo cosmetic enhancements: A consideration of three models of media effects . Communication Theory, 35, 1-27.
58.
Nilsen, T.R. ( 1974). Ethics of speech communication (2nd ed.). Indianapolis, IN: Bobbs-Merrill .
59.
Ochs, E. ( 1979). Transcription as theory. In E. Ochs & B. B. Schieffelin (Eds.), Developmental pragmatics (pp. 43-72). New York: Academic Press.
60.
Pollack, A. ( 2009, September 2). For profit, industry seeks cancer drugs . New York Times, p. A1.
61.
Robinson, J.C. ( 1999). The corporate practice of medicine: Competition and innovation in health care. Berkeley, CA: University of California Press.
62.
Rodwin, M.A. ( 1994). Patient accountability and quality of care: Lessons from medical consumerism and the patients’ rights, women’s health and disability rights movements. American Journal of Law and Medicine , 20, 147-167.
63.
Roter, D., & McNeilis, K.S. (2003). The nature of the therapeutic relationship and the assessment of its discourse in routine medical visits . In T. L. Thompson, A. M. Dorsey, K. I. Miller, & R. Parrott (Eds.), Handbook of health communication (pp. 121-140). Mahwah, NJ : Lawrence Erlbaum.
64.
Rothman, D.J. ( 1991). Strangers at the bedside: A history of how law and bioethics transformed medical decision making. New York: Basic Books.
65.
Sarwer, D.B., Wadden, T.A., Pertschuk, M.J., & Whitaker, L.A. (1998). The psychology of cosmetic surgery: A review and reconceptualization. Clinical Psychology Review, 18, 1-22.
66.
Schiffrin, D., Tannen, D., & Hamilton, H.E. (2001). The handbook of discourse analysis. Malden, MA: Blackwell .
67.
Segal, J.Z. ( 2005). Health and the rhetoric of medicine. Carbondale, IL: Southern Illinois University Press .
68.
Silverman, D. ( 1997). Discourses on counselling: HIV counselling as social interaction. Thousand Oaks, CA: Sage.
69.
Smith, R.C., & Hoppe, R.B. ( 1991). The patient’s story: Integrating the patient- and physician-centered approaches to interviewing. Annals of Internal Medicine, 115, 470-477.
70.
Spitzack, C. ( 1988). The confession mirror: Plastic images for surgery. Canadian Journal of Political and Social Theory, 12, 38-50.
71.
Starr, P. ( 1982). The social transformation of American medicine: The rise of a sovereign profession and the making of a vast industry. New York: Basic Books.
72.
Stewart, M., Brown, J. B., Weston, W. W., McWhinney, I. R., McWilliam, C. L., & Freeman, T. R. ( 1995). (Eds.). Patient-centered medicine: Transforming the clinical method. Thousand Oaks, CA: Sage .
73.
Stivers, T. ( 2002a). Participating in decisions about treatment: Overt parent pressure for antibiotic medication in pediatric encounters. Social Science & Medicine, 54, 1111-1130.
74.
Stivers, T. ( 2002b). Presenting the problem in pediatric encounters: "Symptoms only" versus "candidate diagnosis" presentations. Health Communication , 14, 299-338.
75.
Stivers, T. ( 2005a). Non-antibiotic treatment recommendations: Delivery formats and implications for parent resistance. Social Science & Medicine, 60, 949-964.
76.
Stivers, T. ( 2005b). Parent resistance to physicians’ treatment recommendations: One resource for initiating a negotiation of the treatment decision. Health Communication, 18, 41-74.
77.
Street, R.L., Jr. ( 2003). Communication in medical encounters: An ecological perspective . In T. L. Thompson, A. M. Dorsey, K. I. Miller, & R. Parrot (Eds.), Handbook of health communication (pp. 63-89). Mahwah, NJ: Lawrence Erlbaum Associates.
78.
Sullivan, D.A. ( 2001). Cosmetic surgery: The cutting edge in commercial medicine in America. New Brunswick, NJ: Rutgers University Press.
79.
Thompson, T.L. ( 2003). Provider-patient interaction issues. In T. L. Thompson, A. M. Dorsey, K. I. Miller, & R. Parrot (Eds.), Handbook of health communication (pp. 91-93). Mahwah, NJ: Lawrence Erlbaum.
80.
Tracy, J.F. ( 2004). Between discourse and beings: The commodification of pharmaceuticals in late capitalism. Communication Review, 7, 15-34.
81.
Tracy, K. ( 1995). Action-implicative discourse analysis. Journal of Language and Social Psychology, 14, 195-215.
82.
Tracy, K. ( 1997). Colloquium: Dilemmas of academic discourse. Norwood, NJ: Ablex.
83.
Tracy, K. ( 2001). Discourse analysis in communication. In D. Schiffrin, D. Tannen, & H. Hamilton (Eds.), Handbook of discourse analysis (pp. 725-749). Malden, MA: Blackwell.
84.
Tracy, K. ( 2005). Reconstructing communicative practices: Action-implicative discourse analysis. In K. L. Fitch & R. E. Sanders (Eds.), Handbook of language and social interaction (pp. 301-319). Mahwah, NJ: Lawrence Erlbaum.
85.
Tracy, K. ( 2007). The discourse of crisis in public meetings: Case study of a school district’s multimillion dollar error. Journal of Applied Communication Research, 35, 418-441.
86.
Tracy, K. ( 2008). "Reasonable hostility": Situation-appropriate face attack. Journal of Politeness Research: Language, Behaviour, Culture , 4, 169-191.
87.
Tracy, K., & Agne, R.R. ( 2002). "I just need to ask somebody some questions": Sensitivities in domestic dispute calls. In J. Cottrell (Ed.), Language in the legal process (pp. 75-89). New York: Palgrave.
88.
Tracy, K., & Coupland, N. ( 1990). Multiple goals in discourse. Philadelphia : Multilingual Matters.
89.
Tracy, K., & Muller, H. ( 2001). Diagnosing a school board’s interactional trouble: Theorizing problem formulating. Communication Theory, 11, 84-104.
90.
Tracy, K., & Naughton, J. ( 1994). The identity-work of questioning in intellectual discussion . Communication Monographs, 61, 281-302.
91.
Tracy, K., & Naughton, J.M. (2000). Institutional identity-work: A better lens. In J. Coupland (Ed.), Small talk (pp. 62-83). New York: Longman .
92.
Tracy, K., & Tracy, S.J. ( 1998). Rudeness at 911: Reconceptualizing face and face-attack . Human Communication Research, 25, 225-251.
93.
Vanderford, M.L., Stein, T., Sheeler, R., & Skochelak, S. ( 2001). Communication challenges for experienced clinicians: Topics for an advanced communication curriculum. Health Communication , 13, 261-284.
94.
van Maanen, J. ( 1988). Tales of the field: On writing ethnography. Chicago: University of Chicago Press.
95.
van Manen, M. ( 1990). Researching lived experience: Human science for an action sensitive pedagogy. London, Ontario, Canada: University of Western Ontario.
96.
Wenzel, J., & Steeves, R.H. ( 2008). Experiencing breast cancer in managed care. Qualitative Health Research, 18, 1477-1488.
97.
Wetherell, M., Taylor, S. , & Yates, S. J. (Eds.). (2001). Discourse theory and practice: A reader. Thousand Oaks, CA: Sage.
98.
Wolf, N. ( 1991). The beauty myth: How images of beauty are used against women. New York: William Morrow .
99.
Wood, L.A., & Kroger, R.O. ( 2000). Doing discourse analysis: Methods for studying action in talk and text. Thousand Oaks, CA: Sage.
100.
Young, A., & Flower, L. ( 2002). Patients as partners, patients as problem-solvers. Health Communication, 14, 69-97.
