Introduction

Patients not only describe their symptoms during medical visits, they frequently present possible explanations for those symptoms (Gill, 1995, 1998; Raevaara, 1998, 2000; Stivers, 2002; Gill et al., 2004; Gill and Maynard, 2006). Although patients often display uncertainty about their candidate explanations (Gill, 1998), they typically portray them as reasonable, and at least somewhat likely, possibilities. For this study, we analysed instances in which patients offered serious health conditions (a heart problem, appendicitis) as candidate explanations for symptoms and portrayed those candidate explanations as unlikely to be the case, as improbable, while also implicitly or explicitly directing the doctors to investigate and confirm that they were indeed improbable.

This study is part of a larger project of analysing the range of practices that patients use when they present medically serious conditions as candidate explanations. For this project, we examined a subset of those practices: those used on occasions in which a patient presented a serious health condition as an unlikely candidate explanation. We selected this phenomenon because we were intrigued by the following observations:

1. Patients did not simply raise the spectre of serious health conditions as candidate explanations; they spent considerable effort displaying sceptical stances toward those candidate explanations, often by presenting reports that served as evidence for the improbability of the candidate explanations. We wondered what potentially conflicting issues and constraints the displays of scepticism were designed to address and how the discourse was designed to deal with those issues and constraints.

2. […]