“Having an Ovary This Big Is Not Normal”: Physicians’ Use of<i>Normal</i>to Assess Wellness and Sickness During Oncology Interviews

Abstract

During oncology interviews, physicians and patients routinely employ the term normal to describe patients' condition and overall health status. Surprisingly prevalent but little understood, normal is recruited to achieve an array of social actions comprising a primal aspect of patient-provider interactions: determining, assessing, and treating patients' health status as well and/or sick. Utilizing conversation analysis (CA) to examine a collection of 136 normal references across 61 oncology interviews, this article draws from a subsample of 101 instances to examine how physicians use normal to perform four specific sets of social actions: (a) invoking normal as a preferred range, (b) utilizing normal as evidence that does not explicitly label patients' conditions, (c) treating the absence of normal as indicative of sickness, and (d) providing reassurance to patients in the presence of normal and not normal circumstances. Special attention is given to how oncologists make the case for wellness and/or sickness by identifying patients as normal or not normal/abnormal. Future research is needed to understand how patients employ normal to characterize their symptoms and negotiate health status, to explore how or if alternative orientations to normal are based on gender and/or varying ethnicities, and to develop a more precise understanding of alternative practices for describing and categorizing test results (e.g., common/uncommon).