"How can I Put this?" Exaggerated Self-Disparagement as Alignment Strategy during Problematic Disclosures by Patients to Doctors

Abstract

This article explores how patients engage in problematic disclosures to their physician. Dialogue from medical encounters suggests that patients sometimes use exaggerated self-disparagement to bid for a physician's forgiveness and reassurance. Grounded in work on conversational framing and alignment, this study documents the conversational mechanism of overclaiming. Overclaims function like disclaimers or accounts, but rather than disclaiming responsibility for an action with potentially negative consequences, the speaker seems to claim disproportionate responsibility for it. In the conversations studied, such bids pay off with emphatic compliments and reassurance. Overclaiming facilitates a shift from the primary frame of a medical encounter to a secondary frame that focuses on the nature of the overclaim rather than the nature of the violation. It is suggested that overclaims are used to elicit more-than-usual reassurance, to save face, and to preserve conversational alignment.