Negotiating treatment for hepatitis C: interpersonal alignment in the clinical encounter

Antiviral treatment for hepatitis C constitutes a considerable physical and psycho-social challenge without guarantee of treatment success. Using semi-structured in-depth interviews, this article investigates the experiences of people on hepatitis C treatment and the experiences of physicians who care for people with hepatitis C. Given the importance of the interpersonal dimension of the patient-physician relationship for patients accessing treatment, adhering to treatment, dealing with treatment side-effects and completing treatment, the article focuses on the interpersonal dimension of patients' and physicians' accounts. The theoretical foundation is 'appraisal' theory from systemic functional linguistics, which is grounded in Bakhtin's notions of heteroglossia and dialogism. The article describes the intersubjective stances that patients and physicians adopt in accounts of their interactions about hepatitis C treatment, the values they construct and the semantic backdrop against which these meanings are constructed. The article traces the semantic patterns of intersubjective alignment and disalignment between patients and physicians, as well as the semantics of patients' challenging the intersubjective stances taken by their physicians. While the biomedical discourse was intersubjectively at odds with the experiences of some patients, others aligned with it. In fact, understanding and speaking the language of biomedicine enabled some patients to challenge the traditional doctor-patient relationship and to reconfigure it into a partnership approach.