‘Things aren't the same, are they?’: the management of bad news delivery in the discourse of stroke care

Health professionals associated with stroke care tend to emphasize the optimistic possibilities for recovery from stroke and downplay its disabling nature. Therefore, unlike in cancer care, the ‘bad news’ interview is not a recognized part of stroke care. Nevertheless, at some stages in the trajectory of the illness the issue of disability may have to be discussed and this paper concerns one such occasion. The data are taken from a corpus of video-recorded naturally occurring interactions between stroke patients and health professionals. In the case studied here, an occupational therapist discusses with a patient the arrangements for her care after discharge from hospital. It emerges over the course of the interaction that the patient has to face some unpleasant realities about her future daily life. By conducting a microanalysis of this interaction, using appropriate concepts from conversation analysis and politeness theory, we show how the patient and therapist collaboratively manage the emergent ‘bad news’ situation and, over the course of the interaction, arrive at the realization that ‘things are not the same’.