Koenig2011

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Koenig2011
BibType ARTICLE
Key Koenig2011
Author(s) Christopher J. Koenig
Title Patient resistance as agency in treatment decisions
Editor(s)
Tag(s) EMCA, Medical consultations, Resistance, Medical EMCA, Agency
Publisher
Year 2011
Language
City
Month
Journal Social Science & Medicine
Volume 72
Number 7
Pages 1105–1114
URL Link
DOI 10.1016/j.socscimed.2011.02.010
ISBN
Organization
Institution
School
Type
Edition
Series
Howpublished
Book title
Chapter

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Abstract

Medication is critical to the management of medical problems, however relatively little attention has been paid to the treatment recommendation process where a new medication is first prescribed. This article argues that how and when a patient agrees to a physician’s treatment demonstrates a patient’s active involvement in decisions about treatment. Using 100 video recorded primary care visits across 10 internal medicine clinics in the Western United States, this paper uses conversation analysis to document the delivery and reception of treatment recommendations in acute medical visits with adult patients. Specifically, this article analyzes patients demonstrating active participation regarding treatment decisions as a limited form of agency. Starting from the premise that participants orient to physicians’ treatment recommendations as normatively requiring patient acceptance before moving to a next activity, this article argues that when patients resist a recommendation, they actively participate in how the treatment recommendation emerges as acceptable. This article argues that through resistance to a treatment recommendation, patients work to negotiate and collaboratively co-construct what counts as an acceptable recommendation. Overall, this article argues that patient resistance is an interactional resource for patients to assert their agency by ensuring the ensuing recommendation is acceptable and in accord with their treatment preferences and concerns.

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