Lindstrom2015a

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Lindstrom2015a
BibType ARTICLE
Key Lindstrom2015a
Author(s) Anna Lindström, Ann Weatherall
Title Orientations to epistemics and deontics in treatment discussions
Editor(s)
Tag(s) EMCA, Medical, Epistemics, Deontics, Medical consultations, Resistance
Publisher
Year 2015
Language
City
Month
Journal Journal of Pragmatics
Volume 78
Number
Pages 39–53
URL Link
DOI 10.1016/j.pragma.2015.01.005
ISBN
Organization
Institution
School
Type
Edition
Series
Howpublished
Book title
Chapter

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Abstract

An ideological shift to patient-centered health care raises questions about how, in the face of medical authority, patients can assert agency in interactions with doctors. This study uses conversation analysis to explore how epistemic and deontic orientations are raised and made relevant in different types of responses to treatment proposals across two health care settings – New Zealand general practice consultations and Swedish hospital-based physician encounters. By examining responses ranging from acceptance to strong resistance, we show patient practices for deferring to and resisting medical authority, which includes claiming independent access to expert knowledge and raising everyday, experientially based concerns. Doctors rightfully privilege their own epistemic expertise in treatment decisions but they also take patient experiences into consideration. In cases of strong resistance we found doctors raising patients’ ultimate right to refuse treatment recommendation. Our analysis further nuances current knowledge by documenting the ways epistemic and deontic domains are observably relevant forces shaping the sequential unfolding of treatment proposals.

Notes

Special Issue: Epistemics and Deontics in Conversational Directives