Lindstrom2015a

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 EMCA, Conversation analysis, Medical interaction, Health communication, Treatment proposals, Epistemics, Deontics, Needs Review
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Year	2015
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Journal	Journal of Pragmatics
Volume	78
Number	0
Pages	39 - 53
URL	Link
DOI	http://dx.doi.org/10.1016/j.pragma.2015.01.005
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Howpublished
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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

Epistemics and Deontics in Conversational Directives