期刊
JOURNAL OF PRAGMATICS
卷 78, 期 -, 页码 39-53出版社
ELSEVIER SCIENCE BV
DOI: 10.1016/j.pragma.2015.01.005
关键词
Conversation analysis; Medical interaction; Health communication; Treatment proposals; Epistemics; Deontics
资金
- Swedish Research Council for Health, Working Life and Welfare [2013-2169]
- research initiative on language and aging at the Faculty of Languages at Uppsala University
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. (C) 2015 Elsevier B.V. All rights reserved.
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