Patient resistance in medical interactions: a collaborative, cross-national, conversation analytic study of how resistance is produced and handled in real decision-making sequences

This is a collaborative study of patient resistance in response to clinicians' recommendations. As a multi-disciplinary team of conversation analysts, our focus is on decision-making in practice, using video-recordings to capture real clinician-patient interactions. Previous CA work (including by members of our team) has provided a good understanding of how treatment recommendations are designed and how patients may subtly resist these. Stivers pioneered analysis of passive resistance in the context of antibiotic prescribing. However, we know little about how patients voice active resistance and what happens when they do. This is the focus of our current analytic work. Our work to date shows that active resistance is surprisingly common and may be problematic either because patients resist beneficial treatments or push for something the clinician recommends against. For example, McCabe has found that patients with depression/anxiety may reveal troubling symptoms yet resist the recommended treatment. Conversely, patient resistance is key to understanding why, in Stivers’ dataset, over 60% of upper respiratory infection cases end with an antibiotic prescription despite this being over twice what we’d expect. Based on our prior work, the current project seeks to address the following questions: • What leads to patient resistance to medical recommendations? • What does active resistance look like in healthcare interactions? • On what grounds do patients justify their resistance? • How does resistance affect the trajectory of what happens in the decision-making sequence? • What persuasive strategies are used by patient and clinician? • How do patients or clinicians succeed in getting their preferred outcome? Findings will be written up in a special section in Social Science & Medicine.