“I’m not the doctor; I’m just the patient”: Patient agency and shared decision-making in naturally occurring primary care consultations

Olaug Lian, Sarah Nettleton, Huw Grange, Christopher Dowrick

Research output: Contribution to journalArticlepeer-review


To explore interactional processes in which clinical decisions are made in situ during medical consultations, particularly the ways in which patients show agency in decision-making processes by proposing and opposing actions, and which normative dimensions and role-expectations their engagement entail.

Narrative analysis of verbatim transcripts of 22 naturally occurring consultations, sourced from a corpus of 212 consultations between general practitioners and patients in England. After thematically coding the whole dataset, we selected 22 consultations with particularly engaged patients for in-depth analysis.

Patients oppose further actions more often than they propose actions, and they oppose more directly than they propose. When they explain why they propose and oppose something, they reveal their values. Patients’ role-performance changes throughout the consultations.

Assertive patients claim – and probably also achieve – most influence when they oppose actions directly and elaborate why. Patients display ambiguous role-expectations. In final concluding stages of decision-making processes, patients usually defer to GPs’ authority.
Original languageEnglish
Pages (from-to)1996-2004
JournalPatient Education and Counseling
Issue number7
Early online date10 Jun 2022
Publication statusPublished - Jul 2022

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© 2021 The Author(s).

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