Initiating decision-making in neurology consultations: 'recommending' versus 'option-listing' and the implications for medical authority

TY - JOUR

T1 - Initiating decision-making in neurology consultations

T2 - 'recommending' versus 'option-listing' and the implications for medical authority

AU - Toerien, Merran Gurney

AU - Shaw, Rebecca

AU - Reuber, Markus

PY - 2013/7

Y1 - 2013/7

N2 - This paper compares two practices for initiating treatment decision-making, evident in audio-recorded consultations between a neurologist and thirteen patients in two hospital clinics in the UK. We call these ‘recommending’ and ‘option-listing’. The former entails making a proposal to do x; the latter entails the construction of a list of options. Using conversation analysis (CA), we illustrate each, showing that the distinction between the two matters to participants. Our analysis centres on two distinctions between the practices: epistemic differences; and differences in the slots each creates for the patient’s response. Considering the implications of our findings for understanding medical authority, we argue that option-listing – relative to recommending – is a practice whereby clinicians work to relinquish a little of their authority. This paper contributes, then, to a growing body of CA work which offers a more nuanced, tempered account of medical authority than is typically portrayed in the sociological literature. We argue that future CA studies should map out the range of ways – in addition to recommending – in which treatment decision-making is initiated by clinicians. This will allow for further evidence-based contributions to debates on the related concepts of patient participation, choice, shared decision-making and medical authority.

AB - This paper compares two practices for initiating treatment decision-making, evident in audio-recorded consultations between a neurologist and thirteen patients in two hospital clinics in the UK. We call these ‘recommending’ and ‘option-listing’. The former entails making a proposal to do x; the latter entails the construction of a list of options. Using conversation analysis (CA), we illustrate each, showing that the distinction between the two matters to participants. Our analysis centres on two distinctions between the practices: epistemic differences; and differences in the slots each creates for the patient’s response. Considering the implications of our findings for understanding medical authority, we argue that option-listing – relative to recommending – is a practice whereby clinicians work to relinquish a little of their authority. This paper contributes, then, to a growing body of CA work which offers a more nuanced, tempered account of medical authority than is typically portrayed in the sociological literature. We argue that future CA studies should map out the range of ways – in addition to recommending – in which treatment decision-making is initiated by clinicians. This will allow for further evidence-based contributions to debates on the related concepts of patient participation, choice, shared decision-making and medical authority.

UR - http://www.scopus.com/inward/record.url?scp=84875683803&partnerID=8YFLogxK

U2 - 10.1111/1467-9566.12000

DO - 10.1111/1467-9566.12000

M3 - Article

SN - 1467-9566

VL - 35

SP - 873

EP - 890

JO - Sociology of health & illness

JF - Sociology of health & illness

IS - 6

ER -