scholarly journals Medical Authority under Siege: How Clinicians Transform Patient Resistance into Acceptance

2020 ◽  
Vol 61 (1) ◽  
pp. 60-78 ◽  
Author(s):  
Tanya Stivers ◽  
Stefan Timmermans
Keyword(s):  
Treatment Recommendations ◽  
Communication Styles ◽  
Treatment Recommendation ◽  
Pediatric Epilepsy ◽  
Patient Centered ◽  
Medical Authority ◽  
Professional Authority ◽  
External Pressures ◽  
Centered Care ◽  
Patient Resistance

Over the past decades, professional medical authority has been transformed due to internal and external pressures, including weakened institutional support and patient-centered care. Today’s patients are more likely to resist treatment recommendations. We examine how patient resistance to treatment recommendations indexes the strength of contemporary professional authority. Using conversation analytic methods, we analyze 39 video recordings of patient-clinician encounters involving pediatric epilepsy patients in which parents resist recommended treatments. We identify three distinct grounds for parental resistance to treatments: preference-, fear-, and experience-based resistance. Clinicians meet these grounds with three corresponding persuasion strategies ranging from pressuring, to coaxing, to accommodating. Rather than giving parents what they want, physicians preserve their professional authority, adjusting responses based on whether the resistance threatens their prerogative to prescribe. While physicians are able to convert most resistance into acceptance, resistance has the potential to change the treatment recommendation and may lead to changed communication styles.

scholarly journals Orientations to epistemics and deontics in treatment discussions

2021 ◽  
Author(s):  
A Lindström ◽  
Ann Weatherall
Keyword(s):  
Health Care ◽  
Expert Knowledge ◽  
Current Knowledge ◽  
Treatment Recommendation ◽  
Patient Centered ◽  
Medical Authority ◽  
Different Types ◽  
The Face ◽  
Sequential Unfolding ◽  
Right To Refuse Treatment

© 2015 Elsevier B.V. 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.

scholarly journals Orientations to epistemics and deontics in treatment discussions

2021 ◽  
Author(s):  
A Lindström ◽  
Ann Weatherall
Keyword(s):  
Health Care ◽  
Expert Knowledge ◽  
Current Knowledge ◽  
Treatment Recommendation ◽  
Patient Centered ◽  
Medical Authority ◽  
Different Types ◽  
The Face ◽  
Sequential Unfolding ◽  
Right To Refuse Treatment

© 2015 Elsevier B.V. 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.

scholarly journals Challenges of Communication Skills Transfer of Medical Students in the Cultural Context of Indonesia

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Mora Claramita ◽  
Yayi Suryo Prabandari ◽  
Abraham Graber ◽  
Albert J. J. Scherpbier
Keyword(s):  
Medical Students ◽  
Group Dynamics ◽  
Cultural Context ◽  
Communication Style ◽  
Communication Styles ◽  
Patient Centered ◽  
Skills Transfer ◽  
Student Centered ◽  
Teacher Student ◽  
Centered Care

Medical schools worldwide are promoting a student-centered and patient-centered care curriculum by using problem-based learning (PBL) strategy, emphasizing group dynamics and discussions. This approach facilitates student engagement, participation, and partnership interaction. However, in the context of the wide power-distance or the existence of socio-hierarchical gaps in Indonesia, two-way dialogue is limited. Few studies describe the one-way paternalistic communication styles between physician-patient, teacher-student, and parents-children, which can lead to less effective learning and healthcare environments. In this study, we investigated if students in an Indonesian medical school, who have been learning and practicing a partnership style of communication in a PBL curriculum for three years, are using the same style of communication with their junior peers outside the classroom. We examined the communication style between senior and new medical students, using surveys, observations, and focus group discussions, during a three-day orientation at the beginning of medical education. The results indicated that senior students used a one-sided communication style with their juniors, whereas new students expressed the need for egalitarian interaction with seniors. A classic dilemma of nature versus nurture was found and discussed. To change the traditional values, robust, constructive, and systematic formative training is key.

The Role of Shared Decision-Making in Audiologic Rehabilitation

2014 ◽  
Vol 21 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Helen Pryce ◽  
Amanda Hall
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Behavior Changes ◽  
Shared Decision ◽  
Patient Centered ◽  
Treatment Information ◽  
Centered Care ◽  
Potential Risks ◽  
Audiologic Rehabilitation

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.

Principles of Solution Focused Therapy and Their Application to Audiology

2014 ◽  
Vol 15 (1) ◽  
pp. 27-33
Author(s):  
James C. Blair
Keyword(s):  
Basic Assumption ◽  
Current Practice ◽  
Helping Professions ◽  
Patient Centered ◽  
Therapy Approach ◽  
Agents Of Change ◽  
Centered Care ◽  
Client Centered Therapy ◽  
Solution Focused ◽  
Solution Focused Therapy

The concept of client-centered therapy (Rogers, 1951) has influenced many professions to refocus their treatment of clients from assessment outcomes to the person who uses the information from this assessment. The term adopted for use in the professions of Communication Sciences and Disorders and encouraged by The American Speech-Language-Hearing Association (ASHA) is patient-centered care, with the goal of helping professions, like audiology, focus more centrally on the patient. The purpose of this paper is to examine some of the principles used in a patient-centered therapy approach first described by de Shazer (1985) named Solution-Focused Therapy and how these principles might apply to the practice of audiology. The basic assumption behind this model is that people are the agents of change and the professional is there to help guide and enable clients to make the change the client wants to make. This model then is focused on solutions, not on the problems. It is postulated that by using the assumptions in this model audiologists will be more effective in a shorter time than current practice may allow.

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