Das Problem der zweiten Meinung: Vom Umgang mit Vertrauen und Misstrauen in onkologischen Therapieplanungsgesprächen

The interactional negotiation of trust and distrust is something that can often be observed within doctor-patient-communication. Patients typically fear that the diagnosis might not be correct or that the proposed therapy might not be the best possible for them, while doctors can doubt the frankness and sincerity of their patients. The aim of this analysis is to focus on an interactional aspect which is important for both doctors and patients: The negotiation of trust and distrust regarding the proposed therapy in cancer pre-treatment discussions. For the patients, this negotiation is important because they wish the best possible treatment for themselves and therefore have to ensure that the proposed therapy is indeed the best one and that there are no better alternative options. For the doctors, reducing distrust and establishing trust is important, because trust in the proposed therapy leads to patients’ compliance, i.e. their active co-operation with the therapeutic measures, which may be decisive for the success or failure of the treatment. On the basis of a corpus of oncological therapy planning talks, a qualitative empirical analysis of the interactional processes of dealing with distrust in the context of the sensitive question of getting a ‘second opinion’ concerning the proposed therapy will be presented. The question of the ‘second opinion’ is a sensitive one because it can be interpreted as signaling a patient’s distrust in the competence of the doctor, thus leading to a face-threat. In order to answer the question of how distrust is negotiated interactionally, the paper proceeds as follows: First, the research project will be presented in whose context the data were collected. Then, a short overview of typical problems within doctor-patient-communication in general and of the negotiation of trust and distrust in particular will be given. Next, strategies will be discussed with which – on the one hand – patients introduce the topic of the ‘second opinion’ within a therapy planning talk and with which the doctors react to this topic. Finally, doctors’ ‘pre-emptive’ strategies with which they try to remove patients’ distrust and establish trust in their diagnosis and proposed therapy will be analyzed.