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Orientations to epistemics and deontics in treatment discussions

  • Ann Weatherall
    ,
  • Anna Lindström
  • Uppsala University
Research Output: Contribution to journal Article Peer-review

Open access

Abstract

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.

Publication Information

Output type

Research Output: Contribution to journal Article Peer-review

Original language

English

Pages from-to (Number of pages)

Pages 39-53

Journal (Volume, Issue Number)

Journal of Pragmatics (Volume 78)

Publication milestones

  • Published - 31/01/2015

Publication status

Published - 31/01/2015

ISSN

0378-2166

External Publication IDs

  • handle.net: 10547/625805
  • Scopus: 85027956451

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