Document Detail

'Unilateral' decision making and patient participation in primary care.
MedLine Citation:
PMID:  23264979     Owner:  NLM     Status:  In-Process    
Using conversation analysis as a method, we examine patients' responses to doctors' treatment decision deliveries in Finnish primary care consultations for upper respiratory tract infection. We investigate decision-making sequences that are initiated by doctors' 'unilateral' decision delivery (Collins et al. 2005). In line with Collins et al., we see the doctors' decision deliveries as unilateral when they are offered as suggestions, recommendations or conclusions that make relevant patients' acceptance of the decision rather than their further contributions to the decision. In contrast, more 'bilateral' decision making encourages and is dependent in part on patient's contributions, too (Collins et al. 2005). We examine how patients respond to unilaterally made decisions and how they participate in and contribute to the outcome of the decision-making process. Within minimal responses patients approve the doctor's unilateral agency in decision making whereas within two types of extended responses patients voice their own perspectives. 1) In positive responses they appraise the doctor's decision as appropriate; 2) in other instances, patients may challenge the decision with an extended response that initiates a negotiation on the decision. We suggest that, firstly, unilateral decision making may be collaboratively maintained in consultations and that, secondly, patients have means for challenging it.
Taru Ijäs-Kallio; Johanna Ruusuvuori; Anssi Peräkylä
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Communication & medicine     Volume:  8     ISSN:  1612-1783     ISO Abbreviation:  Commun Med     Publication Date:  2011  
Date Detail:
Created Date:  2012-12-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101201068     Medline TA:  Commun Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  145-55     Citation Subset:  IM    
Department of Social Research, University of Tampere, Finland.
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