Abstract
Context: An effective consultation opening with attention to patient participation
not only increases patient satisfaction, but is also a prerequisite for
shared decision making, which may improve health outcomes and reduce
healthcare costs.
Methods: Using conversation analysis, we examined linguistic and structural
characteristics of 41 video recorded consultation openings of medical
specialists at a large Dutch teaching hospital. The main purpose was to give
an overview of how doctors and patients interactionally shape deontic and
epistemic authority.
Results: Conversation analysis showed different ways in which doctors open
their consultations and patients’ reactions to this. Agenda setting occurred in
6 cases, this was always the doctor’s agenda. Most of the doctors’ utterances
during this phase displayed a high deontic stance and none of the patients
were invited to discuss their expectations or goals for the consultation. 30
doctors started with their opening question, which in itself also reflects a
high deontic stance. During the opening questions, the doctors’ epistemic
stances differed.
Conclusion: During the consultation openings, the doctor was clearly in charge
of the conversation and often did not explore the knowledge domain of
the patient. This can limit patient participation and can hinder shared decision
making in the consultation.
not only increases patient satisfaction, but is also a prerequisite for
shared decision making, which may improve health outcomes and reduce
healthcare costs.
Methods: Using conversation analysis, we examined linguistic and structural
characteristics of 41 video recorded consultation openings of medical
specialists at a large Dutch teaching hospital. The main purpose was to give
an overview of how doctors and patients interactionally shape deontic and
epistemic authority.
Results: Conversation analysis showed different ways in which doctors open
their consultations and patients’ reactions to this. Agenda setting occurred in
6 cases, this was always the doctor’s agenda. Most of the doctors’ utterances
during this phase displayed a high deontic stance and none of the patients
were invited to discuss their expectations or goals for the consultation. 30
doctors started with their opening question, which in itself also reflects a
high deontic stance. During the opening questions, the doctors’ epistemic
stances differed.
Conclusion: During the consultation openings, the doctor was clearly in charge
of the conversation and often did not explore the knowledge domain of
the patient. This can limit patient participation and can hinder shared decision
making in the consultation.
| Translated title of the contribution | Well begun is half done.: Deontic and epistemic authority in the opening phase of medical consultations |
|---|---|
| Original language | Dutch |
| Pages (from-to) | 95-114 |
| Number of pages | 20 |
| Journal | Tijdschrift voor taalbeheersing |
| Volume | 43 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Nov-2021 |