Patients’ practices for taking the initiative in decision-making in outpatient psychiatric consultations
DOI:
https://doi.org/10.1558/cam.27013Keywords:
conversation analysis, decision-making, initiative, patient participation, request psychiatryAbstract
In spite of increasing advocacy for patients’ participation in psychiatric decision-making, there has been little research on how patients actually participate in decision-making in psychiatric consultations. This study explores how patients take the initiative in decision-making over treatment in outpatient psychiatric consultations in Japan. Using the methodology of conversation analysis, we analyze 85 video-recorded ongoing consultations and find that patients select between two practices for taking the initiative in decision-making: making explicit requests for a treatment and displaying interest in a treatment without explicitly requesting it. A close inspection of transcribed interaction reveals that patients make explicit requests under the circumstances where they believe the candidate treatment is appropriate for their condition, whereas they merely display interest in a treatment when they are not certain about its appropriateness. By fitting practices to take the initiative in decision-making with the way they describe their current condition, patients are optimally managing their desire for particular treatments and the validity of their initiative actions. In conclusion, we argue that the orderly use of the two practices is one important resource for patients’ participation in treatment decision-making.References
Adams, J. R. and Drake, R. E. (2006) Shared decision-making and evidence-based practice. Community Mental Health Journal 42 (1): 87–105. https://doi.org/10.1007/s10597-005-9005-8
Adams, J. R., Drake, R. E. and Wolford, G. L. (2007) Shared decision-making preferences of people with severe mental illness. Psychiatric Services 58 (9): 1219–1221. https://doi.org/10.1176/ps.2007.58.9.1219
Angell, B. and Bolden, G. B. (2015) Justifying medication decisions in mental health care: Physicians’ accounts for treatment recommendations. Social Science & Medicine 138: 44–56. https://doi.org/10.1016/j.socscimed.2015.04.029
Angell, B. and Bolden, G. B. (2016) Team work in action: Building grounds for psychiatric medication decisions in assertive community treatment. In M. O’Reilly and J. Lester (eds) Handbook of Adult Mental Health: Discourse and Conversation Studies, 371–393. London: Palgrave Macmillan.
Antaki, C. and Kent, A. (2012) Telling people what to do (and, sometimes, why): Contingency, entitlement and explanation in staff requests to adults with intellectual impairments. Journal of Pragmatics 44 (6–7): 876–889. https://doi.org/10.1016/j.pragma.2012.03.014
Costello, B. A. and Roberts F. (2001) Medical recommendations as joint social practice. Health Communication 13 (3): 241–260. https://doi.org/10.1207/S15327027HC1303_2
Curl, T. and Drew, P. (2008) Contingency and action: A comparison of two forms of requesting. Research on Language and Social Interaction 41 (2): 129–153. https://doi.org/10.1080/08351810802028613
Deegan, P. E. (2005) The importance of personal medicine: A qualitative study of resilience in people with psychiatric disabilities. Scandinavian Journal of Public Health 33 (Suppl 66): 29–35. https://doi.org/10.1080/14034950510033345
Drew, P. and Walker, T. (2010) Citizens’ emergency calls: Requesting assistance in calls to the police. In M. Coulthard and A. Johnson (eds) Routledge Handbook of Forensic Linguistics, 95–110. New York: Routledge.
Gill, V. T. (2005) Patient ‘demand’ for medical interventions: Exerting pressure for an offer in a primary care clinic visit. Research on Language and Social Interaction 38 (4): 451–479. https://doi.org/10.1207/s15327973rlsi3804_3
Gill, V. T., Halkowski, T. and Roberts, F. (2001) Accomplishing a request without making one: A single case analysis of a primary care visit. Text 21 (1–2): 55–82. https://doi.org/10.1515/text.1.21.1-2.55
Haakana, M. (2001) Laughter as a patient’s resource: Dealing with delicate aspects of medical interaction. Text 21 (1–2): 187–220. https://doi.org/10.1515/text.1.21.1-2.187
Halkowski, T. (2006) Realizing illness: Patients’ narratives of symptom discovery. In J. Heritage and D. W. Maynard (eds) Communication in Medical Care: Interaction between Primary Care Physicians and Patients, 86–114. Cambridge: Cambridge University Press.
Hamann, J., Cohen, R., Leucht, S., Busch, R. and Kissling, W. (2005) Do patients with schizophrenia wish to be involved in decisions about their medical treatment? American Journal of Psychiatry 162 (12): 2382–2384. https://doi.org/10.1176/appi.ajp.162.12.2382
Hamann, J., Leucht, S. and Kissling, W. (2003) Shared decision making in psychiatry. Acta Psychiatrica Scandinavica 107 (6): 403–409. https://doi.org/10.1034/j.1600-0447.2003.00130.x
Heinemann, T. (2006) ‘Will you or can’t you?’: Displaying entitlement in interrogative requests. Journal of Pragmatics 38 (7): 1081–1104. https://doi.org/10.1016/j.pragma.2005.09.013
Heritage, J. (2012) Epistemics in action: Action formation and territories of knowledge. Research on Language and Social Interaction 45 (1): 1–29. https://doi.org/10.1080/08351813.2012.646684
Heritage, J. and Robinson, J. D. (2006) Accounting for the visit: Giving reasons for seeking medical care. In J. Heritage and D. W. Maynard (eds) Communication in Medical Care: Interaction between Primary Care Physicians and Patients, 48–85. Cambridge: Cambridge University Press.
Jefferson, G. (2004) Glossary of transcript symbols with introduction. In G. Lerner (ed.) Conversation Analysis: Studies from the First Generation, 13–23. Amsterdam: John Benjamins. https://doi.org/10.1075/pbns.125.02jef
Koenig, C. J. (2011) Patient resistance as agency in treatment decisions. Social Science & Medicine 72 (7): 1105–1114. https://doi.org/10.1016/j.socscimed.2011.02.010
Kushida, S. and Yamakawa, Y. (2015) Fitting proposals to their sequential environment: A comparison of turn designs for proposing treatment in ongoing outpatient psychiatric consultations in Japan. Sociology of Health & Illness 37 (4): 522–544. https://doi.org/10.1111/1467-9566.12204
Landmark, A. M. D., Gulbrandsen, P. and Svennevig, J. (2015) Whose decision? Negotiating epistemic and deontic rights in medical treatment decisions. Journal of Pragmatics 78: 54–69. https://doi.org/10.1016/j.pragma.2014.11.007
Lindström, A. (2005) Language as social action: A study of how senior citizens request assistance with practical tasks in the Swedish home help service. In A. Hakulinen and M. Selting (eds) Syntax and Lexis in Conversation: Studies on the Use of Linguistic Resources in Talk-in-interaction, 209–232. Amsterdam: John Benjamins. https://doi.org/10.1075/sidag.17.11lin
Lindström, A. and Weatherall, A. (2015) Orientations to epistemics and deontics in treatment discussions. Journal of Pragmatics 78: 39–53. https://doi.org/10.1016/j.pragma.2015.01.005
Matthias, M. S., Salyers, M. P. and Frankel, R. M. (2013) Re-thinking shared decision-making: Context matters. Archives of Psychiatric Nursing 25: e27–e36. https://doi.org/10.1016/j.pec.2013.01.006
Maynard, D. W. (1991) Interaction and asymmetry in clinical discourse. American Journal of Sociology 97 (2): 448–495. https://doi.org/10.1086/229785
Quirk, A., Chapin, R., Lelliott, P. and Seale, C. (2009) The negotiation of prescribing decisions: Some good practice issues. In N. Harris, J. Baker and R. Gray (eds) Medicines Management in Mental Health Care, 133–144. Chichester, UK: Wiley Blackwell.
Quirk, A., Chapin, R., Lelliott, P. and Seale, C. (2012) How pressure is applied in shared decisions about antipsychotic medication: A conversation analytic study of psychiatric outpatient consultations. Sociology of Health and Illness 34 (1): 95–113. https://doi.org/10.1111/j.1467-9566.2011.01363.x
Robinson, J. D. (2001) Asymmetry in action: Sequential resources in the negotiation of a prescription request. Text 21 (1–2): 19–54. https://doi.org/10.1515/text.1.21.1-2.19
Robinson, J. D. (2003) An interactional structure of medical activities during acute visits and its implications for patients’ participation. Health Communication 15 (1): 27–57. https://doi.org/10.1207/S15327027HC1501_2
Rogers, A., Day, J. C., Williams, B., Randall, F., Wood, P., Healy, D. and Bentall, R. P. (1998) The meaning and management of neuroleptic medication: A study of patients with a diagnosis of schizophrenia. Social Science & Medicine 47 (9): 1313–1323. https://doi.org/10.1016/S0277-9536(98)00209-3
Rossi, G. (2012) Bilateral and unilateral requests: The use of imperatives and Mi X? interrogatives in Italian. Discourse Processes 49 (5): 426–458. https://doi.org/10.1080/0163853X.2012.684136
Sacks, H. and Schegloff, E. A. (1979) Two preferences in the organization of reference to persons in conversation and their interaction. In G. Psathas (ed.) Everyday Language: Studies in Ethnomethodology, 5–21. New York: Irvington.
Schauer, C., Everett, A., del Vecchio, P. and Anderson, L. (2007) Prompting the value and practice of shared decision-making in mental health care. Psychiatric Rehabilitation Journal 31 (1): 54–61. https://doi.org/10.2975/31.1.2007.54.61
Seale, C., Chapin, R., Lelliott, P. and Quirk, A. (2006) Sharing decisions in consultations involving anti-psychotic medication: A qualitative study of psychiatrists’ experiences. Social Science & Medicine 62 (11): 2861–2873. https://doi.org/10.1016/j.socscimed.2005.11.002
Shepherd, A., Shorthouse, O. and Gask, L. (2014) Consultant psychiatrists’ experiences of and attitudes towards shared decision making in antipsychotic prescribing, a qualitative study. BMC Psychiatry 14 (127). Retrieved from http://www.biomedcentral.com/1471-244X/14/127.
Sidnell, J. (2011) Conversation Analysis: An introduction. Oxford: Blackwell. https://doi.org/10.1093/obo/9780199772810-0062
Stivers, T. (2002a) Participating in decisions about treatment: Overt parent pressure for antibiotic medication in pediatric encounters. Social Science & Medicine 54 (7): 1111–1130. https://doi.org/10.1016/S0277-9536(01)00085-5
Stivers, T. (2002b) Presenting the problem in pediatric encounters: ‘Symptoms only’ versus ‘candidate diagnosis’ presentations. Health Communication 14 (3): 299–338. https://doi.org/10.1207/S15327027HC1403_2
Stivers, T. (2005a) Non-antibiotic treatment recommendations: Delivery formats and implications for parent resistance. Social Science & Medicine 60 (5): 949–964. https://doi.org/10.1016/j.socscimed.2004.06.040
Stivers, T. (2005b) Parent resistance to physicians’ treatment recommendations: One resource for initiating a negotiation of treatment recommendation. Health Communication 18 (1): 41–74. https://doi.org/10.1207/s15327027hc1801_3
Stivers, T. (2007) Prescribing under Pressure: Parent-Physician Conversations and Antibiotics. New York: Oxford University Press. https://doi.org/10.1093/acprof:oso/9780195311150.001.0001
Toerien, M., Shaw, R. and Reuber, M. (2013) Initiating decision-making in neurology consultations: ‘Recommending’ versus ‘option-listing’ and the implications for medical authority. Sociology of Health & Illness 35 (6): 873–890. https://doi.org/10.1111/1467-9566.12000
Woltman, E. M. and Whitley, R. (2010) Shared decision making in public mental health care: Perspectives from consumers living with severe mental illness. Psychiatric Rehabilitation Journal 34 (1): 29–36. https://doi.org/10.2975/34.1.2010.29.36
Wootton, A. J. (1981) Two request forms of four years olds. Journal of Pragmatics 5 (6): 511–523. https://doi.org/10.1016/0378-2166(81)90016-3
Adams, J. R., Drake, R. E. and Wolford, G. L. (2007) Shared decision-making preferences of people with severe mental illness. Psychiatric Services 58 (9): 1219–1221. https://doi.org/10.1176/ps.2007.58.9.1219
Angell, B. and Bolden, G. B. (2015) Justifying medication decisions in mental health care: Physicians’ accounts for treatment recommendations. Social Science & Medicine 138: 44–56. https://doi.org/10.1016/j.socscimed.2015.04.029
Angell, B. and Bolden, G. B. (2016) Team work in action: Building grounds for psychiatric medication decisions in assertive community treatment. In M. O’Reilly and J. Lester (eds) Handbook of Adult Mental Health: Discourse and Conversation Studies, 371–393. London: Palgrave Macmillan.
Antaki, C. and Kent, A. (2012) Telling people what to do (and, sometimes, why): Contingency, entitlement and explanation in staff requests to adults with intellectual impairments. Journal of Pragmatics 44 (6–7): 876–889. https://doi.org/10.1016/j.pragma.2012.03.014
Costello, B. A. and Roberts F. (2001) Medical recommendations as joint social practice. Health Communication 13 (3): 241–260. https://doi.org/10.1207/S15327027HC1303_2
Curl, T. and Drew, P. (2008) Contingency and action: A comparison of two forms of requesting. Research on Language and Social Interaction 41 (2): 129–153. https://doi.org/10.1080/08351810802028613
Deegan, P. E. (2005) The importance of personal medicine: A qualitative study of resilience in people with psychiatric disabilities. Scandinavian Journal of Public Health 33 (Suppl 66): 29–35. https://doi.org/10.1080/14034950510033345
Drew, P. and Walker, T. (2010) Citizens’ emergency calls: Requesting assistance in calls to the police. In M. Coulthard and A. Johnson (eds) Routledge Handbook of Forensic Linguistics, 95–110. New York: Routledge.
Gill, V. T. (2005) Patient ‘demand’ for medical interventions: Exerting pressure for an offer in a primary care clinic visit. Research on Language and Social Interaction 38 (4): 451–479. https://doi.org/10.1207/s15327973rlsi3804_3
Gill, V. T., Halkowski, T. and Roberts, F. (2001) Accomplishing a request without making one: A single case analysis of a primary care visit. Text 21 (1–2): 55–82. https://doi.org/10.1515/text.1.21.1-2.55
Haakana, M. (2001) Laughter as a patient’s resource: Dealing with delicate aspects of medical interaction. Text 21 (1–2): 187–220. https://doi.org/10.1515/text.1.21.1-2.187
Halkowski, T. (2006) Realizing illness: Patients’ narratives of symptom discovery. In J. Heritage and D. W. Maynard (eds) Communication in Medical Care: Interaction between Primary Care Physicians and Patients, 86–114. Cambridge: Cambridge University Press.
Hamann, J., Cohen, R., Leucht, S., Busch, R. and Kissling, W. (2005) Do patients with schizophrenia wish to be involved in decisions about their medical treatment? American Journal of Psychiatry 162 (12): 2382–2384. https://doi.org/10.1176/appi.ajp.162.12.2382
Hamann, J., Leucht, S. and Kissling, W. (2003) Shared decision making in psychiatry. Acta Psychiatrica Scandinavica 107 (6): 403–409. https://doi.org/10.1034/j.1600-0447.2003.00130.x
Heinemann, T. (2006) ‘Will you or can’t you?’: Displaying entitlement in interrogative requests. Journal of Pragmatics 38 (7): 1081–1104. https://doi.org/10.1016/j.pragma.2005.09.013
Heritage, J. (2012) Epistemics in action: Action formation and territories of knowledge. Research on Language and Social Interaction 45 (1): 1–29. https://doi.org/10.1080/08351813.2012.646684
Heritage, J. and Robinson, J. D. (2006) Accounting for the visit: Giving reasons for seeking medical care. In J. Heritage and D. W. Maynard (eds) Communication in Medical Care: Interaction between Primary Care Physicians and Patients, 48–85. Cambridge: Cambridge University Press.
Jefferson, G. (2004) Glossary of transcript symbols with introduction. In G. Lerner (ed.) Conversation Analysis: Studies from the First Generation, 13–23. Amsterdam: John Benjamins. https://doi.org/10.1075/pbns.125.02jef
Koenig, C. J. (2011) Patient resistance as agency in treatment decisions. Social Science & Medicine 72 (7): 1105–1114. https://doi.org/10.1016/j.socscimed.2011.02.010
Kushida, S. and Yamakawa, Y. (2015) Fitting proposals to their sequential environment: A comparison of turn designs for proposing treatment in ongoing outpatient psychiatric consultations in Japan. Sociology of Health & Illness 37 (4): 522–544. https://doi.org/10.1111/1467-9566.12204
Landmark, A. M. D., Gulbrandsen, P. and Svennevig, J. (2015) Whose decision? Negotiating epistemic and deontic rights in medical treatment decisions. Journal of Pragmatics 78: 54–69. https://doi.org/10.1016/j.pragma.2014.11.007
Lindström, A. (2005) Language as social action: A study of how senior citizens request assistance with practical tasks in the Swedish home help service. In A. Hakulinen and M. Selting (eds) Syntax and Lexis in Conversation: Studies on the Use of Linguistic Resources in Talk-in-interaction, 209–232. Amsterdam: John Benjamins. https://doi.org/10.1075/sidag.17.11lin
Lindström, A. and Weatherall, A. (2015) Orientations to epistemics and deontics in treatment discussions. Journal of Pragmatics 78: 39–53. https://doi.org/10.1016/j.pragma.2015.01.005
Matthias, M. S., Salyers, M. P. and Frankel, R. M. (2013) Re-thinking shared decision-making: Context matters. Archives of Psychiatric Nursing 25: e27–e36. https://doi.org/10.1016/j.pec.2013.01.006
Maynard, D. W. (1991) Interaction and asymmetry in clinical discourse. American Journal of Sociology 97 (2): 448–495. https://doi.org/10.1086/229785
Quirk, A., Chapin, R., Lelliott, P. and Seale, C. (2009) The negotiation of prescribing decisions: Some good practice issues. In N. Harris, J. Baker and R. Gray (eds) Medicines Management in Mental Health Care, 133–144. Chichester, UK: Wiley Blackwell.
Quirk, A., Chapin, R., Lelliott, P. and Seale, C. (2012) How pressure is applied in shared decisions about antipsychotic medication: A conversation analytic study of psychiatric outpatient consultations. Sociology of Health and Illness 34 (1): 95–113. https://doi.org/10.1111/j.1467-9566.2011.01363.x
Robinson, J. D. (2001) Asymmetry in action: Sequential resources in the negotiation of a prescription request. Text 21 (1–2): 19–54. https://doi.org/10.1515/text.1.21.1-2.19
Robinson, J. D. (2003) An interactional structure of medical activities during acute visits and its implications for patients’ participation. Health Communication 15 (1): 27–57. https://doi.org/10.1207/S15327027HC1501_2
Rogers, A., Day, J. C., Williams, B., Randall, F., Wood, P., Healy, D. and Bentall, R. P. (1998) The meaning and management of neuroleptic medication: A study of patients with a diagnosis of schizophrenia. Social Science & Medicine 47 (9): 1313–1323. https://doi.org/10.1016/S0277-9536(98)00209-3
Rossi, G. (2012) Bilateral and unilateral requests: The use of imperatives and Mi X? interrogatives in Italian. Discourse Processes 49 (5): 426–458. https://doi.org/10.1080/0163853X.2012.684136
Sacks, H. and Schegloff, E. A. (1979) Two preferences in the organization of reference to persons in conversation and their interaction. In G. Psathas (ed.) Everyday Language: Studies in Ethnomethodology, 5–21. New York: Irvington.
Schauer, C., Everett, A., del Vecchio, P. and Anderson, L. (2007) Prompting the value and practice of shared decision-making in mental health care. Psychiatric Rehabilitation Journal 31 (1): 54–61. https://doi.org/10.2975/31.1.2007.54.61
Seale, C., Chapin, R., Lelliott, P. and Quirk, A. (2006) Sharing decisions in consultations involving anti-psychotic medication: A qualitative study of psychiatrists’ experiences. Social Science & Medicine 62 (11): 2861–2873. https://doi.org/10.1016/j.socscimed.2005.11.002
Shepherd, A., Shorthouse, O. and Gask, L. (2014) Consultant psychiatrists’ experiences of and attitudes towards shared decision making in antipsychotic prescribing, a qualitative study. BMC Psychiatry 14 (127). Retrieved from http://www.biomedcentral.com/1471-244X/14/127.
Sidnell, J. (2011) Conversation Analysis: An introduction. Oxford: Blackwell. https://doi.org/10.1093/obo/9780199772810-0062
Stivers, T. (2002a) Participating in decisions about treatment: Overt parent pressure for antibiotic medication in pediatric encounters. Social Science & Medicine 54 (7): 1111–1130. https://doi.org/10.1016/S0277-9536(01)00085-5
Stivers, T. (2002b) Presenting the problem in pediatric encounters: ‘Symptoms only’ versus ‘candidate diagnosis’ presentations. Health Communication 14 (3): 299–338. https://doi.org/10.1207/S15327027HC1403_2
Stivers, T. (2005a) Non-antibiotic treatment recommendations: Delivery formats and implications for parent resistance. Social Science & Medicine 60 (5): 949–964. https://doi.org/10.1016/j.socscimed.2004.06.040
Stivers, T. (2005b) Parent resistance to physicians’ treatment recommendations: One resource for initiating a negotiation of treatment recommendation. Health Communication 18 (1): 41–74. https://doi.org/10.1207/s15327027hc1801_3
Stivers, T. (2007) Prescribing under Pressure: Parent-Physician Conversations and Antibiotics. New York: Oxford University Press. https://doi.org/10.1093/acprof:oso/9780195311150.001.0001
Toerien, M., Shaw, R. and Reuber, M. (2013) Initiating decision-making in neurology consultations: ‘Recommending’ versus ‘option-listing’ and the implications for medical authority. Sociology of Health & Illness 35 (6): 873–890. https://doi.org/10.1111/1467-9566.12000
Woltman, E. M. and Whitley, R. (2010) Shared decision making in public mental health care: Perspectives from consumers living with severe mental illness. Psychiatric Rehabilitation Journal 34 (1): 29–36. https://doi.org/10.2975/34.1.2010.29.36
Wootton, A. J. (1981) Two request forms of four years olds. Journal of Pragmatics 5 (6): 511–523. https://doi.org/10.1016/0378-2166(81)90016-3
Published
2017-05-04
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How to Cite
Kushida, S., Hiramoto, T., & Yamakawa, Y. (2017). Patients’ practices for taking the initiative in decision-making in outpatient psychiatric consultations. Communication and Medicine, 13(2), 169-184. https://doi.org/10.1558/cam.27013
