Communication & Medicine, Vol 8, No 2 (2011)

‘Unilateral’ decision making and patient participation in primary care

Taru Ijäs-Kallio, Johanna Ruusuvuori, Anssi Peräkylä
Issued Date: 19 Jun 2012


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.

Download Media

PDF (Price: £17.50 )

DOI: 10.1558/cam.v8i2.145


Collins, S. (2005). Communicating for a clinical purpose: Strategy in interaction in healthcare consultations. Communication & Medicine 2 (2): 111–122.
Collins, S., Britten, N., Ruusuvuori, J. and Thompson, A. (2007). Understanding the process of patient participation. In Collins, S., Britten, N., Ruusuvuori, J. and Thompson, A. (eds) Patient participation in health care consultations. Qualitative perspectives 3–21. Maidenhead: Open University Press.
Collins, S., Drew, P., Watt, I. and Entwistle, V. (2005). ‘Unilateral’ and ‘bilateral’ practitioner approaches in decision-making about treatment. Social Science & Medicine 61 (12): 2611–2627.
Drew, P. (2001). Spotlight on the patient. Text 21 (1/2): 261–268.
Heritage, J. and Stivers, T. (1999). Online commentary in acute medical visits: A method of shaping patient expectations. Social Science & Medicine 49 (11): 1501–1517.
Peräkylä, A. (1998). Authority and accountability: The delivery of diagnosis in primary health care. Social Psychology Quarterly 61 (4): 301–320.
Peräkylä, A. (2002). Agency and authority: Extended responses to diagnostic statements in primary care encounters. Research on Language and Social Interaction, 35 (2): 219–247.
Pomerantz, A. (1984). Agreeing and disagreeing with assessments: Some features of preferred/dispreferred turn shapes. In J. M. Atkinson and J. Heritage (eds) Structures of Social Action. Studies in Conversation Analysis 57–101. Cambridge: Cambridge University Press.
Robinson, J. (2003). An interactional structure of medical activities during acute visits and its implications for patients’ participation. Health Communication 15 (1): 27–59.
Ruusuvuori, J. (2001). Looking means listening: Coordinating displays of engagement in doctor-patient interaction. Social Science & Medicine 52 (7): 1093–1108.
Schegloff, E.A. (1998). Body torque. Social Research 65: 535–596.
Schegloff, E. A. (2007). Sequence Organization in Interaction. A Primer in Conversation Analysis. Vol. 1. Cambridge: Cambridge University Press.
Stivers, T. (2002). Presenting the problem in pediatric visit: ‘Symptoms only’ versus ‘candidate diagnosis’ presentations. Health Communication 14 (3): 299–338.
Stivers, T. (2005a). Parent resistance to physicians’ treatment recommendations: One resource for initiating a negotiation of the treatment decision. Health Communication 18 (1): 41–74.
Stivers, T. (2005b). Non-antibiotic treatment recommendations: Delivery formats and implications for parent resistance. Social Science & Medicine 60 (5): 949–964.


  • There are currently no refbacks.

Equinox Publishing Ltd - 415 The Workstation 15 Paternoster Row, Sheffield, S1 2BX United Kingdom
Telephone: +44 (0)114 221-0285 - Email:

Privacy Policy