Negotiation strategies and patient empowerment in Spanish and British medical consultations
Issued Date: 19 Jun 2012
Abstract
Making a decision is not only one of the physician’s most important responsibilities but also one of patients’ most sensitive moments in medical encounters. Drawing from pragmatics studies, this paper explores rapport maintenance and/or enhancement (Spencer-Oatey 2000, 2008) in the decision-making strategies that General Practitioners (GPs) and patients employ in 80 encounters in various areas of England and Spain. The results show that such strategies are context-bound and subject to role specifications: while patients may make use of (dis)agreement strategies and initiate decisions and/or self-diagnosis, doctors give options, show empathy, expand explanations or show explicit or implicit (dis)agreement. In relation to this, notable findings were revealed: first, these communicative strategies may vary not only in terms of frequency but also quality and distribution; second, the Spanish interlocutors in the data gathered tend to negotiate through the explicit expression of opinions, while the British interlocutors prefer the discussion of different alternatives and value the other’s freedom to act. Third, there is higher tolerance of disagreement in the Spanish data. Fourth, negotiation may be undertaken on the basis of either self-affirmation or consensus-seeking beliefs. Finally, patient empowerment is displayed in divergent ways in both sets of data. In short, the decision-making processes examined are subject to social and psychological factors with a direct impact on communicative styles.
Download Media
PDF (Price: £17.50 )
DOI: 10.1558/cam.v8i2.169
References
Atkinson, J. and Heritage, J. (1984). Transcript notation. In J. M. Atkinson and J. Heritage (eds) Structures of Social Action. Studies in Conversational Analysis, ix–xvi. Cambridge: Cambridge University Press.
Bartesaghi, M. (2009). How the therapist does authority: six strategies for substituting client accounts in the session. Communication and Medicine 6 (1): 15–25. http://dx.doi.org/10.1558/cam.v6i1.15
Bissel, P., May, R., Carl y Noyce, P. (2004). From compliance to concordance: barriers to accomplishing a re-framed model of health care interactions. Social Science and Medicine 58 (4): 851–862. http://dx.doi.org/10.1016/S0277-9536(03)00259-4
Burnard, L. (ed.) (1995). Users Reference Guide for the British National Corpus. Published for the British National Corpus Consortium. Oxford University Computing Services, May 1995.
Broadstock, M. and Michie, S. (2000). Processes of patient decision making: theoretical and methodological issues. Psychology and Health 15 (2): 191–204. http://dx.doi.org/10.1080/08870440008400300
Brown, B., Crawford, P., and Carter, R. (2006). Evidence-based Health Communication. Buckingham: Open University Press.
Brown, P. and Levinson, S. ([1978] 1987). Politeness. Some Universals of Language Use. Cambridge: Cambridge University Press.
Campbell, K. S. (2005). The rapport management model: how physicians build relationships with patients. International Professional Communication Conference Proceedings: 422–432. http://dx.doi.org/10.1109/IPCC.2005.1494206
Candlin, C. and Candlin, S. (2003). Health care communication: a problematic site for applied linguistics research. Annual Review of Applied Linguistics 23 (1): 134–154.
Cohen, G. L., García, J., Purdie-Vaughns, V., Apfel, N. and Brzustoski, P. (2009). Recursive processes in self-affirmation: Intervening to close the minority achievement gap. Science 324 (5925): 400–403. http://dx.doi.org/10.1126/science.1170769
Cordella, M. (2007). ‘No, no, I haven’t been taking it Doctor’: Noncompliance, face-saving, and face-threatening acts in medical consultations. In M. E. Placencia and C. García (eds.) Research on Politeness in the Spanish-Speaking World 191–241. New York: Lawrence Erlbaum.
Cordella, M. and Musgrave, S. (2009). Oral communication skills of international medical graduates: Assessing empathy in discourse. Communication and Medicine 6 (2): 129–142.
Elwyn G., Edwards A., Wensing, M., Hood, K., Atwell, C. and Grol, R. (2003). Shared decision making: Developing the OPTION scale for measuring patient involvement. Quality and Safety in Health Care 12 (2): 93–99. http://dx.doi.org/10.1136/qhc.12.2.93
Elwyn, G., Hutchings, H., Edwards, A., Rapport, F., Wensing, M., Cheung, W. and Grol, R., (2005). The OPTION scale: Measuring the extent that clinicians involve patients in decision-making tasks. Health Expectations 8 (1): 34–42. http://dx.doi.org/10.1111/j.1369-7625.2004.00311.x
Erzinger, S. (1991). Communication between Spanish-speaking patients and their doctors in medical encounters. Culture, Medicine and Psychiatry 15 (1): 91–110. http://dx.doi.org/10.1007/BF00050829
Fant, L. (1989). Cultural mismatch in conversations: Spanish and Scandinavian communicative behaviour in negotiation settings. Hermes Journal of Linguistics 2: 247–265.
Fant, L. (1995). Negotiation discourse and interaction in cross-cultural perspective: the case of Sweeden and Spain. In K. Ehlich and J. Wagner (eds) The Discourse of Business Communication 177–201. Berlin: Mouton de Gruyter.
Fant, L. (2007). Rapport and identity management: A model and its application to Spanish dialogue. In M. E. Placencia and C. García (eds) Research on Politeness in the Spanish-speaking World 335–365. London: Routledge.
Guilfoyle, M. (2005). From therapeutic power to resistance? Theory and Psychology 15 (1): 101-124. http://dx.doi.org/10.1177/0959354305049748
Hall. J., Irish, J., Roter, D., Ehrlich, C., Miller, L. (1994). Satisfaction, gender, and communication in medical visits. Medical Care 32 (12): 1216–1231.
Harrison, S. and Barlow, J. (2009). Politeness strategies and advice-giving in an online arthritis workshop. Journal of Politeness Research 5 (1): 93–111.
Heine, S. J. and Lehman, D. R. (1997). Culture, dissonance and self-affirmation. Personality and Social Psychology Bulleting 23 (4): 289–400. http://dx.doi.org/10.1177/0146167297234005
Heritage, J. (1984). Structures of Social Action. Cambridge: Cambridge University Press.
Heritage, J. and Maynard, D. (2006). Problems and prospects in the study of physician-patient interaction: 30 years of research. Annual Review of Sociology 32: 351–374. http://dx.doi.org/10.1146/annurev.soc.32.082905.093959
Hernández López, M. and Placencia, M. E. (2004). Modos de conducirlasrelacionesinterpersonales en interacciones de atención al público: el caso de lasfarmacias en Sevilla y Londres. Estudios de Lingüística de la Universidad de Alicante (ELUA) 18: 129–150.
Hewett, D. G., Watson, B. M., Gallois, C., Ward, M. and Leggett, B. A. (2009). Communication in medical records. Intergroup language and patient care. Journal of Language and Social Psychology 28 (2): 119–138. http://dx.doi.org/10.1016/j.pec.2009.08.008
Holmstrom, I., and Roing, M., (2010). The relation between patient-centeredness and patient empowerment: a discussion of concepts. Patient Education and Counselling 79 (1): 167–172.
Iedema, R. (2007). The Discourse of Hospital Communication: Tracing Complexities in Contemporary Health Organizations. Basingstoke: Palgrave Macmillan.
Kalbfleish, P. J. (2009). Effective health communication in native populations in North America. Journal of Language and Social Psychology 28 (2): 158–173. http://dx.doi.org/10.1177/0261927X08330607
Lehtinen, E. (2007). Merging doctor and client knowledge: on doctors’ ways of dealing with clients’ potentially discrepant information in genetic counselling. Journal of Pragmatics 39 (2): 349–427.
Locher, M. (2004). Power and Politeness in Action. Disagreements in Oral Communication. Nueva York: Mouton de Gruyter.
Locher, M. y Watts, R. (2005). Politeness theory and relational work. Journal of Politeness Research 1: 9–13.
Long Feather, C. (2007). Communicating with native elders: A positional approach. Journal of Native Aging and Health 2 (2): 5–10.
Mills, S. (2003). Gender and Politeness. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511615238
Mullany, L. (2009). Applying politeness research to health care communication. Journal of Politeness Research 5 (1): 1–10.
Pesquera, M., Yoder, L. and Lynk, M. (2008). Improving cross-cultural awareness and skills to reduce health disparities in cancer. Medical Surgery Nursing 17 (2): 114–120.
Pierce, P.F. (1996). When the patient chooses: Describing unaided decisions in health care. Human Factors 38 (2): 278–287. http://dx.doi.org/10.1518/001872096779048084
Piper, S. (2010). Patient empowerment: Emancipatory or technological practice? Patient Education and Counselling 79 (1): 173–177. http://dx.doi.org/10.1016/j.pec.2009.09.032
Redelmeier, D. A., Rozin, P. and Kahneman, D. (1993). Understanding patients’ decisions: cognitive and emotional perspectives. Journal of American Medical Association 270 (1): 72–76. http://dx.doi.org/10.1001/jama.1993.03510010078034
Rivadeneyra, R., Elderkin-Thompson, V., Cohen Silver, R., Waitzkin, H. (2000). Patient centeredness in medical encounters requiring an interpreter. The American Journal of Medicine 108 (6): 470–474. http://dx.doi.org/10.1016/S0002-9343(99)00445-3
Roberts, C. and Sarangi, S. (2002). Mapping and assessing medical student’s interactional involvement styles with patients. In K. Spellman-Miller and P. Thompson (eds) Unity and Diversity in Language Use 99–117. London: Continuum.
Sarangi, S. and Slembrouck, S. (1997). Confrontational asymmetries in institutional discourse: Asociopragmatic view of information exchange and face management. In J. Blommaert and C. Bulcaen (eds) Political Linguistics 255–275. Amsterdam: John Benjamins.
Sherman, D. K., and Cohen, G. L. (2006). The psychology of self-defense: Self-affirmation theory. In M. P. Zanna (ed.) Advances in Experimental Social Psychology 38: 183–242. San Diego, CA: Academic Press.
Spencer-Oatey, H. (2000). Culturally Speaking. Managing Rapport through Talk across Cultures. London: Continuum.
Spencer-Oatey, H. (2008). Culturally Speaking. Culture, Communication and Politeness. London: Continuum.
Steele, C. (1988). The psychology of self-affirmation: sustaining the integrity of the self. In L. Berkowitz (ed.) Advances in Experimental Social Psychology 21: 261–302. New York: Academic Press.
Street, R. (1991). Information-giving in medical consultations: The influence of patients’ communicative styles and personal characteristics. Social Science Medicine 32 (5): 541–548. http://dx.doi.org/10.1016/0277-9536(91)90288-N
Street, R., Voigt, B., Geyer, C., Manning, T. and Swanson, G. (1993). Increasing patient involvement in choosing treatment for early breast cancer. Cancer 76 (11): 2275–2285. http://dx.doi.org/10.1002/1097-0142(19951201)76:113.0.CO;2-S
Thesen, J. (2005). From oppression towards empowerment in clinical practice –offering doctors a model for reflection. Scandinavian Journal of Public Health Supplement 66: 47–52. http://dx.doi.org/10.1080/14034950510033372
Thomas, J. (1983). Cross-cultural pragmatic failure. Applied Linguistics 4 (2): 91–112. http://dx.doi.org/10.1093/applin/4.2.91
Thurén, B. (1988). Left Hand Left Behind. The Changing Gender System of a Barrio in Valencia, Spain. Stockholm: Stockholm Studies in Social Anthropology.
Valbuena de la Fuente, F. (2003). Pragmática de la negociación. Cuadernos de Información y Comunicación 8: 71–116.
Van Wieringen, J. C. M., Harmsen, J. A. M. and Bruijinzeels, M. A. (2002). Intercultural communication in general practice. European Journal of Public Health 12 (1): 63–68. http://dx.doi.org/10.1093/eurpub/12.1.63
Wang, J. (2006) Questions and the exercise of power. Discourse and Society 17 (4): 529–548. http://dx.doi.org/10.1177/0957926506063127
Watts, R. J. (2003). Politeness. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511615184
Young, A. and Flower, L. (2002) Patients as partners, patients as problem-solvers. Health Communication 14 (1): 69–97. http://dx.doi.org/10.1207/S15327027HC1401_4
Bartesaghi, M. (2009). How the therapist does authority: six strategies for substituting client accounts in the session. Communication and Medicine 6 (1): 15–25. http://dx.doi.org/10.1558/cam.v6i1.15
Bissel, P., May, R., Carl y Noyce, P. (2004). From compliance to concordance: barriers to accomplishing a re-framed model of health care interactions. Social Science and Medicine 58 (4): 851–862. http://dx.doi.org/10.1016/S0277-9536(03)00259-4
Burnard, L. (ed.) (1995). Users Reference Guide for the British National Corpus. Published for the British National Corpus Consortium. Oxford University Computing Services, May 1995.
Broadstock, M. and Michie, S. (2000). Processes of patient decision making: theoretical and methodological issues. Psychology and Health 15 (2): 191–204. http://dx.doi.org/10.1080/08870440008400300
Brown, B., Crawford, P., and Carter, R. (2006). Evidence-based Health Communication. Buckingham: Open University Press.
Brown, P. and Levinson, S. ([1978] 1987). Politeness. Some Universals of Language Use. Cambridge: Cambridge University Press.
Campbell, K. S. (2005). The rapport management model: how physicians build relationships with patients. International Professional Communication Conference Proceedings: 422–432. http://dx.doi.org/10.1109/IPCC.2005.1494206
Candlin, C. and Candlin, S. (2003). Health care communication: a problematic site for applied linguistics research. Annual Review of Applied Linguistics 23 (1): 134–154.
Cohen, G. L., García, J., Purdie-Vaughns, V., Apfel, N. and Brzustoski, P. (2009). Recursive processes in self-affirmation: Intervening to close the minority achievement gap. Science 324 (5925): 400–403. http://dx.doi.org/10.1126/science.1170769
Cordella, M. (2007). ‘No, no, I haven’t been taking it Doctor’: Noncompliance, face-saving, and face-threatening acts in medical consultations. In M. E. Placencia and C. García (eds.) Research on Politeness in the Spanish-Speaking World 191–241. New York: Lawrence Erlbaum.
Cordella, M. and Musgrave, S. (2009). Oral communication skills of international medical graduates: Assessing empathy in discourse. Communication and Medicine 6 (2): 129–142.
Elwyn G., Edwards A., Wensing, M., Hood, K., Atwell, C. and Grol, R. (2003). Shared decision making: Developing the OPTION scale for measuring patient involvement. Quality and Safety in Health Care 12 (2): 93–99. http://dx.doi.org/10.1136/qhc.12.2.93
Elwyn, G., Hutchings, H., Edwards, A., Rapport, F., Wensing, M., Cheung, W. and Grol, R., (2005). The OPTION scale: Measuring the extent that clinicians involve patients in decision-making tasks. Health Expectations 8 (1): 34–42. http://dx.doi.org/10.1111/j.1369-7625.2004.00311.x
Erzinger, S. (1991). Communication between Spanish-speaking patients and their doctors in medical encounters. Culture, Medicine and Psychiatry 15 (1): 91–110. http://dx.doi.org/10.1007/BF00050829
Fant, L. (1989). Cultural mismatch in conversations: Spanish and Scandinavian communicative behaviour in negotiation settings. Hermes Journal of Linguistics 2: 247–265.
Fant, L. (1995). Negotiation discourse and interaction in cross-cultural perspective: the case of Sweeden and Spain. In K. Ehlich and J. Wagner (eds) The Discourse of Business Communication 177–201. Berlin: Mouton de Gruyter.
Fant, L. (2007). Rapport and identity management: A model and its application to Spanish dialogue. In M. E. Placencia and C. García (eds) Research on Politeness in the Spanish-speaking World 335–365. London: Routledge.
Guilfoyle, M. (2005). From therapeutic power to resistance? Theory and Psychology 15 (1): 101-124. http://dx.doi.org/10.1177/0959354305049748
Hall. J., Irish, J., Roter, D., Ehrlich, C., Miller, L. (1994). Satisfaction, gender, and communication in medical visits. Medical Care 32 (12): 1216–1231.
Harrison, S. and Barlow, J. (2009). Politeness strategies and advice-giving in an online arthritis workshop. Journal of Politeness Research 5 (1): 93–111.
Heine, S. J. and Lehman, D. R. (1997). Culture, dissonance and self-affirmation. Personality and Social Psychology Bulleting 23 (4): 289–400. http://dx.doi.org/10.1177/0146167297234005
Heritage, J. (1984). Structures of Social Action. Cambridge: Cambridge University Press.
Heritage, J. and Maynard, D. (2006). Problems and prospects in the study of physician-patient interaction: 30 years of research. Annual Review of Sociology 32: 351–374. http://dx.doi.org/10.1146/annurev.soc.32.082905.093959
Hernández López, M. and Placencia, M. E. (2004). Modos de conducirlasrelacionesinterpersonales en interacciones de atención al público: el caso de lasfarmacias en Sevilla y Londres. Estudios de Lingüística de la Universidad de Alicante (ELUA) 18: 129–150.
Hewett, D. G., Watson, B. M., Gallois, C., Ward, M. and Leggett, B. A. (2009). Communication in medical records. Intergroup language and patient care. Journal of Language and Social Psychology 28 (2): 119–138. http://dx.doi.org/10.1016/j.pec.2009.08.008
Holmstrom, I., and Roing, M., (2010). The relation between patient-centeredness and patient empowerment: a discussion of concepts. Patient Education and Counselling 79 (1): 167–172.
Iedema, R. (2007). The Discourse of Hospital Communication: Tracing Complexities in Contemporary Health Organizations. Basingstoke: Palgrave Macmillan.
Kalbfleish, P. J. (2009). Effective health communication in native populations in North America. Journal of Language and Social Psychology 28 (2): 158–173. http://dx.doi.org/10.1177/0261927X08330607
Lehtinen, E. (2007). Merging doctor and client knowledge: on doctors’ ways of dealing with clients’ potentially discrepant information in genetic counselling. Journal of Pragmatics 39 (2): 349–427.
Locher, M. (2004). Power and Politeness in Action. Disagreements in Oral Communication. Nueva York: Mouton de Gruyter.
Locher, M. y Watts, R. (2005). Politeness theory and relational work. Journal of Politeness Research 1: 9–13.
Long Feather, C. (2007). Communicating with native elders: A positional approach. Journal of Native Aging and Health 2 (2): 5–10.
Mills, S. (2003). Gender and Politeness. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511615238
Mullany, L. (2009). Applying politeness research to health care communication. Journal of Politeness Research 5 (1): 1–10.
Pesquera, M., Yoder, L. and Lynk, M. (2008). Improving cross-cultural awareness and skills to reduce health disparities in cancer. Medical Surgery Nursing 17 (2): 114–120.
Pierce, P.F. (1996). When the patient chooses: Describing unaided decisions in health care. Human Factors 38 (2): 278–287. http://dx.doi.org/10.1518/001872096779048084
Piper, S. (2010). Patient empowerment: Emancipatory or technological practice? Patient Education and Counselling 79 (1): 173–177. http://dx.doi.org/10.1016/j.pec.2009.09.032
Redelmeier, D. A., Rozin, P. and Kahneman, D. (1993). Understanding patients’ decisions: cognitive and emotional perspectives. Journal of American Medical Association 270 (1): 72–76. http://dx.doi.org/10.1001/jama.1993.03510010078034
Rivadeneyra, R., Elderkin-Thompson, V., Cohen Silver, R., Waitzkin, H. (2000). Patient centeredness in medical encounters requiring an interpreter. The American Journal of Medicine 108 (6): 470–474. http://dx.doi.org/10.1016/S0002-9343(99)00445-3
Roberts, C. and Sarangi, S. (2002). Mapping and assessing medical student’s interactional involvement styles with patients. In K. Spellman-Miller and P. Thompson (eds) Unity and Diversity in Language Use 99–117. London: Continuum.
Sarangi, S. and Slembrouck, S. (1997). Confrontational asymmetries in institutional discourse: Asociopragmatic view of information exchange and face management. In J. Blommaert and C. Bulcaen (eds) Political Linguistics 255–275. Amsterdam: John Benjamins.
Sherman, D. K., and Cohen, G. L. (2006). The psychology of self-defense: Self-affirmation theory. In M. P. Zanna (ed.) Advances in Experimental Social Psychology 38: 183–242. San Diego, CA: Academic Press.
Spencer-Oatey, H. (2000). Culturally Speaking. Managing Rapport through Talk across Cultures. London: Continuum.
Spencer-Oatey, H. (2008). Culturally Speaking. Culture, Communication and Politeness. London: Continuum.
Steele, C. (1988). The psychology of self-affirmation: sustaining the integrity of the self. In L. Berkowitz (ed.) Advances in Experimental Social Psychology 21: 261–302. New York: Academic Press.
Street, R. (1991). Information-giving in medical consultations: The influence of patients’ communicative styles and personal characteristics. Social Science Medicine 32 (5): 541–548. http://dx.doi.org/10.1016/0277-9536(91)90288-N
Street, R., Voigt, B., Geyer, C., Manning, T. and Swanson, G. (1993). Increasing patient involvement in choosing treatment for early breast cancer. Cancer 76 (11): 2275–2285. http://dx.doi.org/10.1002/1097-0142(19951201)76:113.0.CO;2-S
Thesen, J. (2005). From oppression towards empowerment in clinical practice –offering doctors a model for reflection. Scandinavian Journal of Public Health Supplement 66: 47–52. http://dx.doi.org/10.1080/14034950510033372
Thomas, J. (1983). Cross-cultural pragmatic failure. Applied Linguistics 4 (2): 91–112. http://dx.doi.org/10.1093/applin/4.2.91
Thurén, B. (1988). Left Hand Left Behind. The Changing Gender System of a Barrio in Valencia, Spain. Stockholm: Stockholm Studies in Social Anthropology.
Valbuena de la Fuente, F. (2003). Pragmática de la negociación. Cuadernos de Información y Comunicación 8: 71–116.
Van Wieringen, J. C. M., Harmsen, J. A. M. and Bruijinzeels, M. A. (2002). Intercultural communication in general practice. European Journal of Public Health 12 (1): 63–68. http://dx.doi.org/10.1093/eurpub/12.1.63
Wang, J. (2006) Questions and the exercise of power. Discourse and Society 17 (4): 529–548. http://dx.doi.org/10.1177/0957926506063127
Watts, R. J. (2003). Politeness. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511615184
Young, A. and Flower, L. (2002) Patients as partners, patients as problem-solvers. Health Communication 14 (1): 69–97. http://dx.doi.org/10.1207/S15327027HC1401_4
Refbacks
- There are currently no refbacks.
