Making medical decisions in pediatric consultations : a conversation-analytic study of sequences and actions of physician-parent interaction in a Chinese hospital

Abstract

This research investigates the physician-parent interaction when making medical decisions. Specifically, it examines how the interaction during the making of treatment and prescription decisions is accomplished through sequences of talks and particular turn designs within the treatment recommendation stage. Conversation Analysis (CA) is adopted as the methodology. Sixty video-recorded pediatric consultations have been collected in a hospital in mainland China. Fifty were transcribed and analyzed in considerable details. While studies on medical interaction and shared decision making in China do exist, the present study is a first attempt that approached the topic from CA's qualitative perspective. The findings show that treatment decisions interactions are organized in a way that parent acceptance is required to reach an agreement. The sequence structure normally follows two paths: (1) it will be minimal if the physician's treatment recommendation is followed by parent acceptance; and (2) it will be extended if the parent resists the recommendation (because physicians normally pursue parent acceptance until it is obtained). Parents and physicians' interactional resources for negotiating treatment decisions are also identified and described. In responding to physician's treatment recommendation, parents would either accept or resist with passive or active devices. Physicians will either pursue their acceptance of the original recommendation in various ways or offer alternative plans contingent on the patients' necessity, if parents resist their treatment recommendation. Prescription decision is also investigated. The data show that in making prescription decisions, physicians normally initiate a pre-prescribing sequence to see whether it is warranted to produce the prescribing sequence. Parent responses to physician's pre-prescribing questions are found consequential to the sequence trajectories. The physician proceeds to issue a prescription recommendation if the parent gives a 'go-ahead' response; the physician withholds the issuance of a recommendation the parent gives a 'blocking' response. The sequence will be truncated if the parent provides a 'request' response to the pre-prescribing question; the sequence will be expanded with insertion sequences or post-expansions, in which communication problems of various kinds are dealt with. It is also possible for parents to initiate the sequence for prescription decision.