title: Initiating decision-making in neurology consultations: 'recommending' versus 'option-listing' and the implications for medical authority.
abstract: This article compares two practices for initiating treatment decision-making, evident in audio-recorded consultations between a neurologist and 13 patients in two hospital clinics in the UK. We call these 'recommending' and 'option-listing'. The former entails making a proposal to do something; the latter entails the construction of a list of options. Using conversation analysis (CA), we illustrate each, showing that the distinction between these two practices matters to participants. Our analysis centres on two distinctions between the practices: epistemic differences and differences in the slots each creates for the patient's response. Considering the implications of our findings for understanding medical authority, we argue that option-listing - relative to recommending - is a practice whereby clinicians work to relinquish a little of their authority. This article contributes, then, to a growing body of CA work that offers a more nuanced, tempered account of medical authority than is typically portrayed in the sociological literature. We argue that future CA studies should map out the range of ways - in addition to recommending - in which treatment decision-making is initiated by clinicians. This will allow for further evidence-based contributions to debates on the related concepts of patient participation, choice, shared decision-making and medical authority.
authors.affiliation: Department of Sociology, University of York, Heslington, York, Y010 5DD. merran.toerien@york.ac.uk
authors.forename: Merran
authors.initials: M
authors.lastname: Toerien
authors.forename: Rebecca
authors.initials: R
authors.lastname: Shaw
authors.forename: Markus
authors.initials: M
authors.lastname: Reuber
mesh_terms: D000328:Adult; D002755:Choice Behavior; D003142:Communication; D003657:Decision Making; D004213:Dissociative Disorders / Q000175:diagnosis / Q000628:therapy; D004827:Epilepsy / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006748:Hospital Departments; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000175:diagnosis / Q000628:therapy; D009462:Neurology / Q000379:methods*; D010817:Physician-Patient Relations; D017009:Professional Autonomy; D036301:Qualitative Research; D012017:Referral and Consultation; D012640:Seizures / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D013997:Time Factors; D006113:United Kingdom
keywords: conversation analysis; decision-making; doctor-patient interaction; medical authority; treatment recommendations