title: Justifying medication decisions in mental health care: Psychiatrists' accounts for treatment recommendations.
abstract: Psychiatric practitioners are currently encouraged to adopt a patient centered approach that emphasizes the sharing of decisions with their clients, yet recent research suggests that fully collaborative decision making is rarely actualized in practice. This paper uses the methodology of Conversation Analysis to examine how psychiatrists justify their psychiatric treatment recommendations to clients. The analysis is based on audio-recordings of interactions between clients with severe mental illnesses (such as, schizophrenia, bipolar disorders, etc.) in a long-term, outpatient intensive community treatment program and their psychiatrist. Our focus is on how practitioners design their accounts (or rationales) for recommending for or against changes in medication type and dosage and the interactional deployment of these accounts. We find that psychiatrists use two different types of accounts: they tailor their recommendations to the clients' concerns and needs (client-attentive accounts) and ground their recommendations in their professional expertise (authority-based accounts). Even though psychiatrists have the institutional mandate to prescribe medications, we show how the use of accounts displays psychiatrists' orientation to building consensus with clients in achieving medical decisions by balancing medical authority with the sensitivity to the treatment relationship.
authors.affiliation: School of Social Work and the Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, United States. Electronic address: angell@ssw.rutgers.edu.
authors.forename: Beth
authors.initials: B
authors.lastname: Angell
authors.affiliation: School of Communication and Information, Rutgers, the State University of New Jersey, United States.
authors.forename: Galina B
authors.initials: GB
authors.lastname: Bolden
mesh_terms: D003155:Community Mental Health Centers; D003299:Cooperative Behavior; D003657:Decision Making; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy*; D010358:Patient Participation; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D011570:Psychiatry / Q000379:methods; D014481:United States
keywords: Accounts; Assertive community treatment; Conversation analysis; Medical recommendations; Mental health; Psychiatry; Shared decision-making; United States