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Patient resistance towards clinicians’ diagnostic test-taking advice and its management in Chinese outpatient clinic interaction

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  • Zhao, Chunjuan
  • Ma, Wen

Abstract

Performing diagnostic tests is a fundamental information-gathering activity in diagnostic process. However, little attention has been paid to the interactional process where a diagnostic test is advised and received, especially in Chinese medical settings. Decision making over prescribing diagnostic tests consists of clinicians' advice and patients' acceptance or resistance/rejection. Drawing on audio-recordings of clinician-patient encounters in Chinese outpatient clinics as data and conversation analysis as a method, we discuss how patient resistance to clinicians' diagnostic test-taking advice is displayed and managed over sequences of interaction. Two types of advice deliveries have been identified: advice either with no diagnostic utterances or with indeterminate diagnostic utterances. We find that patients demonstrate their resistance towards the former type of advice in two ways: questioning clinicians’ decisions and proposing an alternative plan. Displaying resistance to the latter type of advice, patients have been found to recurrently resort to one way: proffering additional information about personal experience. Confronted with resistance, clinicians generally proceed to justify decisions by either asserting their epistemic primacy in determining a test or lowering certainty in the original speculative diagnosis. Towards persistent resistance, clinicians mainly employ two techniques to impose acceptance onto patients: repeating the initial advice and terminating forcefully current sequence. This study adds to a growing body of research on resistance in medical settings and contributes to our understanding of the decision making over medical investigations in Chinese outpatient clinic interaction.

Suggested Citation

  • Zhao, Chunjuan & Ma, Wen, 2020. "Patient resistance towards clinicians’ diagnostic test-taking advice and its management in Chinese outpatient clinic interaction," Social Science & Medicine, Elsevier, vol. 258(C).
    • Handle: RePEc:eee:socmed:v:258:y:2020:i:c:s0277953620302604
    DOI: 10.1016/j.socscimed.2020.113041
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    References listed on IDEAS

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    Cited by:

    1. Paulus, Trena M. & Grubbs, Heather & Rice-Moran, Renee & Lester, Jessica N., 2023. "How student healthcare providers in a communication skills course respond to standardized patient resistance," Social Science & Medicine, Elsevier, vol. 337(C).
    2. Lindström, Anna K.B. & Tängdén, Thomas, 2022. "Introducing the C-reactive protein point-of-care test: A conversation analytic study of primary care consultations for respiratory tract infection," Social Science & Medicine, Elsevier, vol. 315(C).

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