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Doctor-patient interaction in a randomised controlled trial of decision-support tools

Author

Listed:
  • Rapley, Tim
  • May, Carl
  • Heaven, Ben
  • Murtagh, Madeline
  • Graham, Ruth
  • Kaner, Eileen F.S.
  • Thomson, Richard

Abstract

In this paper, we draw on the analytic perspectives of ethnomethodology to explore doctor-patient encounters in an experimental trial of a complex intervention: an efficacy randomised controlled trial (RCT) of decision-support tools in the UK. We show how the experimental context in which these encounters take place pervades the interactions within them. We argue that two interactional orders were at work in the encounters that we observed: (i) the ceremonial order of the consultation and (ii) the assemblage of the decision-support tool trial. We demonstrate how doctors in the trial oscillate between positions as authoritative clinician and neutralistic decision-support tool-implementer, and patients move between positions as passive recipients of clinical knowledge and as active subjects required to render their experience as calculable in terms of the demands of the decision-support tools and the broader trial they are embedded in. We demonstrate how the RCT coordinates the world of the clinical environment and the world of experimental evidence.

Suggested Citation

  • Rapley, Tim & May, Carl & Heaven, Ben & Murtagh, Madeline & Graham, Ruth & Kaner, Eileen F.S. & Thomson, Richard, 2006. "Doctor-patient interaction in a randomised controlled trial of decision-support tools," Social Science & Medicine, Elsevier, vol. 62(9), pages 2267-2278, May.
    • Handle: RePEc:eee:socmed:v:62:y:2006:i:9:p:2267-2278
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    References listed on IDEAS

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    1. Armstrong, David, 1985. "Space and time in British general practice," Social Science & Medicine, Elsevier, vol. 20(7), pages 659-666, January.
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    Cited by:

    1. Smith, Sian K. & Dixon, Ann & Trevena, Lyndal & Nutbeam, Don & McCaffery, Kirsten J., 2009. "Exploring patient involvement in healthcare decision making across different education and functional health literacy groups," Social Science & Medicine, Elsevier, vol. 69(12), pages 1805-1812, December.
    2. Simon Dyson & Sue Dyson, 2014. "The Politics of Health Services Research: Health Professionals as Hired Hands in a Commissioned Research Project in England," Sociological Research Online, , vol. 19(3), pages 118-128, September.
    3. May, Carl, 2013. "Agency and implementation: Understanding the embedding of healthcare innovations in practice," Social Science & Medicine, Elsevier, vol. 78(C), pages 26-33.

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