Fitting proposals to their sequential environment: a comparison of turn designs for proposing treatment in ongoing outpatient psychiatric consultations in Japan

Kushida, Shuya; Yamakawa, Yuriko

doi:10.1111/1467-9566.12204

Cited by 23 publications

(27 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The present study thus advances our understanding of patient advocacy in mental health settings, adding to a small but growing body of conversation analytic literature on psychiatric interactions (e.g. Angell and Bolden , , Bergmann , Bolden and Angell , Kushida and Yamakawa , , McCabe et al . , , Quirk et al .…”

Section: Introductionmentioning

confidence: 59%

See 1 more Smart Citation

How clients solicit medication changes in psychiatry

Bolden

Angell

Hepburn

2019

Sociology Health & Illness

View full text Add to dashboard Cite

In psychiatry, practitioners are encouraged to adopt a patient-centred approach that emphasises shared decision-making. In this article, we investigate how clients with severe mental illnesses (e.g. schizophrenia) advocate for their treatment preferences in psychiatric consultations. The study uses Conversation Analysis to examine audio-recorded medication check appointments in a comprehensive treatment programme known as assertive community treatment (ACT). The analysis shows that clients solicit medication changes at activity boundaries and design them in one of the following ways: reporting a physical problem; reporting a medication problem; explicitly requesting a medication change; and demanding a change. These formats put pressure on the psychiatrist to respond by either offering a solution to the client's problem or by accepting or rejecting the client's request. Through a detailed analysis of clients' communicative behaviours, we show that, in soliciting a medication change, clients ordinarily respect boundaries of medical authority and present themselves as 'good' patients who are reliable witnesses of their own experiences. Overall, the paper advances our understanding of patient advocacy in psychiatry and mental health interactions more generally.

show abstract

Section: Introductionmentioning

confidence: 59%

“…). Psychiatrists may also design their recommendations so as to fit the client's perspective (Kushida and Yamakawa ) and address the client's concerns (Angell and Bolden , ); they may also justify and account for their recommendations in ways that draw on their medical authority (Angell and Bolden , ).…”

Section: Introductionmentioning

confidence: 99%

How clients solicit medication changes in psychiatry

Bolden

Angell

Hepburn

2019

Sociology Health & Illness

View full text Add to dashboard Cite

show abstract

“…This delicate balance leaves it up to the patient whether to orient, in response, to the implied action (recommending) or the on-record action (informing). In that regard, assertions function in a similar way to the illness explanations (Gill & Maynard, 2006) and the declarative evaluations (Kushida & Yamakawa, 2015) discussed in the introduction, above.…”

Section: Discussionmentioning

confidence: 88%

“…Although treatment recommendations have long been of special interest to those investigating communication in medical care, there has been little work exploring whether particular turn designs may be employed, systematically, in particular sequential environments. A notable exception is a study of psychiatric consultations in Japan, which compares two formats for treatment proposals: an inclusive "we" form (translated as "let's do x" or "how about x") and declarative evaluations (such as, "it might be better to x") (Kushida & Yamakawa, 2015). The authors demonstrate that the former turn design is used when decision-making proper is relevant next; the latter, by contrast, "is used to propose a treatment cautiously when the sequential environment is not yet ready for decision-making" (p. 522).…”

mentioning

confidence: 99%

Deferring the Decision Point: Treatment Assertions in Neurology Outpatient Consultations

Toerien

2017

Health Communication

View full text Add to dashboard Cite

Recommendations can be implied by asserting some generalisation about a treatment's benefit without overtly directing the patient to take it. Focusing on a collection of assertions in UK neurology consultations, this paper shows that these are overwhelmingly receipted as "merely" doing informing and argues that this is made possible by their ambiguous design: their relatively depersonalised formats convey that the neurologist is simply telling the patient what's available, but the link made between the treatment and the patient's condition implies that it will be of benefit. Thus, assertions, while stopping short of telling the patient what to do, are hearable as recommendation relevant. This delicates balance leaves it up to the patient to respond either to the implied or on-record action (recommending vs. informing). When treated as "merely" doing informing, assertions defer the decision point until the neurologist has done something more. Three main interactional functions of this are identified as follows: (i) indicating the existence of a solution to a concern, without making a decision relevant next; (ii) orienting to the patient's right to choose; and (iii) making "cautious" recommendations.

show abstract

“…Yet, despite these advances in mapping decision-making practices in primary care, there has been relatively less examination of actual interactions between psychiatrists and patients and their negotiation of treatment (cf. Angell & Bolden, 2015; Bolden & Angell, 2017; Kushida & Yamakawa, 2015; Quirk, Chaplin, Lelliott, & Seale, 2012). …”

mentioning

confidence: 99%

How Psychiatrists Recommend Treatment and Its Relationship with Patient Uptake

Thompson

2017

Health Communication

View full text Add to dashboard Cite

Consultations for patients with chronic mental health conditions are conceived as meetings of experts: medical and experiential, respectively. Treatment decisions, in these terms, become a joint responsibility rather than handed down ex-cathedra. One resource for constituting decisions as ‘shared’ is the treatment recommendation – decisional authority can be invoked through its design. There is concern that people diagnosed with schizophrenia are infrequently involved in treatment decisions. However, the methods psychiatrists actually employ remain undefined. This article advances our understanding of psychiatric practice by mapping alternative methods used by psychiatrists to recommend treatment in outpatient consultations in situ. First, we unpack the types of treatments psychiatrists recommend. Then, we ask how psychiatrists recommend treatment? Applying a novel coding taxonomy, informed by the conversation analytic principle that recommendations represent different social actions, we identify the distribution of alternative formulations for psychiatrists’ recommendations (pronouncements, suggestions, proposals, and offers). We also propose one linguistic dimension, personal pronouns, on which recommending actions often depend, implicative for who is projected as ‘accountable’ for the decision. Finally, we examine the relationship between action type and patient uptake: is a particular type of recommendation more likely to attract acceptance/resistance from patients? And how does this relate to decisional accountability?

show abstract

Fitting proposals to their sequential environment: a comparison of turn designs for proposing treatment in ongoing outpatient psychiatric consultations in Japan

Cited by 23 publications

References 31 publications

How clients solicit medication changes in psychiatry

How clients solicit medication changes in psychiatry

Deferring the Decision Point: Treatment Assertions in Neurology Outpatient Consultations

How Psychiatrists Recommend Treatment and Its Relationship with Patient Uptake

Contact Info

Product

Resources

About