Steering interactions away from complaints about persistent symptoms in psychiatric consultations
Journal: East Asian Pragmatics
In medical encounters, doctors sometimes have to convey views of patients' problems which are not in line with patients' views and expectations. One such situation in psychiatric consultations is when the patient complains about symptoms which persist in spite of treatment, while the psychiatrist regards the patient's condition as not serious enough to adjust treatment or has no satisfactory explanations or solutions. Based on an analysis of video-recorded psychiatric consultations in Japan, this study investigates how psychiatrists cope with such situations and shows that they steer the interaction away from the complaints using a series of moves with which they transform the reported symptoms into evidence that supports their view of the patients' problems. It is argued that psychiatrists strike a balance between the two potentially conflicting goals of respecting patients' epistemic authority on their symptoms and minimising inappropriate medication increases.
Author: Shuya Kushida, Yuriko Yamakawa
Angell, B., & Bolden, G. B. (2015). Justifying medication decisions in mental health care: Psychiatrists’ accounts for treatment recommendations. Social Science & Medicine, 138, 44–56. https://doi.org/10.1016/j.socscimed.2015.04.029
Angell, B., & Bolden, G. B. (2016). Team work in action: Building grounds for psychiatric medication decisions in assertive community treatment. In M. O’Reilly & J. Lester (Eds.), The Palgrave Handbook of Adult Mental Health: Discourse and Conversation Studies (pp. 371–393). London: Palgrave Macmillan. https://doi.org/10.1057/9781137496850_20
Bergmann, J. R. (1992). Veiled morality: Notes on discretion in psychiatry. In P. Drew & J. Heritage (Eds.), Talk at work: Interaction in institutional settings (pp. 137–162). Cambridge: Cambridge University Press.
Bergmann, J. R. (2016). Making mental disorders visible: Proto-morality as diagnostic resource in psychiatric exploration. In M. O’Reilly & J. Lester (Eds.), The Palgrave Handbook of Adult Mental Health: Discourse and Conversation Studies (pp. 247–268). London: Palgrave Macmillan. https://doi.org/10.1057/9781137496850_14
Bolden, G. B., & Angell, B. (2017). The organization of the treatment recommendation phase in routine psychiatric visits. Research on Language and Social Interaction, 50(2), 151–170. https://doi.org/10.1080/08351813.2017.1301299
Clark, S. J., & Hudak, P. L. (2011). When surgeons advise against surgery. Research on Language and Social Interaction, 44(4), 385–412. https://doi.org/10.1080/08351813.2011.619313
Curl, T. S., & Drew, P. (2008). Contingency and action: A comparison of two forms of requesting. Research on Language and Social Interaction, 41(2), 129–153. https://doi.org/10.1080/08351810802028613
Gill, V. T., & Maynard, D. W. (2006). Explaining illness: Patients’ proposal and physicians’ responses. In J. Heritage & D. W. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 115–150). Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511607172.007
Gill, V. T., Pomerantz, A., & Denvir, P. (2010). Pre-emptive resistance: Patients’ participation in diagnostic sense-making activities. Sociology of Health & Illness, 32(1), 1–20. https://doi.org/10.1111/j.1467-9566.2009.01208.x
Hayano, K. (2013). Territories of knowledge in Japanese conversation (Unpublished doctoral dissertation). Max Planck Institute, Nijmegen.
Heritage, J. (2012). Epistemics in action: Action formation and territories of knowledge. Research on Language and Social Interaction, 45(1), 1–29. https://doi.org/10.1080/08351813.2012.646684
Heritage, J., & Raymond, G. (2005). The terms of agreement: Indexing epistemic authority and subordination in talk-in-interaction. Social Psychology Quarterly, 68(1), 15–38. https://doi.org/10.1177/019027250506800103
Heritage, J. & Robinson, J. D. (2006). Accounting for the visit: Giving reasons for seeking medical care. In J. Heritage & D. W. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 48–85). Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511607172.005
Heritage, J., & Stivers, T. (1999). Online commentary in acute medical visits: A method of shaping patient expectations. Social Science & Medicine, 49(11), 1501–1517. https://doi.org/10.1016/S0277-9536(99)00219-1
Jefferson, G. (2004). Glossary of transcript symbols with an introduction. In G. H. Lerner (Ed.), Conversation analysis: Studies from the first generation (pp. 13–31). Amsterdam: John Benjamins. https://doi.org/10.1075/pbns.125.02jef
Koshik, I. (2005). Beyond rhetorical questions: Assertive questions in everyday interaction. Amsterdam: John Benjamins. https://doi.org/10.1075/sidag.16
Kushida, S., Hiramoto, T., & Yamakawa, Y. (2016). Patients’ practices for taking the initiative in decision-making in outpatient psychiatric consultations. Communication & Medicine, 13(2): 169–184. https://doi.org/10.1558/cam.27013
Kushida, S., & Yamakawa, Y. (2015). Fitting proposals to their sequential environment: A comparison of turn designs for proposing treatment in ongoing outpatient psychiatric consultations in Japan. Sociology of Health & Illness, 37(4), 522–544. https://doi.org/10.1111/1467-9566.12204
Lee, S.-H., & Sheon, N. (2008). Responsibility and risk: Accounts of reasons for seeking an HIV test. Sociology of Health & Illness, 30(2), 167–181. https://doi.org/10.1111/j.1467-9566.2007.01038.x
Maynard, D. W. (1992). On clinicians co-implicating recipients’ perspective in the delivery of diagnostic news. In P. Drew & J. Heritage (Eds.), Talk at work: Interaction in institutional settings. (pp. 331–358). Cambridge: Cambridge University Press.
Maynard, D. W. (2004). On predicating a diagnosis as an attribute of a person. Discourse Studies, 6(1), 53–76. https://doi.org/10.1177/1461445604039439
Maynard, D. W., & Frankel, R. M. (2006). On diagnostic rationality: Bad news, good news, and the symptom residue. In J. Heritage & D. W. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 248–278). Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511607172.011
McCabe, R., Healey, P. G. T., Priebe, S., Lavelle, M., Dodwell, D., Laugharne, R., Snell, A., Bremner, S. (2013). Shared understanding in psychiatrist–patient communication: Association with treatment adherence in schizophrenia. Patient Education and Counseling, 93(1), 73–79. https://doi.org/10.1016/j.pec.2013.05.015
McCabe, R., Heath, C., Burns, T., & Priebe, S. (2002). Engagement of patients with psychosis in the consultation: Conversation analytic study. British Medical Journal, 325, 1148–1151. https://doi.org/10.1136/bmj.325.7373.1148
Parsons, T. (1951). The social system. New York: Free Press.
Peräkylä, A. (1998). Authority and accountability: The delivery of diagnosis in primary health care. Social Psychology Quarterly, 61(4), 301–320. https://doi.org/10.2307/2787032
Peräkylä, A., Antaki, C., Vehviläinen, S., & Leudar, I. (Eds.). (2008). Conversation analysis and psychotherapy. Cambridge: Cambridge University Press.
Pomerantz, A. (1984). Agreeing and disagreeing with assessments: Some features found in preferred/dispreferred turn shapes. In J. M. Atkinson & J. Heritage (Eds.), Structures of social action: Studies in conversation analysis (pp. 57–101). Cambridge: Cambridge University Press.
Pomerantz, A. (1986). Extreme case formulations: A way of legitimizing claims. Human Studies, 9(2/3), 219–229. https://doi.org/10.1007/BF00148128
Quirk, A., Chaplin, R., Hamilton, S., Lelliott, P., & Seale, C. (2013). Communication about adherence to long-term antipsychotic prescribing: An observational study of psychiatric practice. Social Psychiatry and Psychiatric Epidemiology, 48(4), 639–647. https://doi.org/10.1007/s00127-012-0581-y
Quirk, A., Chaplin, R., Lelliott, P., & Seale, C. (2012). How pressure is applied in shared decisions about antipsychotic medication: A conversation analytic study of psychiatric outpatient consultations. Sociology of Health & Illness, 34(1), 95–113. https://doi.org/10.1111/j.1467-9566.2011.01363.x
Rogers, A., Pilgrim, D., & Lacey, R. (1993). Experiencing psychiatry: Users’ views of services. London: Macmillan. https://doi.org/10.1007/978-1-349-22636-8
Seale, C., Chaplin, R., Lelliott, P., & Quirk, A. (2007). Antipsychotic medication, sedation and mental clouding: An observational study of psychiatric consultations. Social Science & Medicine, 65(4), 698–711. https://doi.org/10.1016/j.socscimed.2007.03.047
Stivers, T. (2007). Prescribing under pressure: Parent–physician conversations and antibiotics. New York: Oxford University Press. https://doi.org/10.1093/acprof:oso/9780195311150.001.0001
Stivers, T., & Heritage, J. (2001). Breaking the sequential mold: Answering ‘more than the question’ during comprehensive history taking. Text, 21(1/2), 151–185. https://doi.org/10.1515/text.1.21.1-2.151
Thompson, L., Howes, C., & McCabe, R. (2016). Effect of questions used by psychiatrists on therapeutic alliance and adherence. British Journal of Psychiatry, 209(1), 40-47. https://doi.org/10.1192/bjp.bp.114.151910