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Article published In: Future Perspectives in Medical Argumentation
Edited by Sarah Bigi and Maria Grazia Rossi
[Journal of Argumentation in Context 14:3] 2025
► pp. 280–304

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Toward a community-centred approach to healthcare

Argumentative tools to disentangle the intertwining of public and interpersonal communication

ORCiD logo with link | Universidade Nova de Lisboa
ORCiD logo with link | Universidade Nova de Lisboa
Published online: 4 December 2025
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https://doi.org/10.1075/jaic.25023.ros
Abstract
In the face of growing medical scepticism and institutional distrust, this article sketches an integrated framework to examine the interplay between public health controversies and clinical interactions. Situated within Community-Centred Approaches (CCA) and participatory public health, the framework employs tools from medical argumentation to show how doubt in healthcare interactions marks a crucial site where communicative and interpretive expertise are essential and trust is actively negotiated — a site that requires participatory practices capable of responding to and repairing it through dialogical engagement and reason-giving. Building on the concept of argumentative potential, it analyses clinical dialogue as the core community in which institutional legitimacy and interpersonal trust are negotiated. A case study on vaccine hesitancy illustrates how expressions of doubt can activate different argumentative potentials — ambivalent, sceptical, or denialist — each opening or closing discursive trajectories that either foster or erode trust. The paper advances the notion of argumentative participation as a key condition for discursive trust, illustrating how clinical dialogue can serve as a site of participatory repair, understood as the active rebuilding of trust through dialogue and shared reasoning, within broader public health controversies.
Article outline
  • 1.Introduction
  • 2.Community-Centred Approaches and the challenge of medical scepticism
    • 2.1Reframing medical scepticism through participatory public health
  • 3.Patient–provider communication as a site of participatory repair
    • 3.1Recognising and managing the argumentative potentials of doubt: A space for argumentative participation
    • 3.2Case study: Managing doubt in an HPV vaccine consultation
    • 3.3From clinical dialogue to public controversy
  • 4.Realising Community-Centred Approaches through argumentation: Bridging public health and clinical communication
  • Notes
  • References
References (84)
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