Cover not available

Article published In: Pragmatics
Vol. 31:3 (2021) ► pp.430–454

Get fulltext from our e-platform
JBE logo with link
PDF logo with download linkDownload PDF

Negotiating patients’ therapy proposals in paternalistic and humanistic clinics

ORCiD logo with link | University of Ibadan
Open Access logo
Available under the Creative Commons Attribution-NonCommercial (CC BY-NC) 4.0 license.
Published online: 8 March 2021
DOI logo with link
https://doi.org/10.1075/prag.18054.ode
Abstract
The negotiation of patients’ therapy proposals often makes a strong statement about doctors’ consultative styles in Nigerian clinical encounters. This invites a search into the relationship between patients’ preferred treatment options and doctors’ and patients’ approaches to negotiating them. Analysis reveals the sequential and face orientation mechanisms deployed in negotiating patients’ proposals in predominantly doctor-centred clinics, the interactional moves made by them in negotiating the proposals in predominantly patient-centred clinics, and the pragmatic implications of the proposals negotiated in both clinics. The negotiations in the clinics are anchored to strategic rapport building, the colonisation of patients’ lifeworld and constrained joint decisions. Rapport is poorly built in the doctor-centred clinic with power-imbued strategies which stifle patients’ voice and lead to completely-constrained joint decisions on therapy proposals by patients. Participatory consultation enhances negotiation in the patient-centred clinic, but the physician’s misleading strategic sequences and exaggerated emotions somewhat weaken the ultimate consultative outcome.
Article outline
  • 1.Introduction
  • 2.Methodology
  • 3.Analysis and findings
    • 3.1Negotiation of Patient’s proposals in a predominantly doctor-centred clinic
      • 3.1.1Sequential negotiations in a doctor-centred clinic
        • 1.Patient makes a procedural appeal to deontic rights and institutional flexibility as a cue for a therapy proposal
        • 2.Doctor interprets the utterances of patient as indexes of personal goals
        • 3.Both parties co-jointly construct patient’s dispreference of Doctor’s therapy proposal as an index of irresponsibility
        • 4.Patient sequentially appeals to spiritual healing as a preferred alternative to medical plan
      • 3.1.2Face orientations and negotiations
        • 1.Face separation in the clash of cultural and institutional interpretations
        • 2.Strategic face connection as an institutional pressure
    • 3.2Negotiation of patient’s proposal in a predominantly patient-centred clinic
      • 3.2.1Interactional moves in a PCA encounter
        • 1.Patient strategically appeals to religious proposal as a cue of positive face orientation
        • 2.Doctor constructs Patient’s religious proposal as a positive act
        • 3.Doctor and patient co-construct religion-informed non-compliance to doctor’s therapy plan as an inconsequential action
        • 4.Doctor and patient co-construct religious option as a serious health hazard
    • 3.3Clinical/pragmatic implications of therapy proposal negotiations
  • 4.Conclusions
  • Acknowledgments
  • Notes
  • References
References (33)
References
Ainsworth-Vaugh, Nancy. 1995. “Claiming Power in the Medical Encounter: The Whirlpool Discourse”. Qualitative Health Research. 5 (3): 270–291. Google Scholar logo with link to Google Scholar
Apker, Julie and Susan Eggly. 2004. “Communicating Professional Identity in Medical Socialisation: Considering the Ideological Discourse of Morning Report”. Quality Health Research 141: 411–429). Google Scholar logo with link to Google Scholar
Ajayi, Ikeoluwapo. 2003. “The Consultation Style of Doctors at an Outpatient Clinic in Ibadan, Oyo State, Nigeria: are Patients Participating?” Nigerian Journal of ClinicalPractices. 6 (1): 10–16.Google Scholar logo with link to Google Scholar
Arundale, Robert. 2010. “Constituting Face in Conversation: Face, Facework, and Interactional Achievement”. Journal of Pragmatics, 421, 2078–2105. Google Scholar logo with link to Google Scholar
Bélanger, Emmanuelle, Charo Rodríguez, Danielle Groleau, France Légaré, Mary Ellen MacDonald, and Robert Marchand. 2016. “Patient Participation in Palliative Care Decisions: An Ethnographic Discourse Analysis”. International Journal of Qualitative Studies on Health and Well-being, 111, 32438. Google Scholar logo with link to Google Scholar
Bishop, Felicity and Lucy Yardley. 2004. “Constructing Responsibility in Treatment Decisions: Negotiating Responsibility in Cancer”. Health Int. J. Soc. Study Health Illn. Med. 8 (4): 465–482.Google Scholar logo with link to Google Scholar
Brown, Penelope and Levinson, Stephen 1987. Politeness: Some Universals in Language Usage. Cambridge: Cambridge University Press. Google Scholar logo with link to Google Scholar
Clark, Herbert. 1996. Using Language. Cambridge: Cambridge University Press. Google Scholar logo with link to Google Scholar
Costello, Brian and Felicia Roberts. 2001. “Medical Recommendations as Joint Social Practice”. Health and Communication 13 (3): 241–260. Google Scholar logo with link to Google Scholar
Cubaka, Vincent, Michael Schriver, Philip Cotton, Laetita Nyirazinyoye and Per Kallestrup. 2018. “Providers’ Perceptions of Communication with Patients in Primary Healthcare in Rwanda”. PLoSONE 13(4). e0195269. Google Scholar logo with link to Google Scholar
De Belder, Zara. 2013. “Power and Discourse Comparing the Power of Doctor in Two Contrasting Interactive Encounters”. Innervate. 51: 106–121.Google Scholar logo with link to Google Scholar
De Kok, B. C., S. Widdicombe, A. Pilnick and E. Laurier. 2018. “Doing patient-centredness versus achieving public health targets: A critical review of interactional dilemmas in ART adherence support”. HYPERLINK “[URL]” Social Science & Medicine. 2051: 17–25.Google Scholar logo with link to Google Scholar
Emanuel, Ezekiel and Nancy Dubler. 1995. “Preserving the Physician-patient Relationship in the Area of Managed Care”. JAMA 2731: 323–329. Google Scholar logo with link to Google Scholar
Hyden, Lars and Pia Bulow. 2006. “Medical Discourse, Illness and Narratives”. Encyclopedia of Language & Linguistics. Google Scholar logo with link to Google Scholar
Jefferson, Gail. 2004. “Glossary of Transcript Symbols with an Introduction”. In Conversation Analysis: Studies from the First Generation, ed by Gene Lerner, 14–31.Google Scholar logo with link to Google Scholar
Kecskes, Istvan. 2010. “Situation-bound Utterances as Pragmatic Acts”. Journal of Pragmatics. 42 (11): 2889–2897. Google Scholar logo with link to Google Scholar
. 2014. Intercultural Pragmatics. Oxford: Oxford University Press.Google Scholar logo with link to Google Scholar
Khawaja, Mahud (nd) “The Power of Talk – Creating a Healing Environment”. [URL]
Landmark, Anne Marie D., Pal Gulbrandsen and Jan Svennevig. 2015. “Whose Decision? Negotiating Epistemic and Deontic Rights in Medical Treatment Decisions”. Journal of Pragmatics. 781: 54–69. Google Scholar logo with link to Google Scholar
Lawal, Joseph, Schadrac Agbla, Queen Bola-Lawal, Muhammed Afolabi and Elvis Ihaji. 2018. “Patients’ Satisfaction with Care from Nigerian Federal Capital Territory’s Public Secondary Hospitals: A Cross-sectional Study”. Journal of Patient Experience 5(4): 250–257. Google Scholar logo with link to Google Scholar
Lings, Pam, Philip Evans, David Seamark, Clare Seamark, Kieran Sweeney, Michael Dixon and Denis Gray. 2003. “The Doctor-patient Relationship in US Primary Care”. Journal of the Royal Society of Medicine 96 (4): 8180–184.Google Scholar logo with link to Google Scholar
Maynard, Douglas. 1996. “On ‘Realisation’ in Everyday Life: the Forecasting of Bad News as a Social Relation”. American Sociological Review. 16 (1): 109–131. Google Scholar logo with link to Google Scholar
Mey, Jacob. 2001. Pragmatics: an Introduction. Oxford: Blackwell Publishers.Google Scholar logo with link to Google Scholar
Mezzich, Juan, Jon Snaedal, Chris van Weel and I. Heath. 2009. “The International Network for Person-centred Medicine: Background and First Steps”. World Medical Journal 551: 104–107.Google Scholar logo with link to Google Scholar
Mishler, Elliot. 1984. Discourse of Medicine: Dialects of Medical Interviews. Norwood, NJ: Ablex.Google Scholar logo with link to Google Scholar
Odebunmi, Akin. 2013. “Multiple Codes, Multiple Impressions: An Analysis of Doctor-client Encounters in Nigeria”. Multilingua 32 (3): 373–403. Google Scholar logo with link to Google Scholar
. 2016. “ ‘You didn’t give me to go and buy’: Negotiating Accountability for Poor Health in Post-recommendation Medical Consultations”. Journal of Pragmatics 931: 1–15. Google Scholar logo with link to Google Scholar
. 2017. “Negotiation of Physician error when Therapy Administration Fails: A Case Study Report”. Quality in Primary Health Journal 1(1): 1–6.Google Scholar logo with link to Google Scholar
Robert di Sarsina, Paolo and Ilara Iseppato. 2010. “Person-centred Medicine: Towards a Definition”. Forschende Komplementärmedizin 171: 277–278. Google Scholar logo with link to Google Scholar
Stivers, Tanya. 2001. “Negotiating Who Presents the Problem: Next Speaker Selection in Pediatric Encounters”. Journal of Communication 51 (2): 231–449. Google Scholar logo with link to Google Scholar
Young, Katharine. 1997. Presence in the Flesh: the Body in Medicine: Harvard University Press.Google Scholar logo with link to Google Scholar
Zuraidah, Don and Ahmad Izadi. 2011. “Relational Connection and Separation in Iranian Dissertation Defences”. Journal of Pragmatics. 431: 3782–3792. Google Scholar logo with link to Google Scholar
Cited by (2)

Cited by two other publications

Odebunmi, Akin & Oluwatomi Adeoti
2024. Discursive management of patients’ disagreement with doctors’ recommendations in Nigerian hospital visits. Discourse Studies 26:1 ► pp. 67 ff. DOI logo
Odebunmi, Akin
2022. Nigerian hospital setting discourse. In Handbook of Pragmatics [Handbook of Pragmatics, ], ► pp. 187 ff. DOI logo

This list is based on CrossRef data as of 29 november 2025. Please note that it may not be complete. Sources presented here have been supplied by the respective publishers. Any errors therein should be reported to them.

Mobile Menu Logo with link to supplementary files background Layer 1 prag Twitter_Logo_Blue