Deferring the Decision Point: Treatment Assertions in Neurology Outpatient Consultations

Abstract

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.

Social deontics: A nano‐level approach to human power play

“…Treating the normative organization of the adjacency-pair sequence as the central locus of negotiation over deontic rights, I will now consider how this negotiation happens in practice. Drawing on previous studies by myself (Stevanovic, 2011;Stevanovic, 2012a;Stevanovic, 2012b;Stevanovic, 2013a;Stevanovic, 2013b;Stevanovic, 2015;Stevanovic, 2017;Stevanovic & Peräkylä, 2012;Stevanovic & Monzoni, 2016) Svennevig & Djordjilovic, 2015;Toerien, 2017), I will discuss three different patterns of managing deontic concerns in and through sequential relations. Arguably, deontic concerns are a potential part of all adjacency pairs, but they are particularly relevant in those sequences where future actions are at issue.…”

Practitioners’ Dilemmas and Strategies in Decision-Making Conversations Where Patients and Companions Take Divergent Positions on a Healthcare Measure: An Observational Study Using Conversation Analysis

“…Extract 5). Rather, she articulates, via generalization, reasons for using a walking stick; an action that implies recommending its use (Toerien, 2018). She does so by addressing two possible misconceptions about the recommendation to use a walking aid (lines 22-23 and 25).…”

Involving patients with dementia in decisions to initiate treatment: effect on patient acceptance, satisfaction and medication prescription

“…The use of assertions to initiate medication discussions has also been described in neurology. 19 Assertions are poised between informing the patient about medication and recommending medication to the patient. This places very little interactional pressure on the patient for an immediate decision, thus allowing for further discussion.…”

“…Toerien describes assertions as 'cautious recommendations' in environments of diagnostic uncertainty, including uncertain efficacy of the mediation and potential patient resistance. 19 In memory clinics, patients will be dealing with a life-changing diagnosis of dementia. The use of assertions before an explicit recommendation may therefore facilitate a smoother, more sensitive transition between the diagnosis and treatment decisionmaking.…”