How clients solicit medication changes in psychiatry

Abstract

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.

Blended human-technology service realities in healthcare

“…However, an imbalance of power between healthcare professionals and consumers, because of the asymmetry of medical knowledge, can exacerbate the breakdown in healthcare relationships, potentially leading to value destruction and hindering health and well-being outcomes (Bolden et al, 2019;Lu et al, 2018;Makkonen and Alkkonen, 2017). Healthcare professionals believing in their authority to interpret the suitability of healthcare consumers' decision-making can often feel empowered or constrained when practicing people-centered care (Lukersmith et al, 2016).…”

“…Shared control influenced by DART on engaged actors' well-being. Value co-creation, through the implementation of DART, is critical as it enables mutualistic relationships by reducing the imbalance of power between healthcare professionals and healthcare consumers (Tibaldi et al, 2011;Bolden et al, 2019;Lukersmith et al, 2016). The use of DART can encourage healthcare professionals/services and consumers to engage in information exchange, communicate shared values and facilitate value co-creation in treatment decisions (Coulter, 2012;Shih et al, 2018).…”

“…Emotional-social and cognitive complexity influenced by DART on engaged actors' well-being. Blended human-technology service realities could create tensions between healthcare professionals and consumers, particularly when there are perceived agency risks and asymmetries of information (Bolden et al, 2019;Lukersmith et al, 2016). Such tensions can contribute to how healthcare consumers respond to the emotional-social and cognitive complexity of blended human-technology service realities (Wirtz et al, 2018;Huang and Rust, 2018;Larivi ere et al, 2017).…”

“…Despite the escalating need for healthcare services to implement technology and digital tools, compounded with improvements in technology, the conceptualization of blended human-technology service realities remains vague and undefined. Additionally, these service realities are challenged by the imbalance of power between healthcare professionals and consumers (Bolden et al, 2019) and potential adoption due to their emotional-social and cognitive complexity (Wirtz et al, 2018).…”

When patients and clinician (dis)agree about the nature of the problem: The role of displays of shared understanding in acceptance of treatment

“…In ongoing secondary care for people with severe mental health problems, Bolden and Angell (2017) found that recommending treatment for psychotropic medication in this setting is a complex course of action that includes building a case for a recommendation and eliciting acceptance in order to manage anticipated resistance, problems with adherence and side-effects. Other studies have examined how patients solicit medication changes in secondary care (Bolden et al 2019) and decision making more broadly, e.g., in group meetings in a mental health rehabilitation community (Stevanovic et al 2020). Also in repeat consultations in secondary care, Kushida and Yamakawa (2015) examined how psychiatrists cautiously approach treatment recommendations based on patient readiness for decision making.…”