How Psychiatrists Recommend Treatment and Its Relationship with Patient Uptake

Abstract

Consultations for patients with chronic mental health conditions are conceived as meetings of experts: medical and experiential, respectively. Treatment decisions, in these terms, become a joint responsibility rather than handed down ex-cathedra. One resource for constituting decisions as ‘shared’ is the treatment recommendation – decisional authority can be invoked through its design. There is concern that people diagnosed with schizophrenia are infrequently involved in treatment decisions. However, the methods psychiatrists actually employ remain undefined. This article advances our understanding of psychiatric practice by mapping alternative methods used by psychiatrists to recommend treatment in outpatient consultations in situ. First, we unpack the types of treatments psychiatrists recommend. Then, we ask how psychiatrists recommend treatment? Applying a novel coding taxonomy, informed by the conversation analytic principle that recommendations represent different social actions, we identify the distribution of alternative formulations for psychiatrists’ recommendations (pronouncements, suggestions, proposals, and offers). We also propose one linguistic dimension, personal pronouns, on which recommending actions often depend, implicative for who is projected as ‘accountable’ for the decision. Finally, we examine the relationship between action type and patient uptake: is a particular type of recommendation more likely to attract acceptance/resistance from patients? And how does this relate to decisional accountability?

Conversation Analysis and Psychotherapy: Identifying Transformative Sequences

“…Studies on the interactional organization of treatment decisions have mostly dealt with adjustment of medication in long-term patients. They have showed patterns of patient engagement in decision making (Bolden & Angell, 2017;Quirk, Chaplin, Lelliott, & Seale, 2012) as well as variation in the clinicians' claims, and patients' submission, to deontic authority (Thompson & McCabe, 2018). Another set of studies deals with the place of patients' subjective experience in psychiatric consultations.…”

Managing the (In)visibility of Chronic Illness at Work: Dialogism, Parody, and Reported Speech

“…Future research might evaluate OPDRS pre-and post-individual or organizational-level interventions in terms of presence/absence, frequency, content and genre/action. Given the likely ubiquity of OPDRS, coding methods could also feasibly be applied to direct reported speech, and its genre/action, in order to explore the relationship with salient outcomes such as chronic illness disclosure, job retention, and psychometric measures (e.g., cf Thompson & McCabe, 2016;Thompson & McCabe, 2017). It may also be important to investigate the possibly differential gendered use of OPDRS, which would be significant for any intervention utilizing OPDRS as an index.…”

Exploring how patients respond to GP recommendations for mental health treatment: an analysis of communication in primary care consultations

“…6 Despite the controversial nature of antidepressant treatment in primary care, little is known about how decisions to start antidepressants and initiate patient referral to talking therapy are negotiated and endorsed in GP-patient consultations. Doctor-patient communication about treatment beyond mental health has been the focus of recent research in primary 16 and secondary 17,18 care. By analysing recordings of doctor-patient communication, this work has shed light on who is driving treatment decisions: of particular interest here is how strongly the doctor recommends the treatment; whether the GP or the patient is the primary decision-maker; and how positively the patient responds to the possibility of starting treatment.…”