When is a shared decision not (Quite) a shared decision? Negotiating preferences in a general practice encounter

Author(s): Elwyn, G.

Journal/Book: Soc Sci Med. 1999; 49: the Boulevard Langford Lane, Kidlington, Oxford Ox5 1GB, England. Pergamon-Elsevier Science Ltd. 437-447.

Abstract: We consider whether there are situations in which 'shared decision making' in primary care is inherently problematic, such as in the demand for antibiotics to treat viral disorders. In such an instance there might be a lack of the equipoise necessary for a decision-making context in which apparent choices are genuine options. Using the techniques of discourse analysis on the transcript of a consultation with the parents of an infant with tonsillitis, we illustrate how a general practitioner's (GP's) efforts to reach a 'shared decision' come unstuck through a combination of the embedded power imbalance and the conflict between the GP's own prescription preferences and those of the parent.

Note: Article Gwyn R, Univ Wales Coll Cardiff, Hlth Commun Res Ctr, Sch Engn Commun & Philosophy, POB 94, Cardiff CF1 3XB, S Glam, WALES

Keyword(s): shared decision-making; primary care; treatment preferences; MEDICAL ENCOUNTER; LAY CONSTRUCTIONS; PATIENT; ASYMMETRY; CHOICE

Zurück | Weiter