Inexplicit Recommendations in Medical Decision-Making: Implications for Patient Participation

Abstract

While patient participation in medical decision-making is increasingly advocated in contemporary medicine, its difficulty has also been repeatedly pointed out. Detailed explorations of actual decision-making are important to deepen our understanding of this gap. Using the methodology of conversation analysis, this study examines how doctors use inexplicit treatment recommendations in outpatient consultations in a Japanese hospital. It shows that this type of recommendation does not immediately place the patient in the position of accepting or rejecting the recommendation. Because of this affordance, it is recurrently used by doctors either to initiate a complex recommendation or to cautiously recommend a treatment which may not be readily acceptable to the patient. In the latter, it enables a patient to initiate negotiation of the recommended treatment by displaying a stance toward it without officially taking a position and thereby enhances the possibility of patient participation. Though the decision-making initiated by an inexplicit recommendation falls short of the ideal model of “shared decision-making,” it can be regarded as a feasible practice for promoting patient participation in everyday consultation.