Related Experiment Videos
When is a shared decision not (quite) a shared decision? Negotiating preferences in a general practice encounter
1Health Communication Research Centre, School of English, Communication and Philosophy, Cardiff University, UK. gwyn@cf.ac.uk
Social Science & Medicine (1982)
|July 22, 1999
Summary
Shared decision making in primary care can fail when patient demands, like for antibiotics for viral illnesses, conflict with physician preferences. This can stem from power imbalances and a lack of genuine choice during consultations.
Area of Science:
- Primary Care Medicine
- Health Communication
- Medical Ethics
Background:
- Shared decision-making (SDM) is a cornerstone of modern primary care.
- However, the practical application of SDM can be complex, particularly when patient expectations diverge from clinical recommendations.
Purpose of the Study:
- To explore situations where shared decision-making in primary care may be inherently problematic.
- To investigate the dynamics of consultations involving antibiotic demand for viral conditions.
Main Methods:
- Discourse analysis of a primary care consultation transcript.
- Focus on a consultation concerning an infant diagnosed with tonsillitis.
Main Results:
- The general practitioner's (GP) attempt at shared decision-making was unsuccessful.
- Challenges arose due to an embedded power imbalance between the GP and parents.
- Conflict between the GP's prescribing preferences and the parents' expectations contributed to the breakdown of SDM.
Conclusions:
- Shared decision-making requires genuine equipoise, which may be absent when patient demands (e.g., antibiotics for viral infections) are misaligned with clinical judgment.
- Power dynamics and differing prescription preferences can undermine SDM in primary care settings.
Keywords:
Professional Patient Relationship