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How clients solicit medication changes in psychiatry.

Galina B Bolden1, Beth Angell2, Alexa Hepburn1

  • 1Department of Communication, Rutgers University, Camden, New Jersey, USA.

Sociology of Health & Illness
|January 24, 2019
PubMed
Summary

Patients with severe mental illness, like schizophrenia, effectively advocate for treatment preferences during psychiatric appointments. They strategically request medication changes by reporting issues, respecting medical authority and presenting as reliable witnesses.

Keywords:
conversation analysisprovider-patient communicationpsychiatryrequesting medications

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Area of Science:

  • Psychiatry
  • Mental Health
  • Conversation Analysis
  • Health Communication

Background:

  • Patient-centered care and shared decision-making are crucial in psychiatric practice.
  • Understanding how patients with severe mental illness express treatment preferences is vital for effective care.
  • Assertive Community Treatment (ACT) programs provide comprehensive care for individuals with severe mental illness.

Purpose of the Study:

  • To investigate how clients with severe mental illnesses advocate for their treatment preferences in psychiatric consultations.
  • To analyze the specific communication strategies used by patients to solicit medication changes.
  • To examine the interactional dynamics between patients and psychiatrists regarding treatment decisions.

Main Methods:

  • Utilized Conversation Analysis (CA) to examine audio-recorded medication check appointments.
  • Focused on consultations within an Assertive Community Treatment (ACT) program.
  • Analyzed clients' communicative behaviors and solicitation of medication changes.

Main Results:

  • Clients solicit medication changes at activity boundaries, employing strategies such as reporting physical or medication problems, explicit requests, or demands.
  • These solicitations create interactional pressure on psychiatrists to respond, either by problem-solving or accepting/rejecting the request.
  • Clients generally respect medical authority and present themselves as credible witnesses to their experiences when advocating for changes.

Conclusions:

  • Clients with severe mental illness actively and strategically advocate for their treatment preferences.
  • The study advances understanding of patient advocacy within psychiatric settings and mental health interactions.
  • Findings highlight the importance of recognizing and responding to patients' communication strategies in shared decision-making.