Resistance Toward Treatment Recommendations at China's Primary Care Clinics and Its Implications for Patient Agency

A hundred and sixty doctor-patient consultations were recorded in primary care outpatient clinics in two Chinese community hospitals. Our analysis of these consultations revealed that patients frequently resisted doctors' treatment recommendations, including recommended medical tests, and in a few cases doctors' diagnoses. Given the normative orientation to the medical authority attributed to doctors, this pattern of resistance was striking. A collection of instances of patients' resistance to doctors' treatment recommendations revealed a continuum from implicit resistance to more explicit, overt forms of resistance. Implicit resistance forms include not responding or responding only minimally, "answering" the doctor's question with a question, and asking the doctor elliptical questions. In addition to these implicit forms, more overtly disaffiliative moves by patients were identified, including direct disagreements and rejections. By upgrading their resistance through using increasingly more overt forms of disaffiliation, along this continuum, patients appear to negotiate for a medical decision which better accords with their preferences. In this way some consultations or phases of consultations take on the character of negotiations; patients were able to assert their agency over their health care provider (doctor) without provoking the kind of conflict that might compromise the consultation.