• 29Apr

    “What would you recommend doctor?”- Discourse analysis of a moment of dissonance when sharing decisions in clinical consultations

    This study published in Health Expectations, by Wiley Online Library, highlights a common patient‐reported barrier is feeling that “doctor knows best”; thus, patients often defer decisions to the clinician.

    The objective of this study was to examine the nature of the discourse when patients ask clinicians for a treatment recommendation during consultations when treatment decisions are being shared and to examine clinicians’ strategies used in response.

    Tension was evident in a number of consultations when treatment recommendations were requested. Clinicians responded to recommendation requests by explaining why the decision was being shared (personal nature of the decision, individual preferences and equivalent survival outcomes of treatment options). There was only one instance where a clinician gave a treatment recommendation.

    The study concluded that strategies are needed to enable clinicians to facilitate SDM when patients seem to defer decisional responsibility include being clear about why the decision is being shared, acknowledging that this is difficult and making patients feel supported. When patients seek guidance, clinicians can provide a recommendation if grounded in an understanding of the patient’s values.


    Rebecca Sherlock MBBCh, Fiona Wood PhD, Natalie Joseph‐Williams PhD, Denitza Williams PhD, Joanna Hyam MBBCh, Helen Sweetland FRCS, Helen McGarrigle MSc, Adrian Edwards MBBS
    Version of Record online: 27 March 2019