IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v258y2020ics0277953620302604.html
   My bibliography  Save this article

Patient resistance towards clinicians’ diagnostic test-taking advice and its management in Chinese outpatient clinic interaction

Author

Listed:
  • Zhao, Chunjuan
  • Ma, Wen

Abstract

Performing diagnostic tests is a fundamental information-gathering activity in diagnostic process. However, little attention has been paid to the interactional process where a diagnostic test is advised and received, especially in Chinese medical settings. Decision making over prescribing diagnostic tests consists of clinicians' advice and patients' acceptance or resistance/rejection. Drawing on audio-recordings of clinician-patient encounters in Chinese outpatient clinics as data and conversation analysis as a method, we discuss how patient resistance to clinicians' diagnostic test-taking advice is displayed and managed over sequences of interaction. Two types of advice deliveries have been identified: advice either with no diagnostic utterances or with indeterminate diagnostic utterances. We find that patients demonstrate their resistance towards the former type of advice in two ways: questioning clinicians’ decisions and proposing an alternative plan. Displaying resistance to the latter type of advice, patients have been found to recurrently resort to one way: proffering additional information about personal experience. Confronted with resistance, clinicians generally proceed to justify decisions by either asserting their epistemic primacy in determining a test or lowering certainty in the original speculative diagnosis. Towards persistent resistance, clinicians mainly employ two techniques to impose acceptance onto patients: repeating the initial advice and terminating forcefully current sequence. This study adds to a growing body of research on resistance in medical settings and contributes to our understanding of the decision making over medical investigations in Chinese outpatient clinic interaction.

Suggested Citation

  • Zhao, Chunjuan & Ma, Wen, 2020. "Patient resistance towards clinicians’ diagnostic test-taking advice and its management in Chinese outpatient clinic interaction," Social Science & Medicine, Elsevier, vol. 258(C).
    • Handle: RePEc:eee:socmed:v:258:y:2020:i:c:s0277953620302604
    DOI: 10.1016/j.socscimed.2020.113041
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953620302604
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2020.113041?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. He, Alex Jingwei, 2014. "The doctor–patient relationship, defensive medicine and overprescription in Chinese public hospitals: Evidence from a cross-sectional survey in Shenzhen city," Social Science & Medicine, Elsevier, vol. 123(C), pages 64-71.
    2. Heritage, John & McArthur, Amanda, 2019. "The diagnostic moment: A study in US primary care," Social Science & Medicine, Elsevier, vol. 228(C), pages 262-271.
    3. He, Alex Jingwei & Qian, Jiwei, 2016. "Explaining medical disputes in Chinese public hospitals: the doctor–patient relationship and its implications for health policy reforms," Health Economics, Policy and Law, Cambridge University Press, vol. 11(4), pages 359-378, October.
    4. Koenig, Christopher J., 2011. "Patient resistance as agency in treatment decisions," Social Science & Medicine, Elsevier, vol. 72(7), pages 1105-1114, April.
    5. Pan, Jay & Liu, Dan & Ali, Shehzad, 2015. "Patient dissatisfaction in China: What matters," Social Science & Medicine, Elsevier, vol. 143(C), pages 145-153.
    6. Stivers, Tanya, 2002. "Participating in decisions about treatment: overt parent pressure for antibiotic medication in pediatric encounters," Social Science & Medicine, Elsevier, vol. 54(7), pages 1111-1130, April.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Lindström, Anna K.B. & Tängdén, Thomas, 2022. "Introducing the C-reactive protein point-of-care test: A conversation analytic study of primary care consultations for respiratory tract infection," Social Science & Medicine, Elsevier, vol. 315(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Dongxu Li & Min Su & Xi Guo & Weile Zhang & Tianjiao Zhang, 2022. "The Effect of Medical Choice on Health Costs of Middle-Aged and Elderly Patients with Chronic Disease: Based on Principal-Agent Theory," IJERPH, MDPI, vol. 19(13), pages 1-14, June.
    2. Xin Zhao & Xiaoxue Li & Benno Torgler & Uwe Dulleck, 2021. "Patient violence, physicians treatment decisions, and patient welfare: Evidence from China," Health Economics, John Wiley & Sons, Ltd., vol. 30(6), pages 1461-1479, June.
    3. Tate, Alexandra, 2020. "Invoking death: How oncologists discuss a deadly outcome," Social Science & Medicine, Elsevier, vol. 246(C).
    4. Zhan Wang & Niying Li & Mengsi Jiang & Keith Dear & Chee-Ruey Hsieh, 2017. "Records of medical malpractice litigation: A potential indicator of healthcare quality in China," WIDER Working Paper Series wp-2017-144, World Institute for Development Economic Research (UNU-WIDER).
    5. Jiwei Qian & Alex Jingwei He, 2018. "The Bonus Scheme, Motivation Crowding-out and Quality of the Doctor-Patient Encounters in Chinese Public Hospitals," Public Organization Review, Springer, vol. 18(2), pages 143-158, June.
    6. Liu, Junqiang & Zhou, Hui & Liu, Lingrui & Wang, Chunxiao, 2020. "The weakness of the strong: Examining the squeaky-wheel effect of hospital violence in China," Social Science & Medicine, Elsevier, vol. 245(C).
    7. Ying Mao & Wei Ning & Ning Zhang & Tao Xie & Jinnan Liu & Yongbo Lu & Bin Zhu, 2021. "The Therapeutic Relationship in China: A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 18(7), pages 1-19, March.
    8. Toerien, Merran, 2021. "When do patients exercise their right to refuse treatment? A conversation analytic study of decision-making trajectories in UK neurology outpatient consultations," Social Science & Medicine, Elsevier, vol. 290(C).
    9. Linghan Shan & Ye Li & Ding Ding & Qunhong Wu & Chaojie Liu & Mingli Jiao & Yanhua Hao & Yuzhen Han & Lijun Gao & Jiejing Hao & Lan Wang & Weilan Xu & Jiaojiao Ren, 2016. "Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-18, October.
    10. Wang, Nan Christine & Liu, Yuetong, 2021. "Going shopping or consulting in medical visits: Caregivers’ roles in pediatric antibiotic prescribing in China," Social Science & Medicine, Elsevier, vol. 290(C).
    11. Wenxin & W. & Bentum-Micah & G. & Zhiqiang & M. & Bing & L. & Asabea Addo & A. & Boadi & B.E. & Atuahene & A.S. & Bondzie-Micah & V., 2020. "The Influence of Encounter Service Quality on Patient Satisfaction: An Empirical Study in Chinese Public Hospitals," International Journal of Economics & Business Administration (IJEBA), International Journal of Economics & Business Administration (IJEBA), vol. 0(3), pages 461-477.
    12. Mengna Luan & Wenjing Shi & Zhigang Tao & Hongjie Yuan, 2023. "When patients have better insurance coverage in China: Provider incentives, costs, and quality of care," Economics of Transition and Institutional Change, John Wiley & Sons, vol. 31(4), pages 1073-1106, October.
    13. Chuan De Foo & Yan Lin Tan & Pami Shrestha & Ke Xin Eh & Ian Yi Han Ang & Milawaty Nurjono & Sue-Anne Toh & Farah Shiraz, 2020. "Exploring the dimensions of patient experience for community-based care programmes in a multi-ethnic Asian context," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-18, November.
    14. Heritage, John & McArthur, Amanda, 2019. "The diagnostic moment: A study in US primary care," Social Science & Medicine, Elsevier, vol. 228(C), pages 262-271.
    15. Yu Xia & Jing Li & Zhongyang Zhang, 2023. "Effects of price cap regulation on pharmaceutical supply chain under the zero markup drug policy," Operational Research, Springer, vol. 23(4), pages 1-27, December.
    16. Murdoch, Jamie & Salter, Charlotte & Ford, John & Lenaghan, Elizabeth & Shiner, Alice & Steel, Nicholas, 2020. "The “unknown territory” of goal-setting: Negotiating a novel interactional activity within primary care doctor-patient consultations for patients with multiple chronic conditions," Social Science & Medicine, Elsevier, vol. 256(C).
    17. Xiaojing Fan & Min Su & Yaxin Zhao & Duolao Wang, 2021. "Dissatisfaction with Local Medical Services for Middle-Aged and Elderly in China: What Is Relevant?," IJERPH, MDPI, vol. 18(8), pages 1-12, April.
    18. Gutin, Iliya, 2022. "Not ‘putting a name to it’: Managing uncertainty in the diagnosis of childhood obesity," Social Science & Medicine, Elsevier, vol. 294(C).
    19. Pilnick, Alison & Dingwall, Robert, 2011. "On the remarkable persistence of asymmetry in doctor/patient interaction: A critical review," Social Science & Medicine, Elsevier, vol. 72(8), pages 1374-1382, April.
    20. Antoci, Angelo & Fiori Maccioni, Alessandro & Russu, Paolo & Sacco, Pier Luigi, 2022. "Curing is caring? Liability reforms, defensive medicine and malpractice litigation in a post-pandemic world," Socio-Economic Planning Sciences, Elsevier, vol. 80(C).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:258:y:2020:i:c:s0277953620302604. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.