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When is a shared decision not (quite) a shared decision? Negotiating preferences in a general practice encounter

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  • Gwyn, Richard
  • Elwyn, Glyn

Abstract

We consider whether there are situations in which 'shared decision making' in primary care is inherently problematic, such as in the demand for antibiotics to treat viral disorders. In such an instance there might be a lack of the equipoise necessary for a decision-making context in which apparent choices are genuine options. Using the techniques of discourse analysis on the transcript of a consultation with the parents of an infant with tonsillitis, we illustrate how a general practitioner's (GP's) efforts to reach a 'shared decision' come unstuck through a combination of the embedded power imbalance and the conflict between the GP's own prescription preferences and those of the parent.

Suggested Citation

  • Gwyn, Richard & Elwyn, Glyn, 1999. "When is a shared decision not (quite) a shared decision? Negotiating preferences in a general practice encounter," Social Science & Medicine, Elsevier, vol. 49(4), pages 437-447, August.
    • Handle: RePEc:eee:socmed:v:49:y:1999:i:4:p:437-447
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    Cited by:

    1. Collins, Sarah & Drew, Paul & Watt, Ian & Entwistle, Vikki, 2005. "'Unilateral' and 'bilateral' practitioner approaches in decision-making about treatment," Social Science & Medicine, Elsevier, vol. 61(12), pages 2611-2627, December.
    2. Diamond-Brown, Lauren, 2018. "“It can be challenging, it can be scary, it can be gratifying”: Obstetricians’ narratives of negotiating patient choice, clinical experience, and standards of care in decision-making," Social Science & Medicine, Elsevier, vol. 205(C), pages 48-54.
    3. Collins, Dorothy L. & Street Jr., Richard L., 2009. "A dialogic model of conversations about risk: Coordinating perceptions and achieving quality decisions in cancer care," Social Science & Medicine, Elsevier, vol. 68(8), pages 1506-1512, April.
    4. May, Carl & Rapley, Tim & Moreira, Tiago & Finch, Tracy & Heaven, Ben, 2006. "Technogovernance: Evidence, subjectivity, and the clinical encounter in primary care medicine," Social Science & Medicine, Elsevier, vol. 62(4), pages 1022-1030, February.
    5. Opher Caspi & Mary Koithan & Michael W. Criddle, 2004. "Alternative Medicine or “Alternative†Patients: A Qualitative Study of Patient-Oriented Decision-Making Processes with Respect to Complementary and Alternative Medicine," Medical Decision Making, , vol. 24(1), pages 64-79, January.

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