Discourses of Influence and Autonomy in Physicians’ Accounts of Treatment Decision Making for Depression

Abstract

Models of patient–physician decision making are typically framed on a continuum of discourses and practices ranging from patient autonomy to physician paternalism, with the middle ground being occupied by terms such as shared decision making. Critiques of these models center on the gulf between these idealized models and actual practice and on how context influences decision-making practices. In this article I focus on how 11 Canadian family physicians talked about patient–physician decision making in interviews about their diagnostic and treatment practices for depression. I adopt a discursive approach to analyzing extracts from these interviews, and show how these physicians constructed themselves as engaging in acts of professional judgment and persuasion, and patients as having the final say in decision making about treatment for depression. I argue that whether the intertwining of discourses of physician influence and patient autonomy is understood as a balance of power between physicians and patients is an open question.