Discursive management of patients’ disagreement with doctors’ recommendations in Nigerian hospital visits

Abstract

Patients’ disagreement with doctors’ treatment recommendations, which receives participatory or non-participatory attention from the consultative parties, constitutes a major discursive issue in clinical encounters. However, the literature on medical discourse has demonstrated more concentration on the participatory than the non-participatory dimension of the encounters. This discursive representation does not adequately capture the consultative encounters in Nigeria where both situations obtain but where none has been significantly studied, leaving a lacuna in the understanding of conflict management in the hospitals. An analysis of 25 purposively sampled doctor-patient interactions in Southwestern Nigerian hospitals was undertaken with theoretical insights from the notion of activity type, common ground models and conversation analysis. Findings indicate that two types of actions are identified in treatment-related indirect disagreement in Nigerian clinical encounters: participatory and non-participatory action. Participatory orientations to indirect disagreement are contextualised in joint therapeutic efficacy or institutional convenience; non-participatory orientations in the same disagreement type are situated in salient emergency. The resulting negotiation, or lack of it, reveals clinical power dynamics, and interpenetrating evocations of the voice of medicine and the voice of the life world in paternalistic and humanistic contexts; and consequently partial or inexistent patient satisfaction. The paper concludes that participatory communication and strategic deployment of humanistic and paternalistic clinical communicative approaches are capable of producing satisfactory consultative encounters in Nigerian hospital visits.