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Article In: Journal of Argumentation in Context: Online-First Articles

Analyzing argumentation in medical consultations within a health communication ecosystem

ORCiD logo with link | Catholic University of the Sacred Heart
 | University of Lisbon
 | Catholic University of the Sacred Heart
 | NOVA University Lisbon
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Abstract
The paper proposes that argumentation in medical consultations should be analyzed by considering consultations as part of a health communication ecosystem in which institutional norms and circulating discourses shape argumentative practices. It outlines a framework that conceptualizes medical consultations as sites where argumentative practices emerge from the interaction between three analytically distinct but interdependent layers: the interactional organization of talk, the institutional structuring of roles and norms, and the broader discursive environment in which medical knowledge circulates. These layers are linked through mechanisms of recontextualization, normative filtering, and epistemic positioning, which account for how external discourses and institutional constraints are selectively mobilized and transformed within situated interaction.
Article outline
  • 1.Introduction
  • 2.Medical consultations within an ecological model of medical argumentation
  • 3.A multi-layered framework for medical argumentation
    • 3.1Activity types, dialogue types, and discursive environment
    • 3.2Dialogue shifts as a key mechanism of articulation
    • 3.3Normative constraints and dialectical failures
    • 3.4Analytical implications
    • 3.5Analysis of a real-life consultation
  • 4.Conclusion
  • Authorship contributions
  • Note
  • References
References (35)
References
American Diabetes Association Professional Practice Committee. 2024. “Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes.” Diabetes Care 1 (47) (Suppl 1): S111–S125.Google Scholar logo with link to Google Scholar
Andone, Corina, Marianne Doury, Sara Greco, Kati Hannken-Illjes, and Menno Reijven. 2026. Qualitative Research Methods in Argumentation Studies. New York/London: Routledge.Google Scholar logo with link to Google Scholar
Bigi, Sarah. 2016. “Communication Skills for Patient Engagement: Argumentation Competencies as Means to Prevent or Limit Reactance Arousal, with an Example from the Italian Healthcare System.” Frontiers in Psychology, 7:1472. Google Scholar logo with link to Google Scholar
Bigi, Sarah, Maria Grazia Rossi, Lisa Mayweg-Paus, and Fabrizio Macagno. 2016. “Assessing the Quality of Deliberation in Chronic Care: An Interdisciplinary Approach”. Paper presented at the 14th Conference on Communication in Healthcare, Heidelberg, 7–10 September 2016.
Bigi, Sarah. 2018. “The Role of Argumentative Practices within Advice-Seeking Activity Types: The Case of the Medical Consultation.” Rivista Italiana di Filosofia del Linguaggio 12 (1): 42–52.Google Scholar logo with link to Google Scholar
. 2022a. Le strutture interrogative nelle interazioni in contesto clinico [Interrogative structures in clinical interactions]. Milano: Vita e Pensiero.Google Scholar logo with link to Google Scholar
. 2022b. “Functions of interrogative structures in advice giving: A case study.” L’Analisi linguistica e letteraria 30 (2): 37–58.Google Scholar logo with link to Google Scholar
Bigi, Sarah, Chiara Midea, Valentina Noseda and Sibilla Parlato. 2024. “Caregivers’ Reasoning about Oncological Treatment in Online Discussions: A Comparative Analysis.” In Proceedings of the Tenth Conference of the International Society for the Study of Argumentation, ed. by Ronny Boogaart, Bart Garssen, Henrike Jansen, Maarten van Leeuwen, Roosmaryn Pilgram, and Alex Reuneker, 138–149. Amsterdam: Rozenberg/Sic Sat.Google Scholar logo with link to Google Scholar
Bigi, Sarah. 2025. “Argumentative Discourse in Clinical Dialogues: An Interdisciplinary Perspective.” Patient Education and Counseling 133: 108626. Google Scholar logo with link to Google Scholar
Fisher, Sue. 1983. “How Treatment Decisions Are Negotiated in Doctor-Patient Communication.” In The Social Organization of Doctor–Patient Communication, ed. by Alexandra Dundas Todd and Sue Fisher, 161–209. Norwood (NJ): Ablex Publishing Corporation.Google Scholar logo with link to Google Scholar
Heritage, John, and Douglas W. Maynard. 2006. Communication in Medical Care: Interactions between Primary Care Physicians and Patients. Cambridge: Cambridge University Press. Google Scholar logo with link to Google Scholar
Labrie, Nanon, and Peter J. Schulz. 2014. “Does Argumentation Matter? A Systematic Literature Review on the Role of Argumentation in Doctor–Patient Communication.” Health Communication 29 (10): 996–1008. Google Scholar logo with link to Google Scholar
Lamiani, Giulia, Sarah Bigi, Maria Elisa, Mancuso, Antonio Coppola, and Elena Vegni. 2017. “Applying a deliberation model to the analysis of consultations in haemophilia: Implications for doctor-patient communication.” Patient Education and Counseling 100 (4): 690–695. Google Scholar logo with link to Google Scholar
Levinson, Stephen C. 1979. “Activity types and language.” Linguistics 17: 365–399. Google Scholar logo with link to Google Scholar
Lewiński, Marcin, and Mark Aakhus. 2023. Argumentation in Complex Communication: Managing Disagreement in a Polylogue. Cambridge: Cambridge University Press.Google Scholar logo with link to Google Scholar
. 2010. “Communicative Activity Types as Organisations in Discourses and Discourses in Organisations.” In Discourses in Interaction, ed. by Sanna-Kaisa Tanskanen, Mia Raitaniemi, Marjut Johansson, and Marja-Liisa Helasvuo, 33–60. Amsterdam: John Benjamins. Google Scholar logo with link to Google Scholar
. 2021. “The role of evidence in chronic care decision making”. Topoi 40 (2): 343–358. Google Scholar logo with link to Google Scholar
Parlato, Sibilla, and Chiara Midea. In press. “Communicating obesity online to healthcare professionals and to the public: An analysis of the textual strategies to signal the source of information in magazine articles.” In Semmelweis Medical Linguistics Investigations, ed. by Katalin Fogarasi and Dániel Mány (Vol. 2). Berlin: Peter Lang.
Pilgram, Roosmaryn. 2017. “Argumentation in Doctor–Patient Interaction: Medical Consultation as a Pragma-Dialectical Communicative Activity Type.” In Contextualizing Pragma-Dialectics, ed. by Peng Wu and Frans van Eemeren, 109–122. Amsterdam: John Benjamins. Google Scholar logo with link to Google Scholar
Pilgram, Roosmaryn, and Lotte van Poppel. 2026. “Considering Argumentation in Context.” In Qualitative Research Methods in Argumentation Studies, ed. by Corina Andone, Marianne Doury, Sara Greco, Kati Hannken-Illjes, and Menno Reijven, 165–180. New York/London: Routledge.Google Scholar logo with link to Google Scholar
Rigotti, Eddo, and Sara Greco. 2019. Inference in Argumentation. A Topics-Based Approach to Argument Schemes. Argumentation Library 34. Cham: Springer. Google Scholar logo with link to Google Scholar
Roberts, Celia, and Srikant Sarangi. 2005. “Theme-oriented Discourse Analysis of Medical Encounters.” Medical Education 39 (6): 632–40. Google Scholar logo with link to Google Scholar
Rossi, Maria Grazia, Mohammed, Dima, Sarah Bigi. 2024. “Exploring the argumentative potential of doubt in medical consultations.” In The Cognitive Dimension of Social Argumentation. Proceedings of the 4th European Conference on Argumentation, ed. by Fabio Paglieri, Alessandro Ansani, and Marco Marini, 217–230. London: College Publications.Google Scholar logo with link to Google Scholar
Stivers, Tanya, and Stefan Timmermans. 2021. “Arriving at no: patient pressure to prescribe antibiotics and physicians’ responses.” Social Science & Medicine 290: 114007. Google Scholar logo with link to Google Scholar
Street Jr, Richard L. 2003. “Communication in Medical Encounters: An Ecological Perspective.” In Handbook of Health Communication, ed. by Teresa L. Thompson, Alicia M. Dorsey, Katherine I. Miller, and Roxanne Parrot, 63–94. Mahwah: Lawrence Erlbaum.Google Scholar logo with link to Google Scholar
2013. “How clinician–patient communication contributes to health improvement: modeling pathways from talk to outcome.” Patient education and counseling 92 (3): 286–291. Google Scholar logo with link to Google Scholar
van Eemeren, Frans. 2017. “Argumentative Patterns Viewed from a Pragma-Dialectical Perspective.” In Prototypical Argumentative Patterns, ed. by Frans van Eemeren, 7–30. Amsterdam/Philadelphia: John Benjamins. Google Scholar logo with link to Google Scholar
van Eemeren, Frans, and Bart Garssen. 2012. “Strategic maneuvering in political argumentation: the plenary debate in the European Parliament as an argumentative activity type.” In Modernitate i interdisciplinaritate în cercetarea lingvistică: omagiu doamnei profesor Liliana Ionescu-Ruxăndoiu, ed. by Mihaela Constantinescu, Gabriela Stoica, and Oana Uţă Bărbulescu, 227–241. Editura Universităţii din Bucureti.Google Scholar logo with link to Google Scholar
Walton, Douglas N. 1985. Physician–Patient Decision–Making: A Study in Medical Ethics. Westport, CT: Greenwood Press.Google Scholar logo with link to Google Scholar
Walton, Douglas. 1998. The New Dialectic: Conversational Contexts of Argument. Toronto: University of Toronto Press. Google Scholar logo with link to Google Scholar
Walton, Douglas N., and Neil Donen. 1986. “Ethical Decision Making and the Critical Care Team.” Critical Care Clinics 2 (1): 101–109. Google Scholar logo with link to Google Scholar
Walton, Douglas, and Fabrizio Macagno. 2007. “Types of dialogue, dialectical relevance and textual congruity.” Anthropology and Philosophy, 8 (1–2): 101–119.Google Scholar logo with link to Google Scholar
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