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Article published In:
Pragmatics
Vol. 31:3 (2021) ► pp.430–454

Negotiating patients’ therapy proposals in paternalistic and humanistic clinics

ORCID logo | University of Ibadan

The negotiation of patients’ therapy proposals often makes a strong statement about doctors’ consultative styles in Nigerian clinical encounters. This invites a search into the relationship between patients’ preferred treatment options and doctors’ and patients’ approaches to negotiating them. Analysis reveals the sequential and face orientation mechanisms deployed in negotiating patients’ proposals in predominantly doctor-centred clinics, the interactional moves made by them in negotiating the proposals in predominantly patient-centred clinics, and the pragmatic implications of the proposals negotiated in both clinics. The negotiations in the clinics are anchored to strategic rapport building, the colonisation of patients’ lifeworld and constrained joint decisions. Rapport is poorly built in the doctor-centred clinic with power-imbued strategies which stifle patients’ voice and lead to completely-constrained joint decisions on therapy proposals by patients. Participatory consultation enhances negotiation in the patient-centred clinic, but the physician’s misleading strategic sequences and exaggerated emotions somewhat weaken the ultimate consultative outcome.

Keywords: therapy proposals, paternalistic and humanistic doctoring styles, Kecskes’socio-cognitive approach, interactional moves, Yoruba culture, Nigerian clinical meetings
Article outline
  • 1.Introduction
  • 2.Methodology
  • 3.Analysis and findings
    • 3.1Negotiation of Patient’s proposals in a predominantly doctor-centred clinic
      • 3.1.1Sequential negotiations in a doctor-centred clinic
        • 1.Patient makes a procedural appeal to deontic rights and institutional flexibility as a cue for a therapy proposal
        • 2.Doctor interprets the utterances of patient as indexes of personal goals
        • 3.Both parties co-jointly construct patient’s dispreference of Doctor’s therapy proposal as an index of irresponsibility
        • 4.Patient sequentially appeals to spiritual healing as a preferred alternative to medical plan
      • 3.1.2Face orientations and negotiations
        • 1.Face separation in the clash of cultural and institutional interpretations
        • 2.Strategic face connection as an institutional pressure
    • 3.2Negotiation of patient’s proposal in a predominantly patient-centred clinic
      • 3.2.1Interactional moves in a PCA encounter
        • 1.Patient strategically appeals to religious proposal as a cue of positive face orientation
        • 2.Doctor constructs Patient’s religious proposal as a positive act
        • 3.Doctor and patient co-construct religion-informed non-compliance to doctor’s therapy plan as an inconsequential action
        • 4.Doctor and patient co-construct religious option as a serious health hazard
    • 3.3Clinical/pragmatic implications of therapy proposal negotiations
  • 4.Conclusions
  • Acknowledgments
  • Notes
  • References
Available under the Creative Commons Attribution-NonCommercial (CC BY-NC) 4.0 license.
Published online: 8 March 2021
DOI logo
https://doi.org/10.1075/prag.18054.ode
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