Modulating Certainty: Pursuing Parent Acceptance of Diagnoses and Treatment Recommendations in Pediatric Neurology

• In Event: 40207 - Research in Ethnomethodology and Conversation Analysis

Abstract

Over the past several decades there have been efforts to “modernize” the doctor-patient relationship by encouraging physicians to adopt a patient-centered approach. As a result, patients have become increasingly empowered and engaged in their care (Timmermans 2020), and these changes are often understood as implying a proportional reduction in medical authority. While there is evidence to suggest that the expression of medical authority has softened since the mid-20th century (Heritage and McArthur 2019; Peräkylä 1998), there is also evidence to suggest that physicians are capable of overcoming resistance to their professional assessments and advice (Stivers and Timmermans 2020; Tate 2020). In this paper, I use conversation analysis to examine a practice that physicians use to overcome parent resistance to diagnoses and treatment recommendations in pediatric neurology visits for overnight vEEG testing. Specifically, I focus on how physicians in this context can pursue parent acceptance through “modulating certainty” — including upgrading or downgrading the (un)certainty of test results, diagnoses, prognoses, and the effects that specific treatments will engender, among others. My analysis suggests that the rise of patient engagement has not led to a proportional reduction in physicians’ authority per se, but it has shaped how medical authority is ultimately realized in clinical encounters.

Author

• Keith Cox, George Washington University