The single-option dilemma: some challenges for clinicians offering
patient choice in practice
Dr Merran Toerien, University of York, Department of Sociology
merran.toerien [at] york.ac.uk
Drawing on a conversation analytic study of over 200 recordings of consultations in neurology outpatient clinics, this presentation will highlight a dilemma that can arise for clinicians when attempting to give patients a choice about a single course of action (i.e. whether or not to undergo a particular treatment or test). I’ll start by showing how ‘patient view elicitors’ (PVEs) can be used to construct such a decision for the patient. In my dataset, these PVEs fell into two main groups: those where the course of action was introduced prior to the use of the PVE, and those where it was introduced through its use. I’ll illustrate each of these, showing how each can function to place the decision in the patient’s domain. However, I’ll also argue that each raises a potential difficulty for patient choice, which amounts to a dilemma for the clinician. Illustrating this dilemma in my data, I will explain it in terms of the twin concepts of epistemic and deontic authority (see Stevanovic and Peräkylä, 2012). I’ll conclude by considering some ways in which clinicians may be able to address these difficulties most effectively – including by borrowing some of the structure evident in an alternative practice my colleagues and I have identified for offering patients choice, which we refer to as option-listing.
