Collaboration and Communication in Clinical Consultations with Chronically Ill Patients: Cultural Perspectives

The main aim of the research project is to conduct a qualitative exploration of interaction in naturally occurring consultations between hospital clinicians and patients with chronic conditions. Observational data of consultations will be supplemented by interview data collected from both clinicians and patients. While exploring their interaction and juxtaposing paired accounts of how patients and clinicians experienced them, our main aim is to gain new knowledge about a) relational factors that affect these clinical encounters in positive and negative ways, b) about barriers and facilitators of patient-centred care and c) the ways in which the wider socio-cultural context influences on their interaction.

Clinical interaction in context: a narrative exploration of 212 naturally occurring GP consultations.

Clinical interaction between patients and doctors is embedded within, positioned and inseparable from social context. In this study, we explore how illness narratives are co-constructed within naturally occurring clinical consultations between doctors and patients. Clinical uncertainty and shared decision-making are emphasised. Although our empirical exploration focuses on in situ consultations between patients and GPs as they unfold, we situate their interaction in the sociocultural context in which it is embedded and explore their negotiations in relation to their institutionalized positions and roles. The study is based on 212 naturally occurring GP consultations in England, sourced from the One in a Million data archive in the UK. Consultations involve musculoskeletal, psychological, digestive, cardiovascular, neurological, endocrine/metabolic and general conditions. By exploring complete naturally occurring consultations with a heterogenous sample of patients, we capture the interactional dynamics of negotiations in relation to a wide range of consultation aspects and clinical conditions. Contextualising these negotiations enables us to see how the actions of both patients and GPs are tied to their different institutionalised positions. Through data-grounded coding of all 212 consultations in NVivo, we are able to relate our in-depth cases to the wider dataset. Although we use a mix of analytical methods, our main approach is qualitative interpretive methods, particularly narrative and thematic analysis. The researchgroup is international and interdiciplinary.

Most recent publication from the project:

• Lian, OS; Nettleton, S; Grange, H and Dowrick, C (2021) “I’m not the doctor; I’m just the patient”: Patient agency and shared decision-making in naturally occurring primary care consultations. Patient Education and Counceling. https://doi.org/10.1016/j.pec.2021.10.031
• Lian, OS; Nettleton, S; Wifstad, Å and Dowrick, C (2021) Negotiating Uncertainty in Clinical Encounters: A Narrative Exploration of Naturally Occurring Primary Care Consultations. Social Science & Medicine 291 (114467). https://doi.org/10.1016/j.socscimed.2021.114467. Social media response.
• Lian OS; Nettleton, S; Wifstad, Å and Dowrick, C (2021) Modes of Interaction in Naturally Occurring Medical Encounters with General Practitioners: The ´One in a Million´ Study. Qualitative Health Research 31(6): 1129-1143. https://doi.org/10.1177/1049732321993790.

Complete list of research interests:

• Clinical interaction and shared decision-making
• Uncertainty and risk
• Medical uncertainty
• Illness narratives
• Contested Chronic Conditions: experiential perspectives
• Sociology of diagnosis
• Social constructions of health and illness
• Cultural, historical and gendered perspectives on medical knowledge and practice
• Medicalisation as a modern phenomena
• Qualitative research and narrative theory
• The role of theory in qualitative research
• Photography and visual research

Medical ethics

Health care ethics

Philosophy of science

My research background is in language and literary studies. Following a BA in French and Italian at the University of Cambridge, I completed a PhD in Modern & Medieval Languages in 2012, also at the University of Cambridge. I have held teaching and research positions in the School of English at the University of Kent and, most recently, as a Departmental Lecturer in French at the University of Oxford. My interest in the Medical Humanities stems from my postdoctoral work at the University of Nottingham with the 'Hungry for Words' project, exploring arts and humanities approaches to understanding and raising awareness of eating disorders in men.

• Eating disorders, disordered eating
• Food and eating in literature
• Illness narratives
• Arts and humanities approaches in healthcare education
• Medieval literature and culture