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 in context is a research project dealing with the interaction between patients and doctors in clinical consultations, with a focus on patient centred care and shared decision-making. Through various sub-studies, we explore the moment-to-moment unfolding of naturally occurring clinical consultations between patients and general practitioners (GPs). 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 institutionalised 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 constrained by their different institutionalised positions. Through data-grounded semantic coding of all 212 consultations in NVivo, we are able to relate single cases to the wider dataset. While analysing the data, we combine qualitative thematic analysis and narrative analysis, but our main analytical approach is qualitative interpretive narrative analysis. In line with this methodology, we analyse the consultations as narratives, and explore complete consultation transcripts in relation to what was uttered (content), how it was uttered (form), and by whom (speaker). By focusing on the interactional dynamics; quoting long extracts; analysing components in light of the whole, and attending to sequentiality, we respect the integrity of the narrative. The project is structured around three main overlapping subthemes: (1) modes of interaction; (2) risk and uncertainty, and (3) patient agency. Read more on separate webpage here.

Most recent publication from the project:

Lian OS, Nettleton S, Grange H and Dowrick C (2022) "It feels like my metabolism has shut down". Negotiating interactional roles and epistemic positions in a primary care consultation. Health Expectations. https://onlinelibrary.wiley.com/doi/epdf/10.1111/hex.13666

Lian OS, Nettleton S, Grange H and Dowrick C (2022) “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 105(7): 1996-2004.  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

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