Negotiating patients’ therapy proposals in paternalistic and humanistic clinics

Abstract

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.