Authority and Accountability: The Delivery of Diagnosis in Primary Health Care

Abstract

Drawing on a database of more than 100 videotaped and transcribed medical consultations, this paper analyzes the balance between authority and accountability in delivering diagnostic news in interactions between doctors and patients in Finnish primary health care. Three designs of diagnostic turns are identified: (1) In plain assertions, the doctor states the name of the illness in a classical proposition format: It is X. (2) In diagnostic tuns incorporating inexplicit references to the evidence, the doctor usually uses evidential verb constructions, such as It seems to be X.' (3) In turns that explicate the evidence, the doctor describes specific observations as evidence for the diagnostic statement. Through the coordination of the design and placement of their diagnostic turns, the doctors treat themselves as accountable for the evidential basis of the diagnosis, and thereby do not claim unconditional authority in relation to the patients. The observations reported here make it possible to specify Parsons' and Freidson's classical formulations concerning doctors' authority.