Comments on ‘Arguing ‘for’ the Patient. Informed Consent and Strategic Maneuvering in Doctor–Patient Interaction’

Abstract

Schulz and Rubinelli’s project ‘Informed consent and strategic maneuvering in doctor–patient interaction’ provides an excellent opportunity for studying argumentation in a specific institutional context because a medical consultation is a special communicative activity type that may involve argumentative discussion. Before engaging in empirical research regarding such a consultation it is necessary to make a conceptional analysis of this type of doctor–patient interaction. One first needs to give a general characterization of the type of interaction concerned: what is the structure of the interaction in a doctor–patient consultation in terms of speech acts, role taking and time constraints? For doing so a better understanding is required of the type of difference of opinion that will be at issue in such a consultation. What type of standpoint initiates the discussion? Which parts can be distinguished in the activity type of medical consultation and which of them are typically or potentially argumentative? What are the roles of the two participants in each of these cases? Is it the doctor or the patient who initiates the discussion by putting forward a standpoint or can this be done by either of them? Schulz and Rubinelli characterize doctor–patient interaction as an ‘info-suasive dialogue.’ This characterization is, however, problematic. The authors claim that the interaction partly can be seen as an instance of an information-seeking dialogue and partly an argumentative encounter, ‘at a higher level.’ But in a consultation argumentation is not necessarily required. The patient may be in complete agreement with everything the doctor says and the doctor may not expect the patient to disagree with him so that no anticipation of doubt is necessary. Since argumentation is not a constitutive part of this activity type it is not automatically a ‘persuasive’ type of dialogue. Of course the moment one the parties has reason to believe that the other party is not or will not be in full agreement with him,