Diagnosis resistance in Chinese medical encounters and its implications on medical authority

Abstract

By examining outpatient consultations recorded in a hospital-based specialist clinic in China, the study reports a strikingly frequent occurrence of resistance in the diagnosis phase. Drawing on conversation analysis, we found that besides resistance patterns and resources previously studied, second-position repetition and the absence of uptake, both involving no substantive content of resistance, are also recurrently exploited by Chinese patients in diagnosis disalignment. As to resources of substantive resistance, temporarily absent symptoms, medical test results and self-proposed treatment recommendation are found in Chinese patients' reservoir, in addition to other common resources. Patients' disregard for epistemic vise is shown through their exploitation of expertise-demanding knowledge like interpreting medical test results to contest diagnostic decisions. The frequency, patterns and resources of diagnosis resistance in our data all point to the great recession of medical authority along with a significant rise of patients’ agency in Chinese medical encounters today.