Negotiation, temporality and context - a qualitative study of the clinical encounter

Abstract

Background, aims and objectives: In general practice, obtaining patients’ perspectives and finding common ground with patients has for many years been a core value. Negotiation is often associated with agenda setting as well as shared decision-making (SDM) and finding common ground between two parties. This study aims to connect the social meeting between general practitioner (GP) and patient with the organisational, physical and temporal contexts of general practice, to account for the possibilities of negotiation. Methods: We employed a qualitative study design which combined observations of clinical encounters and semi-structured interviews of GPs as well as of patients. The empirical material was collected in relation to the intervention project Check-In . The intervention examined the effectiveness of an invitation of patients with no formal education beyond the mandatory 7-9 years of schooling to a pre-scheduled preventive health check at his or her GP. Results: Overall, the findings in this study reveal how the wider context influences the degree to which time is spent on negotiation and finding common ground in the clinical encounter. Conclusion: This study shows that negotiation is sensitive to both the contexts of patients’ everyday lives as well as the contexts of the clinical encounter. In this way, finding common ground between GP and patients varies in different social contexts as the temporal conditions of the wider contexts influences and are influenced by negotiations between GPs and patients.