Patients' compliance and resistance to medical authority in Nigerian clinical encounters

Abstract

Studies of doctor–patient interactions have shown that invoking medical authority in clinical consultations presents a recognisable practice with various outcomes. While doctors can impose the authority to make decisions for patients, patients can align or disalign with such rights by determining what constitutes authority in the consultations and negotiating for the preferred or alternate action. Extensive research in this domain has neglected how patients palliate medical authority when doctors' treatment recommendation formats do not set up the possibility for a negotiation. This paper uses the method of conversation analysis to investigate the varying degrees of medical authority being exerted through doctors' treatment recommendations, and the extent to which patients comply or resist. The research data draws on a corpus of 70 audio recorded encounters between doctors and HIV-positive patients in clinics in Southwestern Nigeria. Analyses of the consultations suggest that discussions about patients' adherence to treatment recommendations is predominant in the routine visits of HIV-positive patients. Doctors invoke high and low degrees of medical authority when recommending treatment while patients respond by endorsing or resisting the doctors' authority. For the implications on medical practice, the findings are that doctors seldom pull back with respect to displays of authority, although patients retain the rights to take life- and health-preserving drugs.