Steering interactions away from complaints about persistent symptoms in psychiatric consultations

In medical encounters, doctors sometimes have to convey views of patients’ problems which are not in line with patients’ views and expectations. One such situation in psychiatric consultations is when the patient complains about symptoms which persist in spite of treatment, while the psychiatrist regards the patient’s condition as not serious enough to adjust treatment or has no satisfactory explanations or solutions. Based on an analysis of video-recorded psychiatric consultations in Japan, this study investigates how psychiatrists cope with such situations and shows that they steer the interaction away from the complaints using a series of moves with which they transform the reported symptoms into evidence that supports their view of the patients’ problems. It is argued that psychiatrists strike a balance between the two potentially conflicting goals of respecting patients’ epistemic authority on their symptoms and minimising inappropriate medication increases

Family medicine · Medical treatment · Psychiatry · Psychotherapist · Clinical Reasoning and Diagnostic Skills · Medicine · Mental Health and Patient Involvement · Mental Health and Psychiatry · Psychology

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