TY - JOUR
T1 - Doctor-patient interaction in a randomised controlled trial of decision-support tools
AU - Rapley, Tim
AU - May, Carl
AU - Heaven, Ben
AU - Murtagh, Madeline
AU - Graham, Ruth
AU - Kaner, Eileen F.S.
AU - Thomson, Richard
N1 - Funding Information:
We gratefully acknowledge the co-operation and candour of participating patients and general practitioners. We acknowledge the financial support of the Wellcome Trust (Grant HSR GR068380AIA). CM's contribution to this paper was partly supported by an ESRC personal research fellowship (RES 000270084), EFK's contribution was supported by an NHS Career Scientist Award. We thank Emma Hutchinson and Margaret Childs for their secretarial support, and the practice staff of contributing practices for aid in facilitating clinics. We also thank Mildred Blaxter, the anonymous reviewers, members of the Health Technology & Human Relations Wednesday workshops, John Hindmarsh and Moira Kelly for their detailed and thoughtful comments.
Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2006/5/1
Y1 - 2006/5/1
N2 - In this paper, we draw on the analytic perspectives of ethnomethodology to explore doctor-patient encounters in an experimental trial of a complex intervention: an efficacy randomised controlled trial (RCT) of decision-support tools in the UK. We show how the experimental context in which these encounters take place pervades the interactions within them. We argue that two interactional orders were at work in the encounters that we observed: (i) the ceremonial order of the consultation and (ii) the assemblage of the decision-support tool trial. We demonstrate how doctors in the trial oscillate between positions as authoritative clinician and neutralistic decision-support tool-implementer, and patients move between positions as passive recipients of clinical knowledge and as active subjects required to render their experience as calculable in terms of the demands of the decision-support tools and the broader trial they are embedded in. We demonstrate how the RCT coordinates the world of the clinical environment and the world of experimental evidence.
AB - In this paper, we draw on the analytic perspectives of ethnomethodology to explore doctor-patient encounters in an experimental trial of a complex intervention: an efficacy randomised controlled trial (RCT) of decision-support tools in the UK. We show how the experimental context in which these encounters take place pervades the interactions within them. We argue that two interactional orders were at work in the encounters that we observed: (i) the ceremonial order of the consultation and (ii) the assemblage of the decision-support tool trial. We demonstrate how doctors in the trial oscillate between positions as authoritative clinician and neutralistic decision-support tool-implementer, and patients move between positions as passive recipients of clinical knowledge and as active subjects required to render their experience as calculable in terms of the demands of the decision-support tools and the broader trial they are embedded in. We demonstrate how the RCT coordinates the world of the clinical environment and the world of experimental evidence.
KW - Decision-support tools
KW - Doctor-patient interaction
KW - Primary care
KW - Randomised controlled trials
KW - UK
KW - Video-based ethnography
UR - http://www.scopus.com/inward/record.url?scp=33644923492&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2005.10.011
DO - 10.1016/j.socscimed.2005.10.011
M3 - Article
C2 - 16290918
AN - SCOPUS:33644923492
SN - 0277-9536
VL - 62
SP - 2267
EP - 2278
JO - Social Science and Medicine
JF - Social Science and Medicine
IS - 9
ER -