Doctor-patient interaction in a randomised controlled trial of decision-support tools

Tim Rapley*, Carl May, Ben Heaven, Madeline Murtagh, Ruth Graham, Eileen F.S. Kaner, Richard Thomson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)2267-2278
Number of pages12
JournalSocial Science and Medicine
Volume62
Issue number9
Early online date15 Nov 2005
DOIs
Publication statusPublished - 1 May 2006
Externally publishedYes

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