Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Qual Health Res. 2012 Feb;22(2):238-49. doi: 10.1177/1049732311420738. Epub 2011 Sep 2.
Models of patient-physician decision making are typically framed on a continuum of discourses and practices ranging from patient autonomy to physician paternalism, with the middle ground being occupied by terms such as shared decision making. Critiques of these models center on the gulf between these idealized models and actual practice and on how context influences decision-making practices. In this article I focus on how 11 Canadian family physicians talked about patient-physician decision making in interviews about their diagnostic and treatment practices for depression. I adopt a discursive approach to analyzing extracts from these interviews, and show how these physicians constructed themselves as engaging in acts of professional judgment and persuasion, and patients as having the final say in decision making about treatment for depression. I argue that whether the intertwining of discourses of physician influence and patient autonomy is understood as a balance of power between physicians and patients is an open question.
患者-医生决策模型通常在话语和实践的连续体上进行构建，范围从患者自主到医生家长式作风，中间立场则由共享决策等术语占据。对这些模型的批评集中在这些理想化模型与实际实践之间的差距，以及背景如何影响决策实践上。在本文中，我关注的是 11 位加拿大家庭医生在接受有关其抑郁症诊断和治疗实践的访谈时如何谈论医患决策。我采用话语分析方法来分析这些访谈的摘录，并展示这些医生如何将自己描述为进行专业判断和说服的行为，以及患者在决定治疗抑郁症的决策中拥有最终发言权。我认为，医生影响和患者自主权的话语交织是否被理解为医生和患者之间权力平衡的问题是一个悬而未决的问题。
