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Full text release has been delayed at the author's request until May 08, 2028

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Constructing Empowerment: Epistemic and Deontic Authority in Patient-Centered Care Interactions

Richards, Nathan Ray
http://rave.ohiolink.edu/etdc/view?acc_num=osu1682006015231863

Abstract Details

2023, Doctor of Philosophy, Ohio State University, English.
Interaction between patients and healthcare clinicians comprise a central aspect of American medical practice. This feature of medicine—patient-clinician communication—has received attention from various fields of study that aim to improve communication between these parties. One oft-cited aspect of this communication is the imbalance in authority that favors clinicians over patients; policies such as patient-centered care and shared decision-making have been advocated for as ways to balance these relationships. This dissertation takes up this asymmetry and identifies the ways in which patients and clinicians negotiate their authority in the course of interaction. Bringing together diverse data sets, Constructing Empowerment: Epistemic and Deontic Authority in Patient-Centered Care Interactions delineates ways that patients and clinicians negotiate authority while working to achieve patient-centered care. The data sets range from recordings between actual patients and their primary care clinicians to focus groups gathered with practicing physicians, current policy documents, and a fictional medical drama. Each chapter identifies key linguistic features that play a role in the negotiation of authority that patients and clinicians are engaged in as a part of medical practice. Starting with an extended analysis of one interaction between a patient and clinician, subsequent chapters expand the context to include the ways that institutional and cultural constraints shape and are shaped by these interactions. Chapter one demonstrates the role discourse markers and imperatives play to manage competing territories of knowledge and create empowering positions. Chapter two focuses on the ways that issues regarding health insurance emerge in the course of patient-clinician interaction; here, health insurance itself is seen to provide an additional set of assumptions that lie outside of traditional notions of what patients and clinicians are expected to know and functions to disempower both parties. Chapter 3 analyzes the use of modal verbs in Opioid Treatment Agreements (OTAs). Specific attention is given to the ways that these documents determine the parties’ rights to and responsibilities for future action and act as a barrier to patients and clinicians collaborating on care. Using focus group data from physician who are familiar with OTAs, how the language in these documents moves into practice is considered. Finally, in chapter 4, clinician-clinician talk is analyzed as characters work toward radical change that will empower their clinicians and patients. In using multiple data sets and expanding the context from individual patients and clinicians to institutional concerns, this dissertation seeks to reveal ways in which different sources of authority are operating across medical discourses. From this vantage point, the potential for patients and clinicians to build more empowered positions in the course interaction is clarified and strategies to do so are advocated for as one way engender more effective care for the future.
Gabriella Modan (Advisor)
Seuli Bose Brill (Committee Member)
James Phelan (Committee Member)
Amy Shuman (Committee Member)
188 p.
Health; Health Care; Language
Discourse Analysis; Conversation Analysis; Patient-Centered Care; Epistemic Authority; Deontic Authority; Medical Humanities

Recommended Citations

Citations

  • Richards, N. R. (2023). Constructing Empowerment: Epistemic and Deontic Authority in Patient-Centered Care Interactions [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1682006015231863

    APA Style (7th edition)

  • Richards, Nathan. Constructing Empowerment: Epistemic and Deontic Authority in Patient-Centered Care Interactions. 2023. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1682006015231863.

    MLA Style (8th edition)

  • Richards, Nathan. "Constructing Empowerment: Epistemic and Deontic Authority in Patient-Centered Care Interactions." Doctoral dissertation, Ohio State University, 2023. http://rave.ohiolink.edu/etdc/view?acc_num=osu1682006015231863

    Chicago Manual of Style (17th edition)

osu1682006015231863
© 2023, all rights reserved.
This open access ETD is published by The Ohio State University and OhioLINK.