Een goed begin

Well begun is half done. Deontic and epistemic authority in the opening phase of medical consultations Context: An effective consultation opening with attention to patient participation not only increases patient satisfaction, but is also a prerequisite for shared decision making, which may improve health outcomes and reduce healthcare costs. Methods: Using conversation analysis, we examined linguistic and structural characteristics of 41 video recorded consultation openings of medical specialists at a large Dutch teaching hospital. The main purpose was to give an overview of how doctors and patients interactionally shape deontic and epistemic authority. Results: Conversation analysis showed different ways in which doctors open their consultations and patients’ reactions to this. Agenda setting occurred in 6 cases, this was always the doctor’s agenda. Most of the doctors’ utterances during this phase displayed a high deontic stance and none of the patients were invited to discuss their expectations or goals for the consultation. 30 doctors started with their opening question, which in itself also reflects a high deontic stance. During the opening questions, the doctors’ epistemic stances differed. Conclusion: During the consultation openings, the doctor was clearly in charge of the conversation and often did not explore the knowledge domain of the patient. This can limit patient participation and can hinder shared decision making in the consultation.