![]() ![]() ![]() It has been pointed out that the implementation of shared decision making in mental health treatment is particularly delicate and challenging ( Bolden and Angell, 2017). There is a struggle between doctors’ epistemics of expertise and patient’s epistemics of subjective experience: if the claim is grounded in doctors’ expertise domain, the doctors would assert their deontic authority while if the claim belongs to patient’s epistemic domain, the patients’ deontic rights would be invoked ( Ekberg and LeCouteur, 2015). Deontic domain on the other hand is concerned with participants’ rights to determine future actions ( Lindström and Weatherall, 2015). In the area of medicine, patients have primary rights to knowledge about their experiences of illness and preferences while doctors have professional authority ( Landmark et al., 2015). Epistemic domain relates to a person’s knowledge and personal experiences ( Heritage, 2012, 2013). The first issue falls within the domain of deontics and the second epistemics ( Landmark et al., 2015). It seems that two issues are relevant in the negotiation of treatment decision making: first, who should make the decision, and second, what knowledge should be taken as the basis for the decision. ![]() Despite the significance of patient-centered practice, recent research suggests that the shared decision-making model is only partially actualized in medical encounters in general and in psychiatry in particular ( Seale et al., 2006 Adams et al., 2007 Woltmann and Whitley, 2010). It highlights the importance of understanding and seeking patients’ values, needs and treatment preferences, which is associated with treatment adherence and regarded as a cornerstone of successful treatment in mental health care ( Thompson and McCabe, 2012 McCabe et al., 2013). In the field of psychiatry, as in many areas of medicine, there has been a trend toward patient-centered care that emphasizes shared decision making with patients in planning and enacting treatment regimens ( Quirk et al., 2012 Angell and Bolden, 2015 Bolden and Angell, 2017 Thompson and McCabe, 2018). Data are in Chinese with English translation. We argue that in the process of treatment decision making, psychiatrists do not simply impose their perspectives upon the patients, instead, they attempt to achieve consensus with patients by balancing their institutional authority and orientation to the patients’ perspectives. We found that by eliciting patients’ views and perspectives toward treatment, this type of formulation is not only used to achieve mutual understanding and establish the grounds for treatment decisions, but may also be used to challenge the legitimacy of patients’ position, steering treatment decision to the direction preferred by the psychiatrists. Taking the naturally occurring, face-to-face outpatient psychiatric consultations as the data, the present study uses conversation analysis (CA) as a method to demonstrate in a fine-grained detail what functions formulations of patients’ perspectives serve in psychiatric contexts. This article attempts to examine a conversational practice that psychiatrists use to deal with patients’ views and perspectives by formulating what the patients have said related to treatment. However, negotiating treatment in psychiatric contexts can be challenging with patients whose ability to evaluate treatment recommendations rationally may be impaired. Seeking and understanding patients’ values and preferences is one of the essential elements in shared decision making, which is associated with treatment adherence in psychiatry.
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