Over the past decades, professional medical authority has been transformed due to internal and external pressures, including weakened institutional support and patient-centered care. Today’s patients are more likely to resist treatment recommendations. We examine how patient resistance to treatment recommendations indexes the strength of contemporary professional authority. Using conversation analytic methods, we analyze 39 video recordings of patient-clinician encounters involving pediatric epilepsy patients in which parents resist recommended treatments. We identify three distinct grounds for parental resistance to treatments: preference-, fear-, and experience-based resistance. Clinicians meet these grounds with three corresponding persuasion strategies ranging from pressuring, to coaxing, to accommodating. Rather than giving parents what they want, physicians preserve their professional authority, adjusting responses based on whether the resistance threatens their prerogative to prescribe. While physicians are able to convert most resistance into acceptance, resistance has the potential to change the treatment recommendation and may lead to changed communication styles.

中文翻译：

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围困中的医疗机构：临床医生如何将患者的抵抗力转化为接受度。

在过去的几十年中，由于内部和外部的压力，包括削弱的机构支持和以患者为中心的护理，专业医疗机构已经发生了变化。如今的患者更有可能拒绝治疗建议。我们研究了患者对治疗建议的抵抗力如何体现当代专业权威的实力。使用对话分析方法，我们分析了涉及小儿癫痫患者的39位患者-临床医生遭遇的录像，其中父母抵制了推荐的治疗方法。我们确定了父母对治疗的抵抗力的三个截然不同的理由：偏好，恐惧和基于经验的抵抗力。临床医生通过三种相应的说服策略来满足这些要求，这些策略从加压，哄哄到包容。医生没有给父母他们想要的东西，而是保留了他们的专业权威，根据抵制是否威胁到他们的特权来调整答复。尽管医生能够将大多数抵抗力转化为接受力，但抵抗力有可能改变治疗建议，并可能导致交流方式的改变。