To explore how doctors maintain dominance during their meetings with patients, researchers have conducted detailed analyses of conversation patterns between doctors and patients. These studies show that doctors typically dominate discussions. Doctors typically indicate when to begin discussing a topic and when the topic is closed, and ask closed-ended rather than open-ended questions, thus making it difficult for patients to raise new topics. For example, a patient might come to a doctor complaining of various problems. The doctor will ask for further details about only some of those problems, typi- cally ignoring how patients’ work or living situations might affect their health. The doctor also can ask questions about problems the patient had not mentioned but that the doctor expects to find, thereby defining certain problems as more relevant than others.
Doctors also can reinforce their dominance by the simple tactic of referring to the patient by first name but expecting patients to refer to them by their title (“Dr. Smith”). Finally, when patients must choose between two different treat- ments or between treatment and “watchful waiting,” doctors typically present those options in ways that strongly bias the patient toward accepting whichever course of action the doctor considers best.
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