Volume 31, Issue 3
  • ISSN 1018-2101
  • E-ISSN: 2406-4238



The negotiation of patients’ therapy proposals often makes a strong statement about doctors’ consultative styles in Nigerian clinical encounters. This invites a search into the relationship between patients’ preferred treatment options and doctors’ and patients’ approaches to negotiating them. Analysis reveals the sequential and face orientation mechanisms deployed in negotiating patients’ proposals in predominantly doctor-centred clinics, the interactional moves made by them in negotiating the proposals in predominantly patient-centred clinics, and the pragmatic implications of the proposals negotiated in both clinics. The negotiations in the clinics are anchored to strategic rapport building, the colonisation of patients’ lifeworld and constrained joint decisions. Rapport is poorly built in the doctor-centred clinic with power-imbued strategies which stifle patients’ voice and lead to completely-constrained joint decisions on therapy proposals by patients. Participatory consultation enhances negotiation in the patient-centred clinic, but the physician’s misleading strategic sequences and exaggerated emotions somewhat weaken the ultimate consultative outcome.


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  1. Ainsworth-Vaugh, Nancy
    1995 “Claiming Power in the Medical Encounter: The Whirlpool Discourse”. Qualitative Health Research. 5 (3): 270–291. 10.1016/j.socscimed.2004.03.005
    https://doi.org/10.1016/j.socscimed.2004.03.005 [Google Scholar]
  2. Apker, Julie and Susan Eggly
    2004 “Communicating Professional Identity in Medical Socialisation: Considering the Ideological Discourse of Morning Report”. Quality Health Research14: 411–429). 10.1177/1049732303260577
    https://doi.org/10.1177/1049732303260577 [Google Scholar]
  3. Ajayi, Ikeoluwapo
    2003 “The Consultation Style of Doctors at an Outpatient Clinic in Ibadan, Oyo State, Nigeria: are Patients Participating?” Nigerian Journal of ClinicalPractices. 6 (1): 10–16.
    [Google Scholar]
  4. Arundale, Robert
    2010 “Constituting Face in Conversation: Face, Facework, and Interactional Achievement”. Journal of Pragmatics, 42, 2078–2105. 10.1016/j.pragma.2009.12.021
    https://doi.org/10.1016/j.pragma.2009.12.021 [Google Scholar]
  5. Bélanger, Emmanuelle, Charo Rodríguez, Danielle Groleau, France Légaré, Mary Ellen MacDonald, and Robert Marchand
    2016 “Patient Participation in Palliative Care Decisions: An Ethnographic Discourse Analysis”. International Journal of Qualitative Studies on Health and Well-being, 11, 32438. doi:  10.3402/qhw.v11.32438
    https://doi.org/10.3402/qhw.v11.32438 [Google Scholar]
  6. Bishop, Felicity and Lucy Yardley
    2004 “Constructing Responsibility in Treatment Decisions: Negotiating Responsibility in Cancer”. Health Int. J. Soc. Study Health Illn. Med. 8 (4): 465–482.
    [Google Scholar]
  7. Brown, Penelope and Levinson, Stephen
    1987Politeness: Some Universals in Language Usage. Cambridge: Cambridge University Press. 10.1017/CBO9780511813085
    https://doi.org/10.1017/CBO9780511813085 [Google Scholar]
  8. Clark, Herbert
    1996Using Language. Cambridge: Cambridge University Press. 10.1017/CBO9780511620539
    https://doi.org/10.1017/CBO9780511620539 [Google Scholar]
  9. Costello, Brian and Felicia Roberts
    2001 “Medical Recommendations as Joint Social Practice”. Health and Communication13 (3): 241–260. 10.1207/S15327027HC1303_2
    https://doi.org/10.1207/S15327027HC1303_2 [Google Scholar]
  10. Cubaka, Vincent, Michael Schriver, Philip Cotton, Laetita Nyirazinyoye and Per Kallestrup
    2018 “Providers’ Perceptions of Communication with Patients in Primary Healthcare in Rwanda”. PLoSONE13(4). e0195269. doi: 10.1371/journal
    https://doi.org/10.1371/journal [Google Scholar]
  11. De Belder, Zara
    2013 “Power and Discourse Comparing the Power of Doctor in Two Contrasting Interactive Encounters”. Innervate. 5: 106–121.
    [Google Scholar]
  12. De Kok, B. C., S. Widdicombe, A. Pilnick and E. Laurier
    2018 “Doing patient-centredness versus achieving public health targets: A critical review of interactional dilemmas in ART adherence support”. HYPERLINK “https://www.sciencedirect.com/science/journal/02779536” Social Science & Medicine. 205: 17–25.
    [Google Scholar]
  13. Emanuel, Ezekiel and Nancy Dubler
    1995 “Preserving the Physician-patient Relationship in the Area of Managed Care”. JAMA273: 323–329. 10.1001/jama.1995.03520280069043
    https://doi.org/10.1001/jama.1995.03520280069043 [Google Scholar]
  14. Hyden, Lars and Pia Bulow
    2006 “Medical Discourse, Illness and Narratives”. Encyclopedia of Language & Linguistics. doi:  10.1016/B0‑08‑044854‑2/04277‑2
    https://doi.org/10.1016/B0-08-044854-2/04277-2 [Google Scholar]
  15. Jefferson, Gail
    2004 “Glossary of Transcript Symbols with an Introduction”. InConversation Analysis: Studies from the First Generation, ed byGene Lerner, 14–31.
    [Google Scholar]
  16. Kecskes, Istvan
    2010 “Situation-bound Utterances as Pragmatic Acts”. Journal of Pragmatics. 42 (11): 2889–2897. 10.1016/j.pragma.2010.06.008
    https://doi.org/10.1016/j.pragma.2010.06.008 [Google Scholar]
  17. 2014Intercultural Pragmatics. Oxford: Oxford University Press.
    [Google Scholar]
  18. Khawaja, Mahud
    (nd) “The Power of Talk – Creating a Healing Environment”. https://weatherhead.case.edu/departments/organizational-behavior/workingpapers/WP-08-05.pdf
  19. Landmark, Anne Marie D., Pal Gulbrandsen and Jan Svennevig
    2015 “Whose Decision? Negotiating Epistemic and Deontic Rights in Medical Treatment Decisions”. Journal of Pragmatics. 78: 54–69. 10.1016/j.pragma.2014.11.007
    https://doi.org/10.1016/j.pragma.2014.11.007 [Google Scholar]
  20. Lawal, Joseph, Schadrac Agbla, Queen Bola-Lawal, Muhammed Afolabi and Elvis Ihaji
    2018 “Patients’ Satisfaction with Care from Nigerian Federal Capital Territory’s Public Secondary Hospitals: A Cross-sectional Study”. Journal of Patient Experience5(4): 250–257. 10.1177/2374373517752696
    https://doi.org/10.1177/2374373517752696 [Google Scholar]
  21. Lings, Pam, Philip Evans, David Seamark, Clare Seamark, Kieran Sweeney, Michael Dixon and Denis Gray
    2003 “The Doctor-patient Relationship in US Primary Care”. Journal of the Royal Society of Medicine96 (4): 8180–184.
    [Google Scholar]
  22. Maynard, Douglas
    1996 “On ‘Realisation’ in Everyday Life: the Forecasting of Bad News as a Social Relation”. American Sociological Review. 16 (1): 109–131. 10.2307/2096409
    https://doi.org/10.2307/2096409 [Google Scholar]
  23. Mey, Jacob
    2001Pragmatics: an Introduction. Oxford: Blackwell Publishers.
    [Google Scholar]
  24. Mezzich, Juan, Jon Snaedal, Chris van Weel and I. Heath
    2009 “The International Network for Person-centred Medicine: Background and First Steps”. World Medical Journal55: 104–107.
    [Google Scholar]
  25. Mishler, Elliot
    1984Discourse of Medicine: Dialects of Medical Interviews. Norwood, NJ: Ablex.
    [Google Scholar]
  26. Odebunmi, Akin
    2013 “Multiple Codes, Multiple Impressions: An Analysis of Doctor-client Encounters in Nigeria”. Multilingua32 (3): 373–403. 10.1515/multi‑2013‑0017
    https://doi.org/10.1515/multi-2013-0017 [Google Scholar]
  27. 2016 “ ‘You didn’t give me to go and buy’: Negotiating Accountability for Poor Health in Post-recommendation Medical Consultations”. Journal of Pragmatics93: 1–15. 10.1016/j.pragma.2015.11.011
    https://doi.org/10.1016/j.pragma.2015.11.011 [Google Scholar]
  28. 2017 “Negotiation of Physician error when Therapy Administration Fails: A Case Study Report”. Quality in Primary Health Journal1(1): 1–6.
    [Google Scholar]
  29. Robert di Sarsina, Paolo and Ilara Iseppato
    2010 “Person-centred Medicine: Towards a Definition”. Forschende Komplementärmedizin17: 277–278. 10.1159/000320603
    https://doi.org/10.1159/000320603 [Google Scholar]
  30. Ruhi, Sukriye
    2006 “Politeness in Compliment Responses: a Perspective from Naturally Occurring Exchanges in Turkish”. Pragmatics16(1): 43–101. 10.1075/prag.16.1.03ruh
    https://doi.org/10.1075/prag.16.1.03ruh [Google Scholar]
  31. Stivers, Tanya
    2001 “Negotiating Who Presents the Problem: Next Speaker Selection in Pediatric Encounters”. Journal of Communication51 (2): 231–449. 10.1016/j.socscimed.2010.06.005
    https://doi.org/10.1016/j.socscimed.2010.06.005 [Google Scholar]
  32. Young, Katharine
    1997Presence in the Flesh: the Body in Medicine: Harvard University Press.
    [Google Scholar]
  33. Zuraidah, Don and Ahmad Izadi
    2011 “Relational Connection and Separation in Iranian Dissertation Defences”. Journal of Pragmatics. 43: 3782–3792. 10.1016/j.pragma.2011.09.010
    https://doi.org/10.1016/j.pragma.2011.09.010 [Google Scholar]
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