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Discourses of influence and autonomy in physicians' accounts of treatment decision making for depression

机译：医师对抑郁症治疗决策的描述中的影响力和自主性话语

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Models of patient-physician decision making are typically framed on a continuum of discourses and practices ranging from patient autonomy to physician paternalism, with the middle ground being occupied by terms such as shared decision making. Critiques of these models center on the gulf between these idealized models and actual practice and on how context influences decision-making practices. In this article I focus on how 11 Canadian family physicians talked about patient-physician decision making in interviews about their diagnostic and treatment practices for depression. I adopt a discursive approach to analyzing extracts from these interviews, and show how these physicians constructed themselves as engaging in acts of professional judgment and persuasion, and patients as having the final say in decision making about treatment for depression. I argue that whether the intertwining of discourses of physician influence and patient autonomy is understood as a balance of power between physicians and patients is an open question.
机译：患者-医师决策制定的模型通常以从患者自主权到医师家长式的一系列话语和实践为框架，中间立场由诸如共同决策之类的术语占据。对这些模型的批评集中在这些理想化模型与实际实践之间的鸿沟，以及环境如何影响决策实践。在本文中，我将重点介绍11位加拿大家庭医生在采访中有关抑郁症的诊断和治疗方法时如何谈论患者-医师的决策。我采用了一种话语方法来分析这些访谈的摘录，并展示这些医生如何将自己建构为从事专业判断和说服行为，以及使患者在对抑郁症的治疗决策中拥有最终决定权。我认为，医师影响和患者自主权的话语交织是否被理解为医师和患者之间力量的平衡是一个悬而未决的问题。

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