I want to have you.
You must adhere strictly to the time and days of intake, medical advices and negotiations on medical authority in Nigeria and HIV consultation.
So I will begin with an introduction to the church, followed by the research for cause the data copper's beta process and the method of data analysis.
The findings of the research. And my concluding thoughts or statements.
How did research on medical authority in medical sociology and medical composition analysis present two distinct arguments?
On the one hand, researchers teach that doctors paternalistic approach to medical encounters is quite predominant,
and this constitutes the underlying cause of patients non-participating behaviour during consultations.
Although there are various perceptions of the doctors authority and this vary across various cultures,
the notion of paternalistic dominance really implies that the doctor's authority limits patients centred work.
And this is evident, for instance,
when she said physicians adopt a greater position of epistemic and deonte authority that is relative to the patient when recommending treatment.
Then, on the other hand, findings indicate that doctors work to withdraw some of this authority, thereby encouraging the patients to, for instance,
participate more in the encounters by maybe answering more than the question that doctors are asking during medical history taking,
or sometimes also requests for diagnostic diagnostic tests in the process of consulting the patients and asking for the patient's concerns.
And the patients will be. Now,
to learn more understanding on these two perspectives as a research of thought that an
examination of the advice given sequences in medical interactions become insightful,
and especially because the pragmatic understanding of and advice means telling you what is best for
you to do and in professional talent and countless advice giving is not massively uni directional,
so it often happens in situations where the doctors will be the one to offer the advice to the patient.
So and this justifies, to some extent my reason for taking the professional as a point of departure for the
exploration of this particular intellectual practise in medical and health related settings.
Advisory interactions that have been the focus of extensive research by linguists,
including interactions between health visitors and first time mothers in Britain,
and so many other interactions, also including mediated interactions.
The central arguments indicate that certain factors influence participants actions and advisory interactions,
and these include the social context of the interactions,
whether one would be the Scots taboo topics and of course, the impacts of the societal and cultural ideologies,
including the epistemic anxiety asymmetries between the doctor and the patient.
So in view of these findings, this paper contributes to some extent to previous research by investigating how
medical authorities negotiated through the communicative practises of advise giving.
And of course, also looking at its responsive actions in India on HIV consultations.
So basically, I want to look at our advice. Given this, I reflect a consolidated and negotiated India account.
Now, just a quick look at an extract that shows that advice giving is indeed negotiated in the major HIV.
One. Then I use this word negotiating a very negotiated share,
not negotiate or negotiate that very often to refer to all the practise of advice given comes through in interaction.
In that sense, now in this extract, the patient does not seem to be thriving medical.
She stores instructed to take various medical texts and use prophylactic drugs.
The patient had complained about stomach ache, and a CD4 count is low.
These are not shown in the extract the up to Iowa states,
but a stomach ache is probably caused by using painkillers a la booking, an e-book of the locally made painkillers in Nigeria.
And you know, we can look at how that really takes place in the first Langton in.
Now, in the 10th line, the patient is instructed to stop taking the painkillers, Doctor says.
So you stop using its Anthony nine 12 and that one is initiated that gives more instructions concerning conducting chest X-rays.
Now, these instructions are substantiated and reinforced with the Dr. self-initiated self-repair
that addresses the problem of hearing when the patient does not immediately respond.
When he sees you year in and year out, when someone tells you, you hear me.
If not most of the time, it happens within a month. This is not certain.
It's not a request for clarification or a request to actually, you know,
understand whether or not the other participant has heard what you said it is to reinforce this or some sort of instructions.
I sort of order. That's the well, the first person who has altered his statement has, as mentioned,
not Israel should essentially that the doctor's instructions are used to assess his role as a doctor and established his role and of course,
also set future course of the patients are there is medical recommendations.
We'll take a more in-depth look at this phenomenon subsequently.
Now, this study draws from 70 doctor patient interactions, which were collected in 10 visits for outpatient clinics in Nigeria.
Start with its cousin between August and December 2015.
This was during the time I was conducting my practise and of course, during the postdoctoral stage as well.
I went out to do some, some more fieldwork to, you know, get some more data.
Now these visits were made to the clinic to record interactions between doctors and patients.
The audio files were a total of eight thousand seven or fifteen minutes twenty nine hours in total.
The map shows the study area. The clinics are federal and state hospitals, which provide outpatient services to HIV positive patients.
Now, other select clinics, doctors and patients converse in Eurobank,
which is the native language of the ethnic group in southwest Nigeria, sometimes also the participants using Nigerian,
pidgin, English and Nigerian English, and all linguistic codes, including cases of code mixing and other languages used in the interaction.
The participants consist of eight male doctors, two female doctors and 70 patients.
Now, the recordings involve a minimum of two practises by interactions and, of course, data collected for this.
So do you have to make sure was approved by the local ethics and research committees of
the selection mix and patients who participated during the study in a well-informed.
Give informed consent about this study, and they also give you a permission to publish their their recordings.
Now, audio recordings of interactions with transcribed using the transcription convention provided by German linguists,
and it was likely because I studied in German Germany anyway, so my supervisors feel that this would be something that would be nice to use.
They are all that transition conventions used by Jefferson and some other prominent C scholars, but I use the gut to transition convention.
And like I said earlier, this sort of adopts competition analysis for data processing analysis.
Now, Medical sees a body of research reading a strong analysis that focuses on analysing
fine grained detail or instructional practises and actions within medical settings.
Case preferred for this study due to its objective and empirical focus on analysing naturally occurring interactions.
Now, moving on to my findings before I bore you too much. No, as you'd seen in the analysis,
we are going to be looking at how doctors issue medical advice that specifically enforce patient adherence to medical recommendations.
Now, so finding that adherence really informs the primary reason for offering advice.
The second step the analysis will explore the town designs of the advice giving sequence.
Now I'm going to be using instructions interchangeably with some advice, and this is in response to the patient's deteriorating medical health.
And such evaluation is organised such a way that patients agency insure decision making on the treatment routine is not recognised,
as we saw in previous following extracts.
Also, the doctor's directives are made relevance with tongues that do not allocates proceeding tons for patients to respond.
Advisors are also issued as optics on patients just preferred responses, and they are also mitigated by accounts.
These patterns are privileged in about 80 percent of interactions. That's only about seven through sequences, treatment or conditional sequences.
Now I move on to the first observation. The reasons for offering advice on the treatment we're seeing now.
This is so prominent in the data because probably given the fact that the context of the interaction and
the type of patients that are being spoken with adherence is very central to HIV care because I mean,
the the patient LS depend on their regular and consistent intake of your drug anyway.
So I suppose this justifies the reason why there's so much focus on the adherence to medical recommendations.
But I think the interesting thing for me from the outset was that the concept of identity really goes beyond just drug use,
as I've found a community teacher. So there's always so much emphasis on patients using drug patients using drugs.
But in the clinic settings, adherence tends to, you know, I have a more holistic perspective such that the patients use of the patient's use of drug,
the patient's regular CD4 count testing and the patient's regular visits to the clinic to collect a fully
distributed Altis are so important that all of this constitutes factors in which the doctors consider.
And that's why I joke that the patients are not DairyNZ or not.
So I wanted to put this in mind when I speak about doing so doesn't only refer to drug use alone, no advice on patient, I mean, advice on patients.
Good medical course when patients are healed from opportunistic infections, as shown in this extra year,
the doctors medical authorities asserted when E. struck the patient to, first of all,
purchase drugs outside the clinic before receiving drugs from the clinic.
The patient response by expressing reservations about the effectiveness of the current treatments.
So she requests an assurance of future wellness if she attends the doctor's instructions.
The doctors response to this reservation serves to assure the patient for good medical health by leaning towards a religious reference.
When you say by God's grace, you'll be OK. By God's grace, you'll be well.
And also, this was a medicated little concern. Like, we have it in line now, you say said, make sure you take it and use your drug every day.
Although the instructions here advocates for the patients good medical, it's it's obvious that Dr. Leverage is also on his epistemic superiority.
That's an. In terms of his knowledge of know-how is knowledge of the nature of his profession and the opportunities
that the profession offers him to direct the patient's future action with regards to our health.
Now, concerns relating to patients health related behaviour also serves to enact medical authority,
assuming these extracts are what about the drug that the doctor prescribed for you?
Make sure you study drugs, did you buy one that looks at it is what are inside and then when the patient is?
Yeah, that's usually what I say is an assessment of the response.
And I just say I didn't buy this hour right before you go and buy it right for me, I go and buy, do you said Chin.
Also, I use as an OK, use U.S. Army, so I use it always.
So also is very like to discuss. Market is very similar to the EU.
Yeah, you know that we had looked at earlier. That really reinforces obedience.
You now, as we can see a case about the price previously prescribed RC and subsequently instruct are to use it.
Not that doctor request to know about another type of drug that she may have bought in line fifty two or three.
So when the patient offered it this preferred tone in Line 54, an instruction follows again, I'll write it for you.
Go and buy it in like two to five and 56. Now the patient's response is cooperating,
she has said this prescription and consent to follow these doctors instruction when she says yes, write it for me.
However, when he repeats instruction, go on, buy it and use it. We see here.
But I mean, the term design I mean of the doctor's instructions allows does not really call for a negotiated agreement.
And then the patient also shows that these instructions do not require a jointly formulated decision.
Making on treatment would seem rather. She submitted rights and against doctor's instructions on the prescribed Treat me.
I'm going to see a lot more of these. I'm not going to really go in-depth on the obvious.
Yet these are the one is the advice on my routine. So like I mentioned earlier,
the reason for offering the advice and the return design of the advice sequences are really
locations or spots in the interactions through which we see how the doctor negotiates authority.
So I ran briefly through also the trial design sequences.
Now, when I say that there are no time allocation for patients responses,
I mean that at very appropriate point in the interactions when patients should offer more, they offer less.
And that is because there are no explicit questions that require some sort of response.
And of course, through which they can, each of the parties can jointly negotiate decision or share decision on treatment.
So as we see here,
the second over hacking observation is that doctors established medical authority through trial designs of the advice given to patients.
Now I saw the patient's apparent good medical ethics everything.
She's evidently in good health, although she has no complaints and has no M.D. for count and all of that.
However, this does not, you know, um, you know, stop the doctor from giving such very explicit instruction on Skippy that we added to your drugs.
And of course, the patient is just left to agree. OK, thank you, doctor. Yeah, you've done the right thing.
You had medical professional implications.
Now the issuing of instructions in the imperative format also, of course, when your doctor offered an optic on a patient, these preferred responses.
These are technical terms. I'd be dicey because they are.
We'll see a related terms by term design time designs.
I understood in terms of, I guess, take pays in C such that all chances comes in pair when a greeting is offered.
A greeting is innovative response to a greeting when you make a request.
The expected return is that, you know, the person gives you a positive response and so forth.
And so of course, when you also ask a question, the hospital response is an answer.
But sometimes these preferred responses appear in such a way that, well,
I wouldn't say the preference system does not really talk about the the the preference of the speaker in that term.
It talks about the grammatical grammatical mess in terms of grammatical construction of the
utterances in what one utterance would require in terms of the response to the utterance.
So it's preference instead of looks at it from the perspective of the grammatical makeup of the utterance.
So when someone offers a district judge response, as you would know in interaction,
sometimes when someone asks you something or make a request when you are about to not agree or we know about your partner not to conform to.
The action that request Axel, if you do something so there are months, sometimes you delay your response or I'd like to take you to lunch today.
I may be busy. You are about to offer this report response. And so they are marked by delays.
They are marked by sometimes by account. If you want to say no, you can give an account.
If someone says, Well, I want you invited to lunch today because they're, well, actually, I'm actually going to maybe this two sentences.
I'm going to give an account for why you would not obey the request.
So that's how the preference systems look. And of course, when someone at the time optic, if more or less response on how the response is designed,
you know how the the tone from and all the other parties or tracks also, you know, really major sweeps.
OK. So, like I said, any additional instructions as an interesting format, of course.
Also here we see also like we've been saying before, instructions you have to go and do it now.
See what happens? You have to wonder this tests and the patient offered a justified response.
Yes, this is my test. I wouldn't be able to do it. I don't have money.
I mean, line it says it's not the type you pay for. This one is free, so you have to do it.
And she agrees again. OK, so what we see here is that, first of all,
the use of the honorific Tamar is really in reference to the Iraqi position between doctor and patients.
I mean, I have not been to medical encounter where the patient calls the doctor by name to even start with is always Mr. Doctor Sir.
And so already there's already an Iraqi police.
So, you know, even in the event that maybe non-compliance, or maybe I would see disobedience if I could use that term to do.
Moving on. Still, the final one also advises students that are being targeted by accounts.
Instructors may be given us pronouncements in a sequential environment that offers an extended explanation for the instructions.
In other words, instructions may be mitigated by doctors accounts as evidenced in this shot extracts doctors a doctor.
This doctor formulates its treatment of us with a pronouncement in lines one and two.
You have to do this. You have to take this drug. Then you proceeds by offering an explanation that audiences pronounce names as systemically
immobilised initiative about the inappropriateness of the patient's previous drug.
This is all it seems. I see what I gave you earlier. It's not working.
So by saying your aims towards the knowledge that the previous drug was inappropriate and then not to be given to the patient,
not to be changed on this premise, I did not specify the new drug these two drugs and then instructs how to get those drugs are the pharmacists.
In effect, the patients request for clarification on the current Iraqi case doctors authority may be
perceived as being weakened slightly because it is shown on drug change may be indecisive.
Now, move on to a discussion quickly, as I've tried to show briefly related trajectories,
I really made relevant during twinges treatment discussions and this and this sequence is characterised by the practise of giving instructions.
The focus on patients adherence is really crucial because it exemplifies the phenomenon of shared or non strong making between doctor and patient.
It also really touches on the issue of patient expertise.
It touches also on the issue of Dr InStyle's and, of course, advancing the discussion on the problem of compliance amongst patients.
The ratification of medical authority, of course, regardless of the possibility that patients may participates in the interactions or not.
What I have observed that the patients are mostly neglected doing shared decision making, so they offered advice and give me simultaneously and offer.
Of course, it reflects on the error. It reflects on patients maintenance of their responsibility for wellness.
So there is this true faith dynamic.
I see that it's very obvious that doctors have some sort of a Germany, have some sort of autonomy over patients willingness,
but also there's a tricky side to it because simultaneously they construct responsibility with the patients on alt related behaviour, you see.
So these are two different perspectives that I think, you know, needs to be more explicit.
Meanwhile, in the literature, the the focus on austerity is always on two different extremes.
So that, you know, is both those videos pretty authoritative or not authoritative.
But how about when data is authoritative,
but also making allowance for the patients to exercise our own autonomy as well or agency and in indoor consultations?
So I think I'm ready at the end.
I'm sure half of my time. OK.
So I would like to want to suggest that for I mean, for future discussions.
And, you know, when cross-fertilisation of ideas on how to go about these issues,
especially with respect to interactions in African states and in Nigeria,
I think it's a need to accommodate a broader concept of what our various means in the first place and also what it means to have medical authority.
Could it also be that medical authority is established or in place for the patients benefits,
especially when it comes to chronic puts in context such as this? So I think this opens up to more discussions in that area.
I think I'm at the end now so that if you show that conducted, then thank you for listening to questions.