2004
Volume 43, Issue 2
  • ISSN: 1573-9775
  • E-ISSN: 2352-1236

Abstract

Abstract

Regelmatig nemen patiënten een begeleider mee naar medische consulten. Het verloop van (SDM) in consulten met drie partijen heeft tot nu toe echter weinig aandacht gekregen. In deze studie wordt nagegaan welke invloed de derde partij kan hebben op het beslisproces. Daartoe specificeren we de rollen die deze partij op zich kan nemen en bespreken we, vanuit een pragma-dialectisch perspectief, hoe deze rollen zich vertalen naar rollen binnen een discussie. Tot slot zetten we op basis van voorbeelden uiteen hoe deze rollen tot uiting kunnen komen in het besluitvormingsproces.

In een consult met drie partijen blijken vanuit argumentatief oogpunt twaalf complexe discussiesituaties te kunnen ontstaan, afhankelijk van de aard van het geschil, eventuele coalitievorming en de rollen die de partijen op zich nemen. In een aantal discussiesituaties kan de derde partij een actieve rol spelen en zodoende deelnemen aan het besluitvormingsproces. Alle drie partijen kunnen daarnaast anderen bij de discussie betrekken (bijvoorbeeld door hun mening te vragen) of een coalitie suggereren (bijvoorbeeld door in de wij-vorm te spreken).

Indien een derde partij een coalitie suggereert, kan dit enerzijds SDM ten goede komen, doordat de begeleider de patiënt in het besluitvormingsproces steunt. Anderzijds kan dit ook het besluitvormingsproces bemoeilijken wanneer de derde partij (bewust of onbewust) ten onrechte namens de patiënt spreekt. Op eenzelfde wijze kan een derde partij meer of minder constructieve bijdragen leveren aan de besluitvorming door standpunten of argumenten te baseren op de eigen (vermeende) expertise.

Patients often bring along a companion to medical consultations, which ideally involve (SDM). The way in which SDM proceeds in consultations with three parties has, nonetheless, so far received little attention. In this study, we analyse how the presence of a third party can affect the decision making process. To do so, we specify the roles that this party can fulfil, and discuss, using the pragma-dialectical framework, how these roles relate to discussion roles. Lastly, based on a qualitative analysis of a number of examples we illustrate how the roles that a third party could fulfil can be expressed in actual medical decision making.

From an argumentative perspective, twelve complex discussion situations could arise from the presence of three parties, depending on the nature of the disagreement, possible coalition building, and the roles that the parties fulfil. In a number of discussion situations, the third party can play an active role and thus take part in the decision making process itself. All three parties could additionally invite others to participate in the discussion (for instance, by asking for their opinion) or suggest that a coalition has been formed (for instance, by using inclusive ‘we’).

A third party suggesting that a coalition exists can further SDM, as the companion could thereby support the patient in the decision making process. However, this could also hinder the decision making process if the third party (consciously or unconsciously) unjustifiably speaks on behalf of the patient. In a similar vein, a third party could contribute in a more constructive or less constructive manner to the decision making process by basing standpoints or arguments on their own (supposed) expertise.

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