Lidar com a incerteza: o potencial argumentativo da dúvida nas consultas médicas

• Rossi, Maria Grazia ^[1] ; Mohammed, Dima ^[1] ; Bigi, Sarah ^[2]
  1. [1] Universidade Nova de Lisboa

     Universidade Nova de Lisboa

     Socorro, Portugal

     
  2. [2] Catholic University of the Sacred Heart

     Catholic University of the Sacred Heart

     Milán, Italia

     
• Localización: Revista iberoamericana de argumentación, ISSN-e 2172-8801, Nº. Extra 2, 2024 (Ejemplar dedicado a: La argumentación en sus contextos. Actas del II CIbA - Madrid 2023), págs. 35-48
• Idioma: portugués
• DOI: 10.15366/ria2024.m2.003
• Títulos paralelos:
  • Dealing with uncertainty: the argumentative potential of doubt in medical consultations
• Enlaces
  • Texto completo
• Resumen
  • español

    Neste artigo, exploramos uma dimensão normativa particular das estratégias utilizadas pelos profissionais de saúde na gestão da incerteza nas consultas médicas. Analisamos as consultas médicas centrando-nos no potencial argumentativo das dúvidas expressas pelos pacientes e pelas suas famílias, examinando as inferências ativadas, para além do que é explicitamente afirmado nas passagens dialógicas que exibem dúvidas. Utilizando a distinção entre três potenciais argumentativos da dúvida (dúvida ambivalente, dúvida cética e negacionismo), efetuamos uma análise exploratória de um corpus italiano de 52 consultas médicas compostas por profissionais de saúde e doentes com diabetes tipo 2. Com base na análise, argumentamos que, quando expressas em consultas médicas, as dúvidas céticas devem ser explicitamente reconhecidas e adequadamente abordadas para evitar que a dúvida adquira um potencial negacionista, o que pode prejudicar a adesão do paciente e comprometer a possibilidade de resultados favoráveis para a sua saúde.

  • English

    In this paper, we explore a particular normative dimension of the strategies used by healthcare professionals to manage uncertainty in medical consultations. We analyze medical consultations focusing on the argumentative potential of doubts expressed by patients and their families by examining the inferences activated beyond what is explicitly stated in the sequences exhibiting doubt. Using the distinction between three argumentative potentials of doubt (ambivalent doubt, skeptic doubt, and denialism), we run an exploratory analysis on an Italian corpus of 52 medical consultations between health professionals and patients with Type 2 diabetes. Based on the analysis, we argue that when expressed in medical consultations, skeptical doubts should be explicitly acknowledged and adequately addressed to prevent the doubt from acquiring a denialist potential, which can undermine patient adherence and the possibility of favorable health outcomes.

• Referencias bibliográficas
  • Ainsworth-Vaughn, N. (1998). Claiming power in doctor-patient talk. Oxford: Oxford University Press.
  • Alrasheedy, A. A., Hassali, M. A., Stewart, K., Kong, D. C., Aljadhey, H., Mohamed Ibrahim, M., & Al-Tamimi, S. K. (2014). Patient knowledge,...
  • Amossy, R. (2009). “Argumentation in Discourse: A Socio-discursive Approach to Arguments”. Informal Logic 29(3), 252.
  • Andrade, G. (2020). “Medical conspiracy theories: cognitive science and implications for ethics”. Medicine, Health Care and Philosophy 23(3),...
  • Anscombre, J.-C., & Ducrot, O. (1983). L’argumentation dans la langue. Bruxelles: Pierre Mardaga.
  • Beisecker, A. E. (1990). “Patient Power in Doctor-Patient Communication: What Do We Know?” Health Communication 2(2), 105–122.
  • Bigi, S. (2014). “Healthy Reasoning: The Role of Effective Argumentation for Enhancing Elderly Patients’ Self-management Abilities in Chronic...
  • Bigi, S. (2018) “The role of argumentative practices within advice-seeking activity types. The case of the medical consultation”. Rivista...
  • Bigi, S., & Rossi, M. G. (2020). “Considering Mono- and Multilingual Interactions on a Continuum: An Analysis of Interactions in Medical...
  • Bigi, S., & Rossi, M. G. (2023) “Fostering interdisciplinary knowledge translation at the interface between healthcare communication and...
  • Candlin, C. N. (2000). The Cardiff lecture 2000: Reinventing the patient/client: New challenges to healthcare communication (Cardiff Papers...
  • Dahm, M. R., & Crock, C. (2022). “Understanding and Communicating Uncertainty in Achieving Diagnostic Excellence”. JAMA 327(12), 1127–1128.
  • Eachempati, P., Büchter, R. B., Ks, K. K., Hanks, S., Martin, J., & Nasser, M. (2022). “Developing an integrated multilevel model of uncertainty...
  • Eemeren, F. H., Garssen, B., & Labrie, N. (2021). Argumentation between Doctors and Patients: Understanding clinical argumentative discourse....
  • European Medicines Agency (EMA) (2021). “COVID-19 Vaccine Janssen: assessment of very rare cases of unusual blood clots with low platelets...
  • Flores, A., Cole, J. C., Dickert, S., Eom, K., Jiga-Boy, G. M., Kogut, T., … Van Boven, L. (2022). “Politicians polarize and experts depolarize...
  • Godman, B., Massele, A., Fadare, J., Kwon, H.-Y., Kurdi, A., Kalemeera, F., … Meyer, J. C. (2021). “Generic drugs–essential for the sustainability...
  • Graham, S., & Brookey, J. (2008). “Do patients understand?”. The Permanente Journal 12(3), 67–69.
  • Han, P. K. J., Klein, W. M. P., & Arora, N. K. (2011). “Varieties of Uncertainty in Health Care: A Conceptual Taxonomy”. Medical Decision...
  • Han, Paul K.J., Strout, T. D., Gutheil, C., Germann, C., King, B., Ofstad, E., … Trowbridge, R. (2021). “How Physicians Manage Medical Uncertainty:...
  • Jackson, S. (2020). “Evidence in Health Controversies”. OSSA Conference Archive 15.
  • Kalke, K., Studd, H., & Scherr, C. L. (2021). “The communication of uncertainty in health: A scoping review”. Patient Education and Counseling...
  • Kjeldsen, J. E. (2007). “Visual Argumentation in Scandinavian Political Advertising: A Cognitive, Contextual, and Reception Oriented Approach”....
  • Maynard, D. W. (1991). “Interaction and Asymmetry in Clinical Discourse”. American Journal of Sociology 97(2), 448–495.
  • McCabe, R. (2021). “When patients and clinician (dis)agree about the nature of the problem: The role of displays of shared understanding in...
  • Mohammed, D. (2019a). “Managing Argumentative Potential in the Networked Public Sphere?: The Anti- # MeToo Manifesto as a Case in Point”....
  • Mohammed, D. (2019b) “Standing Standpoints and Argumentative Associates: What is at Stake in a Public Political Argument?” Argumentation 33(3),...
  • Mohammed, D., & Rossi, M. G. (2022). “The Argumentative Potential of Doubt: From Legitimate Concerns to Conspiracy Theories About COVID-19...
  • Mostafa, S., Mohammad, M. A., & Ebrahim, J. (2021). “Policies and practices catalyzing the use of generic medicines: a systematic search...
  • Negash, Z., & Mekonen, T. (2023). “Patient perception towards shifting oral antihyperglycemic agents to injectable insulin and associated...
  • Pomerantz, A. (1985). “Agreeing and disagreeing with assessments: some features of preferred/dispreferred turn shapes”. In: J. M. Atkinson...
  • Regina Wu, R. J. (2009). “Repetition in the initiation of repair”. In: J. Sidnell (Ed.), Conversation Analysis: Comparative Perspectives (pp....
  • Rentmeester, C. A. (2013). “Professionalism, fidelity and relationship-preservation”. Human Vaccines & Immunotherapeutics 9(8), 1812–1814.
  • Rossi, M. G., & Macagno, F. (2020). “Coding Problematic Understanding in Patient–provider Interactions”. Health Communication 35(12),...
  • Rossi, M. G., Macagno, F., & Bigi, S. (2022). “Dialogical functions of metaphors in medical interactions”. Text and Talk 42(1), 77–103.
  • Rossi, M. G., Mohammed, D., & Bigi, S. (2024). “Exploring the argumentative potential of doubt in medical consultations”. In: A. Ansani,...
  • Rummens, S., & De Mesel, B. (2022). “A Wittgensteinian Account of Free Will and Moral Responsibility. In Philosophical Perspectives on...
  • Schegloff, E., Jefferson, G., & Sacks, H. (1977). “The preference for self-correction in the organization of repair in conversation”....
  • Serafis, D. (2022). “Unveiling the rationale of soft hate speech in multimodal artefacts”. Journal of Language and Discrimination 6(2), 261–288.
  • Singh, S. K., & Jain, R. (2020). Myths About Insulin Therapy. RSSDI’s Insulin Monograph: A Complete Guide to Insulin Therapy 245. New...
  • Snoeck Henkemans, A. F., & Mohammed, D. (2012). “Institutional constraints on strategic maneuvering in shared medical decision-making”....
  • Stevens, L. M. (2018). ““We have to be mythbusters”: Clinician attitudes about the legitimacy of patient concerns and dissatisfaction with...
  • Todd, A. D. (1989). Intimate Adversaries: Cultural Conflict Between Doctors and Women Patients. Philadelphia: University of Pennsylvania Press.
  • WHO. (2016). “Generic medicines: interchangeability of WHO-prequalified generics”. WHO Drug Information 30(3), 370–375.
  • Wittgenstein, L., Anscombe, G. E. M., von Wright, G. H., Paul, D., & Anscombe, G. E. M. (1969). On certainty (Vol. 174). Blackwell Oxford.