3 Conversation analysis of authentic care decision conversations 57 The second example shows an example of patient-related accountability to introduce the topic of care decisions. In this example, the physician moves from evaluating the good blood results (lines 90-91) to stating it is not necessary to give the patient information about care decisions (line 95). The physician uses the ‘good’ or ‘high’ blood levels as a way to make the transition to the possibility that the kidney might stop working. In this transition (lines 92-93), we see that the physician edits her speech in progress [26] after a short ‘uhm’. This all takes place while the physician is measuring the patient’s blood pressure. After a minimal agreement with rising intonation by the patient in line 94, the physician refers to a (possible) future scenario (‘about what if’) in lines 95-96. By presenting the information about this particular care decision (dialysis) as something that needs not to be discussed right now, the physician attends to two underlying dilemmas: 1) this could have been an appropriate slot to introduce care decisions, but since the blood result is fine it is no longer appropriate; 2) the topic of care decisions is only relevant in the future when things get worse, but, at the same time we should not wait until it is too late. The patient demonstrates understanding with a nodding agreement (line 97), and the physician responds to this by indeed providing further information about future care decisions (until line 143). The patient’s minimal responses throughout this elaborate stretch of talk solicits continued information-giving from the physician, noticeable throughout the entire excerpt. Although the physician introduces all sorts of topics and points for consideration (age, type of medication, hassle), she presents them in an information-giving format, rather than as items for that discussion at that point in time. The physician emphasizes multiple times that at this point, no decision has to be made, and that it is in fact unnecessary to have the information at all (lines 110, 124-125). However, she does provide some information about what dialysis entails (omitted lines), when a decision should be made (not in actual ‘time’ but in ‘lab value’) (lines 112-118), that the patient needs to be well-informed before that moment arrives (lines 119-120), that they should elaborately discuss the care options (131-139), and that it is a legitimate choice not to opt for dialysis (141-143). By presenting all this information - even though she said she did not have to (lines 95-96) – the physician solves two dilemmas: she has created a slot in which to initiate the topic and she prepares
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