Proposing surgery at the prosthetic clinic: managing patient resistance

Objective: Investigating doctors' communicative practices for recommending surgery to amputees when the proposal counters patients' expectation. Method: Conversation Analysis of 77 videorecorded medical consultations at an Italian prosthesis clinic. Results: Compared to the direct format doctors used to prescribe prosthesis, when suggesting surgery doctors adopted a more circuitous, indirect approach. They used a range of communication strategies, orientating to patients' likely resistance - indeed, patients were frequently observed to reject surgical options. Conclusions: Considering patients' expectations is part of a patient centred approach, hence the cautious ways in which doctors introduce the option of surgery. Moreover, doctors do not pursue recommending surgery when patients display their reluctance or resistance. Practice implications: Doctors in prosthetics clinics might adopt a more balanced communicative strategy that takes into account patients' perspectives, concerns and expectations, whilst but also providing patients with the necessary information to collaborate meaningfully to decision making.