Medical recommendations as joint social practice.

Treatment plans can be thought of as one of the products of a medical interaction. As such, treatment for illness has been investigated as an outcome measure and seems to reflect bias in some areas of the practice of medicine. Although the evidence for patterns of differential treatment is compelling, determining the source of treatment bias has been difficult. Based on detailed analysis of transcripts of actual interactions in general medicine and oncology clinics, we propose that treatment plans are negotiated through everyday language practices that work to maximize agreement. We demonstrate that, on the level of individual medical encounters, patient agency is both apparent and operative and that physician power does not unilaterally determine outcomes. Thus, this investigation goes beyond the abstract study of physician and patient preferences or prejudices, focusing closely on the consequences of actual talk in settings where medical recommendations are being made.