PM.20.009 – Dialogue in medical shared decision making

Route: Personalised medicine: the individual at the centre

Cluster question: 094 How do we improve the quality of health care as much as possible while keeping it affordable?

What can dialogue studies and conversation analysis contribute to improve the implementation and practice of shared decision making (SDM) in health care? In SDM, patients and healthcare professionals in various medical contexts together go through the stages of the decision-making process to reach agreement on a particular treatment. Due to the widely acknowledged significance of patient involvement in treatment decisions, SDM has become the ideal in medical communication, but its practice is far from perfect. There is a shared sense of urgency (by all stakeholders) to improve the implementation of SDM, as demonstrated by (Dutch) campaigns such as the website Betere zorg begint met een goed gesprek. The idea behind this slogan begs the question what we consider to be a good conversation, and how the answer to that question helps to understand the process of SDM and provide models for its analysis and improvement. Conversation is the most basic form of language use and human interaction. Therefore, studying dialogue is crucial to understand SDM as a form of communication, focusing on the roles of participants, their (explicit) commitments to engage in interaction, the argumentation structures and the forms of anticipation, reaction and improvisation that shape every conversation. However, healthcare professionals and patients are still simply advised to follow standardised steps (e.g., asking ‘three good questions’). Yet, even the most cooperative conversations are ‘messy’, as interlocutors may interrupt each other, digress or ignore each other’s utterances. This initiative brings a novel approach to the study of SDM to refine the theory and improve its practice by adding insights from linguistics and literary studies to health communication and medical practice. If better personalised care really starts with a good conversation, the empowerment of patients and the training of healthcare professionals start with understanding the mechanisms and dynamics of their dialogues.


discourse studies, literary studies, patient centered care, shared decision making


Organisation Leiden Unversity, Faculty of Humanities, Leiden University Centre for the Arts in Society (LEI)
Name Dr. G. (Geert) Warnar