Preliminaries to Treatment Recommendations in UK Primary Care: A Vehicle for Shared Decision Making?

This paper focuses on a recurrent practice observed in UK primary care data–how physicians use pre-recommendations: action sequences that when initiated post-diagnosis are recognisably preliminary to the drug treatment recommendations that they contingently project. Data are drawn from recorded primary care consultations collected in England. Pre-recommendations consist of physician requests for information about prior medicines such as, What’ve you tried taking? or Have you taken anything so far? Patient responses subsequently shape the first part of the base treatment recommendation pair. These preliminaries can help physicians manage potential obstacles to patient acceptance: by avoiding prescribing something a patient is already taking, or has tried and found to be ineffective, and by accommodating concerns such as side effects or practical barriers to acceptance. Pre-recommendations are a strategy for convincing/persuading whilst allowing physicians to avoid making an ill-fitted recommendation that might be resisted or rejected as unwanted or unnecessary.