Doctors (and sociologists) have a long history of struggling to understand why patients seek medical help yet resist treatment recommendations. Explanations for resistance have pointed to macrostructural changes, such as the rise of the engaged patient or decline of physician authority. Rather than assuming that concepts such as resistance, authority, or engagement are exogenous phenomena transmitted via conversational conduits, we examine how they are dynamically co-constituted interactionally. Using conversation analysis to analyze a videotaped interaction of an oncology patient resisting the treatment recommendation even though she might die without treatment, we show how sustained resistance manifests in and through her doctor's actions. This paradox, in which the doctor can both recommend life-prolonging care and condition resistance to it, has broad relevance beyond cancer treatment; it also can help us to understand other doctor-patient decisional conflicts, for instance, medication nonadherence, delaying emergent care, and vaccine refusal.

中文翻译：

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高风险的治疗谈判出了差错：互动对于理解治疗倡导和患者抵抗的重要性。

医生（和社会学家）长期以来一直在努力理解为什么患者寻求医疗帮助却拒绝治疗建议。对阻力的解释指向宏观结构的变化，例如患者参与度的上升或医生权威的下降。我们没有假设诸如抵抗、权威或参与之类的概念是通过对话渠道传播的外生现象，而是研究它们如何动态地交互构建。通过对话分析来分析一位肿瘤患者抵制治疗建议的录像互动，即使她不接受治疗可能会死亡，我们展示了持续的抵抗如何在她的医生的行为中体现出来。这种悖论，即医生既可以推荐延长生命的护理，又可以对其产生抵抗力，除了癌症治疗之外，还具有广泛的相关性。它还可以帮助我们理解其他医患决策冲突，例如不遵守药物治疗、延迟紧急护理和拒绝接种疫苗。