‘You Must Adhere Strictly to the Time and Days of Intake’: Negotiating Medical Authority in Nigerian HIV Consultations

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Using the methodology of conversation analysis, this talk examines one practice by which doctors negotiate medical authority in the treatment recommendation phase of Nigerian HIV consultations. An analysis of seventy audio-recorded interactions between doctors and HIV-positive patients reveal that doctors issue instructions on patients’ adherence to the treatment routine. Such instructions occur at two sequential environments: the treatment recommendation sequence, and the proceeding uptake on patient’s dis-preferred responses. The turn design and sequential distribution of these instructions indicate that they enact authoritative roles despite patients’ active participation through shared decision-making on treatment. This finding is a counter-balance to the position, in existing conversation analysis research on medical authority, that patients’ actions palliate medical authority. Future conversation analysis studies may examine more practices for accomplishing medical authority across various medical contexts. This will contribute to further understanding of the treatment recommendation phase in chronic-routine visits, especially as it relates to patients’ adherence and medical authority.

Dr Eniola Boluwaduro is a Lecturer in the Department of English, Redeemer’s University, Ede, Osun state, Nigeria. She is one of the AfOx-TORCH Visiting Fellows for the year 2019.

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