, Volume 29, Issue 1, pp 33–55 | Cite as

Quantifying Doctors’ Argumentation in General Practice Consultation Through Content Analysis: Measurement Development and Preliminary Results

  • Nanon Labrie
  • Peter J. Schulz


General practice consultation has often been characterized by pragma-dialecticians as an argumentative activity type. These characterizations are typically derived from theoretical insights and qualitative analyses. Yet, descriptions that are based on quantitative data are thus far lacking. This paper provides a detailed account of the development of an instrument to guide the quantitative analysis of argumentation in doctor–patient consultation. It describes the implementation and preliminary results of a content analysis of seventy videotaped medical consultations of which the extent and type of doctors’ argumentative support for medical opinions and advice are analyzed. Based on the study results, this paper addresses the merits of observational studies using content analysis as a method for the analysis of argumentative discourse in context as well as some of its key challenges and limitations, laying bare the opportunities for future research.


General practice consultation Argumentative activity type Pragma-dialectical theory of argumentation Quantitative methods Content analysis 


  1. de Bekker-Grob, E.W., S. van Dulmen, M. van den Berg, R.A. Verheij, and L.C.J. Slobbe. 2011. Primary prevention of cardiovascular diseases: A cost study in family practices. Family Practice 12: 69–78.CrossRefGoogle Scholar
  2. Degner, L.F., and J.A. Sloan. 1992. Decision making during serious illness: What role do patients really want to play? Journal of Clinical Epidemiology 45(9): 941–950.CrossRefGoogle Scholar
  3. Deveugele, M., A. Derese, A. van den Brink-Muinen, J. Bensing, and J. De Maeseneer. 2002. Consultation length in general practice: Cross sectional study in six European countries. British Medical Journal 325: 1–6.CrossRefGoogle Scholar
  4. Elwyn, G., A. Edwards, M. Wensing, K. Hood, C. Atwell, and R. Grol. 2003. Shared decision making: Developing the OPTION scale for measuring patient involvement. Quality and Safety in Health Care 12: 93–99.CrossRefGoogle Scholar
  5. Elwyn, G., A. Edwards, K. Hood, M. Robling, M. Wensing, and R. Grol. 2005. OPTION training pack. Evaluating the extent that clinicians involve patients in decisions.
  6. Hayes, A.F., and K. Krippendorff. 2007. Answering the call for a standard reliability measure for coding data. Communication Methods and Measures 1: 77–89.CrossRefGoogle Scholar
  7. Herring, J. 2009. Medical law, 2nd ed. Harlow: Pearson Education.Google Scholar
  8. Krippendorff, K. 2004. Reliability in content analysis: Some common misconceptions and recommendations. Human Communication Research 30(3): 411–433.Google Scholar
  9. Krippendorff, K. 2013. Content analysis: An introduction to its methodology, 3rd ed. Thousand Oaks, CA: Sage.Google Scholar
  10. Labrie, N.H.M. 2012. Strategic maneuvering in treatment decision-making discussions: Two cases in point. Argumentation 26(2): 171–199.Google Scholar
  11. Labrie, N.H.M. 2013. Strategically eliciting concessions from patients in treatment decision-making discussions. Journal of Argumentation in Context 2(3): 322–341.Google Scholar
  12. Labrie, N.H.M., and P.J. Schulz. 2013. Does argumentation matter? A systematic literature review on the role of argumentation in doctor-patient communication. Health Communication 29(10): 996–1008.Google Scholar
  13. Labrie, N.H.M., P.J. Schulz, and S. Zurbriggen. under revision. The effects of reasoned shared decision-making on consultation outcomes: Results of a randomized-controlled experiment among a student population. Journal of Communication in Healthcare: Strategies, Media and Engagement in Global Health.Google Scholar
  14. Lasswell, H.D., D. Lerner, and I. Pool. 1952. The comparative study of symbols: An introduction. Stanford: Stanford University Press.Google Scholar
  15. Neuendorf, K.A. 2002. The content analysis guidebook. Thousand Oaks, CA: Sage.Google Scholar
  16. Noordman, J., B. Koopmans, J. C. Korevaar, T. van der Weijden, and S. van Dulmen. 2012. Exploring lifestyle counseling in routine primary care consultations: The professionals’ role. Family Practice. doi: 10.1093/fampra/cms077.
  17. Noordman, J., P. Verhaak, and S. van Dulmen. 2010. Discussing patient’s lifestyle choices in the consulting room: Analysis of GP-patient consultations between 1975 and 2008. Family Practice 11: 87–97.CrossRefGoogle Scholar
  18. Pilgram, R. 2009. Argumentation in doctor–patient interaction: Medical consultation as a pragma-dialectical communicative activity type. Studies in Communication Sciences 92: 153–169.Google Scholar
  19. Pilnick, A., and R. Dingwall. 2011. On the remarkable persistence of asymmetry in doctor/patient interaction: A critical review. Social Science and Medicine 72(8): 1374–1382.CrossRefGoogle Scholar
  20. Roter, D., and S. Larson. 2002. The Roter interaction analysis system (RIAS): Utility and flexibility for analysis of medical interactions. Patient Education and Counseling 46(4): 243–251.CrossRefGoogle Scholar
  21. Snoeck Henkemans, A.F., and D. Mohammed. 2012. Institutional constraints on strategic maneuvering in shared medical decision-making. Journal of Argumentation in Context 1(1): 19–32.CrossRefGoogle Scholar
  22. Van Eemeren, F.H. 1986. For reason’s sake: Maximal argumentative analysis of discourse. In Argumentation: Across the lines of discipline. Proceedings of the conference on argumentation, ed. F.H. van Eemeren, R. Grootendorst, J.A. Blair, and C.A. Willard, 201–216. Dordrecht: de Gruyter.Google Scholar
  23. van Eemeren, F.H. 2012. From critical discussion to strategic manoeuvring: Extending the pragma-dialectical theory of argumentation. In Proceedings of the second international conference on argumentation and rhetoric, ed. R.K. Bakó, K. Bernáth, E. Biró-Kaszás, I. Györgyjakab, and G. Horváth. Oradea: Partium Press.Google Scholar
  24. van Eemeren, F.H., and R. Grootendorst. 1984. Speech acts in argumentative discourse: A theoretical model for the analysis of discussions directed towards solving conflicts of opinion. Dordrecht: de Gruyter.CrossRefGoogle Scholar
  25. van Eemeren, F.H., and R. Grootendorst. 1992. Argumentation, communication, and fallacies: A pragma-dialectical perspective. Hillsdale: Lawrence Erlbaum.Google Scholar
  26. van Eemeren, F.H., and R. Grootendorst. 2003. A pragma-dialectical procedure for a critical discussion. Argumentation 17: 365–386.CrossRefGoogle Scholar
  27. van Eemeren, F.H., and R. Grootendorst. 2004. A systematic theory of argumentation: The pragma-dialectical approach. Cambridge: Cambridge University Press.Google Scholar
  28. van Eemeren, F.H., P. Houtlosser, and A.F. Snoeck Henkemans. 2007. Argumentative indicators in discourse. A pragma-dialectical study. Dordrecht: Springer.CrossRefGoogle Scholar
  29. Vermeire, E., H. Hearnshaw, P. van Royen, and J. Denekens. 2001. Patient adherence to treatment: Three decades of research. A comprehensive review. Journal of Clinical Pharmacy and Therapeutics 26(5): 331–342.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.Institute of Communication and HealthUniversity of LuganoLuganoSwitzerland

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