Linguistic features of power dynamics in triadic dementia diagnostic conversations

ObjectiveThe purpose of this study was to examine linguistic expressions of power during dementia diagnosis disclosure.MethodsVideotapes of dementia diagnosis disclosure sessions were reviewed to examine linguistic features of 86 physician-patient-companion triads. Verbal dominance and pronoun use were measured as indications of power.ResultsPhysicians dominated the conversation, speaking 83% of the total time. Patients spoke more than companions (10% versus 6%). Dementia status was only related to the amount of time companions spent talking. Physicians used fewer first person singular and more first person plural pronouns than patients and companions. Power indices did not predict anxiety, depression, or satisfaction with the medical visit.ConclusionDuring the disclosure of a dementia diagnosis, physicians tend to dominate the conversation, exerting their social status through a variety of linguistic features. Patients and companions are not more distressed or dissatisfied as a result and exert their own subtle attempts to assert their role in the conversation.Practice implicationsRecognition of a hierarchical structure within healthcare interactions may be the first step toward maximizing patient outcomes. Evaluating patient expectations and preferences regarding physician communication style may be the most effective way of promoting patient-centered healthcare communication.