Nota sugli indicatori di forza argomentativa nella comunicazione tra medico e paziente

Well argued and critically grounded decisions are of primary importance for the establishment of a trust relation as required by patient–centred care. The communication exchange in the clinical setting can be thus viewed as an “argumentative discussion”, a term introduced by clinical argumentation scholars, working within the theoretical framework of Pragma–dialectics, a normative model for the reasonable resolution of a divergence of opinion in order to achieve mutually shared clinical decisions. The present paper aims at presenting the main theoretical and methodological foundations of a research in progress, focusing on an analysis of the argumentative approach pursued by clinicians in their interaction with patients. By assuming as theoretical framework a normative model, that shows how to argue in a sound manner, our research in its first phase was directed to outline a set of theoretical and methodological aspects clinicians should comply with for the development of good health–communication practices and that can also highly contribute to the assessment of the quality of doctor–patient communication. In a patient–centered approach to care the asymmetry between doctor and patient should firstly be viewed as an opportunity for the development of an argumentative discussion. Particular attention should also be paid to the patient’s natural adherence to unexpressed assumptions and premises underlying argumentative moves for their enrichment or reframing. For a greater transparency of the argumentative structures, it will be helpful to use argumentative indicators, linguistic elements of various nature that can play a strategic role also in the assessment of the communication quality by facilitating the identification of the rate of argumentation present in doctor–patient interactions. For the communication quality assessment, it will also be particularly relevant to verify the soundness of arguments through critical questions and the compliance of argumentative moves with a code of conduct for argumentative discussion, in order to effectively involve patients in the decision–making process in compliance with a critically founded informed consent.