The limitations of a negotiation model for perimenopausal women

The clinical negotiation model proposed by Katon and Kleinman (1981) puts c ulture at the very heart of the patient-doctor relationship. As opposed to the asymmetric model that stresses an unequal power relationship between a dominant physician and a powerless patient, this transactional model sugges ts that we view the clinical encounter as the locus of a negotiation that t akes place between two kinds of knowledge (lay and professional), and betwe en two agendas: the doctor's and the patient's, According to such a model, the doctor is taught to listen to the patient's own explanatory model of di sease. Using an in-depth analysis of clinical encounters between perimenopa usal women and female physicians, and of separate interviews with individua l doctors and patients concerning their respective explanatory models, this pilot study puts emphasis on both the limitations of a transactional model and on the strategies deployed by doctors for enhancing the credibility of hormonal replacement therapy.