ABSTRACT
Making a decision is not only one of the physician's most important responsibilities but also one of patients' most sensitive moments in medical encounters. Drawing from pragmatics studies, this paper explores rapport maintenance and/or enhancement (Spencer-Oatey 2000, 2008) in the decision-making strategies that General Practitioners (GPs) and patients employ in 80 encounters in various areas of England and Spain. The results show that such strategies are context-bound and subject to role specifications: while patients may make use of (dis)agreement strategies and initiate decisions and/or self-diagnosis, doctors give options, show empathy, expand explanations or show explicit or implicit (dis) agreement. In relation to this, notable findings were revealed: first, these communicative strategies may vary not only in terms of frequency but also quality and distribution; second, the Spanish interlocutors in the data gathered tend to negotiate through the explicit expression of opinions, while the British interlocutors prefer the discussion of different alternatives and value the other's freedom to act. Third, there is higher tolerance of disagreement in the Spanish data. Fourth, negotiation may be undertaken on the basis of either self-affirmation or consensus-seeking beliefs. Finally, patient empowerment is displayed in divergent ways in both sets of data. In short, the decision-making processes examined are subject to social and psychological factors with a direct impact on communicative styles.