“You Must Adhere Strictly to the Time and Days of Intake”: Medical Advice and Negotiations of Medical Authority in Nigerian HIV Consultations

Abstract

Using the methodology of conversation analysis, this paper examines the practice of offering medical advice and its implication for negotiations of medical authority in Nigerian HIV consultations. Analyses of ninety treatment recommendation sequences from seventy audio-recorded interactions between doctors and HIV-positive patients reveal that doctors issue instructions as a form of medical advice on patients’ adherence to medical recommendations. During the advisory interactions, patients are held accountable for maintaining medical wellness, although the doctors’ reasons for offering medical advice, and the turn design and sequential distribution of the advice-giving sequence indicate that advice serves to enact authoritative roles. The findings are a counter-balance to the position, in existing conversation analysis research, that patients’ actions palliate medical authority. This paper calls for a broader conceptualisation of “adherence” and “medical authority” within medical institutional settings.