Power Struggles in MDT Meetings: Using Different Orders of Interaction to Understand the Interplay of Hierarchy, Knowledge and Accountability

  • Cordet SmartEmail author
  • Christianne Pollock
  • Lindsay Aikman
  • Erica Willoughby
Part of the The Language of Mental Health book series (TLMH)


Power and hierarchy are key themes in MDT interactions. The literature suggests they can lead to some clinicians not being heard, with negative consequences for assessments. Power and hierarchy can be considered as relational, best studied as one person talks to another. Applying a conversation analysis approach, we introduced epistemic and deontic status and stance as key analytic tools. We show how respect can be shown for the professional knowledge of others and how this can be usurped, for example through a lack of historical knowledge of a person. We illustrate how groups can manage, drown out and challenge the epistemic status of a team member (in this case the psychiatrist). Findings illustrated interactional practices where professional hierarchies were shown to have less impact.


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Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Cordet Smart
    • 1
    Email author
  • Christianne Pollock
    • 2
  • Lindsay Aikman
    • 3
  • Erica Willoughby
    • 4
  1. 1.School of PsychologyUniversity of PlymouthPlymouthUK
  2. 2.NHS England, Transforming Care ProgrammeLondonUK
  3. 3.Livewell SouthwestPlymouthUK
  4. 4.Cornwall Partnership NHS Foundation TrustCornwallUK

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