Box 4.

Theme 4: Power dynamics

Quote	Quotation [source]	Participant
4a	A doctor has a plan and I think, as a patient, yon kind of just give into that because they’re supposed to be educated enough above you to know why they came up with that plan and you have to just trust that the doctor is correct when she may or may not be. [patient interview]	19
4b	Everybody talks about like that’s the absolute, you’re going to be on dialysis. Why am I hearing that all the time? It’s like you’re trying to talk me into it…“What do you think about dialysis? How are you going to…“I don’t want to do dialysis. [patient interview]	39
4c	They tell me, “You’re getting worse and worse…“ I argue with my kidney doctor, I say, “Well I don’t feel sick. I feel the same…“ They just say, “Why are you arguing with me all the time?” [patient interview]	12
4d	As a physician, the patient may not agree with you all the time…if you don’t agree, then you may challenge it, “Why is this?”…I guess, when I ask questions, my tone is a question and not a challenge, that’s very important. [patient interview]	34
4e	I’m going to admit something now…I said, “I’m taking these herbs, “and [my nephrologist] says, “I don’t know what’s in them, but I don’t want you to take them.” Well, I’ve been taking them, constantly, for two years now, and I’m not willing to stop. [patient interview]	9
4f	“[Patient} claims she just can’t do it…I feel like every time I see her, I just have to say, ‘Listen, you have to. You can do this. You can take care of yourself. You just have to do it.’ Monitoring her blood pressure, watching her diet, taking her medications. But she’s just very sort of fatalistic.” [clinician interview]	29
4g	[Patient] actually left the visit early because she was not happy with what I was telling her. She didn’t want to talk about [dialysis]. She absolutely did not want to go there at all. This is something that is going to happen to her in her lifetime…That’s why I really tried to push for getting her to the [dialysis education classes] and learn about dialysis…I mean, it’s her choice. As a provider, as long as the patient has capacity to make decisions, I can’t push any of my beliefs onto her…I have no right to impose. I think my role is to educate her about the consequences of her disease, as long as I’ve done that, maybe she doesn’t believe me, I don’t feel strongly to further push my beliefs…if you force care onto patients, when they don’t really want to accept it, in the long term, I don’t think it’s a good idea. [clinician interview]	1
4h	We discussed that reducing [medication] is unlikely to precipitate chest pain and encouraged her to hold or lower this dose…Unable to convince [patient] to reduce [medication] as recommended. [medical record]	H
4i	I just talk to people like they’re my fiend or they’re just a normal person…I always try to get to know someone…I try to find some common ground as I’m doing the history…I try to find something that I share with someone. I try to figure out more what’s special about them and try to bring that out…I don’t actually talk about dialysis at the beginning because I want to have a relationship with someone before that even happens. [clinician interview]	33