需要醫療治療卻拒絕接受治療的患者不僅將自身健康置於風險中，也對醫療人員的溝通技巧造成了挑戰。對於談話研究者研究此議題具有方法學和醫療倫理上的困境，因為取得相關語料有困難。醫療劇的虛擬對話可作為探索此問題的替代語料。本研究透過對《芝加哥醫情》劇中的十個片段進行對話分析，以探討患者拒絕治療的模式，以及醫療人員用於說服患者接受治療之策略。在我們的研究中，大多數患者由於心理社會因素而拒絕推薦的治療。本研究總結出九種不同的拒絕模式，其中有四種拒絕模式佔據主要比例。在多數情況下，患者直接拒絕醫師所提出的治療方案，表明他們不願或無法接受治療，並給予合理化自己的拒絕。由於劇中患者堅持拒絕治療，說服他們接受治療便成為一個漫長的過程。因此，醫療人員須採用多種說服策略。我們的研究發現三種關鍵策略，包括：「運用醫療團隊資源和進階的醫學權威」、「同理溝通」以及「回應患者的拒絕原因」。這些說服策略可以解決患者的擔憂或說服他們考慮治療。其他說服策略也一樣重要，因為它們足以減弱拒絕治療的堅持。但需要強調的是，我們於劇中所觀察到為製造戲劇效果的的「濫用權力」和「否定患者個人經驗」是現實生活中，醫療人員不宜採用的負面說服策略。我們的研究結果還表明，了解患者的拒絕模式可以幫助醫療人員找到合適且有效的方法來說服患者。因此，我們建議醫療人員多關注患者如何表達拒絕治療。我們的研究表明，醫療劇中的虛擬對話不僅可以成為話語研究的有用數據源，還可以成為醫學教材。使用醫療劇是培養醫患良好溝通的一種潛在而有效的方法，尤其是如何應對堅持拒絕推薦治療的患者。

Patients who need medical treatment but refuse to receive it not only put their health at risk but also challenge the communication skills of medical professionals. Such difficult situations are also methodologically and ethically challenging for discourse researchers to access. Artificial dialogues from medical dramas can become alternative data to explore this issue. With discourse analysis on ten movie clips in Chicago Med, the current study investigates the patterns of patients’ treatment refusals, as well as the persuasion strategies employed by medical professionals to convince patients to accept the recommended treatment. In our study, most patients refuse the recommended treatment due to psychosocial factors. Our analysis identified nine different refusal patterns in total and four of them have a higher prevalence. In our drama, most patients refuse the proposed treatment straightforwardly, show their unwillingness or negative ability to undergo treatment, and legitimize their treatment refusal. Since the patients in the drama refuse the recommended treatment persistently, persuading them to change their decisions becomes a lengthy process. Consequently, the medical professionals had to apply multiple persuasion strategies. The three key strategies found in the study include: ‘medical team and advanced Aesculapian power',‘empathetic communication’, and ‘effective response to patients’ sources of refusal’. These persuasion strategies can address patients' concerns or convince them to reconsider their treatment refusals. Other persuasion strategies are also essential since they can gradually weaken the patients' persistent refusal. It should be noted that ‘abusing power’ and ‘negating patients’ personal experience’, two strategies observed in our artificial data to create dramatic effects, are two negative strategies that are not recommended to be used by medical professionals. Our findings also show that the understanding of patients’ refusal patterns can help medical professionals find appropriate and effective ways to persuade patients. Thus, we suggest that medical professionals should pay more attention to how patients express their treatment refusal. Our study indicates that artificial dialogues in medical dramas can become useful data sources not only for discourse study but also for medical teaching materials. Using medical dramas is a potential and effective method for educating good doctor-patient communication, particularly how to deal with patients who persistently refuse recommended treatment.

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