One of the cultural traditions in Saudi Arabia is that the Saudi female patient has to be accompanied by a third-party on her medical visits, thus giving rise to consultations between three parties. By third-party, I mean a chaperone or a family member who can be a patient’s spouse, parent, adult child, sibling, or relative. This person shares responsibility for the patient’s health and the patient relies on them to support them generally with assistance in terms of their health care needs and especially for medical visits. In this research, I focus on the presence of a third party in medical consultations with reference to patient satisfaction, how patients perceive the role of their chaperones during the medical visit and the nature of three-party medical interactions. To investigate these aspects, a convergent parallel mixed method design was used in order to develop a better understanding of doctor-patient-three party interactions, as no mixed method study has been conducted on these issues in medical consultations in Saudi Arabia. Hence, this study addresses this gap in literature by focusing on the interaction between the Saudi female patients, their male physicians and their chaperones. I have concentrated on the Saudi female patients (from different age groups, i.e. 19-75) for religious and cultural reasons. Therefore, the overall aim of this thesis is to understand the phenomenon of three-party consultations in Saudi Arabia through a variety of aspects including patient satisfaction, patients’ perceptions, and what actually happens in three-party medical interactions (e.g., alignment and epistemic asymmetry). The data for this study included quantitative (i.e. questionnaires) and qualitative (i.e. four open-ended questions and observational and audio-recorded) data collected in one phase from 20 clinics in 3 hospitals in Jeddah in Saudi Arabia (two private and one governmental). A total of 117 female patients along with their chaperones were recruited. Statistical analysis of the questionnaire ratings showed that only patient’s education has a positive effect on patient satisfaction with chaperone involvement. Findings from thematic analysis of the open-ended questions data revealed that patients described three supportive roles of the chaperones, namely emotional, informational and logistical support. The patients’ perceptions regarding their chaperones’ supportive roles are re-evaluated in a real-life context by observing the chaperone’s facilitative role in three-party consultations. Therefore, conversation analysis of the audio-recorded data showed three main patterns of alignment: (1) doctor-patient, (2) chaperone-patient (and patient-chaperone), and (3) chaperone-doctor (and chaperone-patient) alignments. All these actions indicate that the participants were collaboratively involved in the positive interaction and this enhanced patient participation. However, in analysing three exceptional cases from the Chemotherapy and Haematology clinics, it was found that the presence of a chaperone dominates as well as complicates doctor-patient interaction and thus can significantly override or ostracise the patient who does not know her illness. For example, by using the Conversation Analysis approach, various epistemic resources used by the interlocutors (i.e. the oncologist and chaperones) are displayed by which the patient’s epistemic primacy is usurped and her epistemic access is controlled in terms of participation and the amount of information given. In comparing the mixed methods used in this study, congruent and discrepant results are found between the quantitative and qualitative data. In terms of congruent results, overall, the findings of this study concurred on the importance of having a supportive chaperone during a female patient’s medical appointment. Chaperones’ supportive roles appear to differently influence female patients’ symptoms, diagnosis or treatment plan. Chaperones in the current study have provided a useful contribution to the doctor-patient interactions. However, in terms of discrepancy, findings yielded by the conversation analysis (in Chapters 6 and 7) showed a discrepancy between what patients reported (see Chapter 5) about their chaperones’ supportive roles and what their chaperones did in the consultation. For example, the thematic analysis of the open-ended questions found that both genders were equally likely to be active in speaking for the patient. However, the conversation analysis of observational data adds and clarifies to what patients reported about their chaperones speaking on their behalf. The conversation analysis has given a good picture of the chaperone’s supportive role during medical visits in orienting towards patients as being the actual owners of their bodies and illness (see Chapter 6). Therefore, patients were given the chance to present their problem. Chaperones, in working collaboratively with patients and physicians, support the patient and facilitate the physician’s understanding. However, in only two exceptional cases (see Chapter 7) of actual medical interactions, the chaperone acts as a surrogate patient and restricts the patient’s own knowledge of their illness. Therefore, the current study contributes to three important areas, namely: (1) the literature of three-party interactions, (2) three-party interactions in Saudi Arabia, and (3) clinical practices in Saudi Arabia.

A presente tese constitui-se numa proposta de contribuição teórica para a disciplina de marketing. Defende que, existe uma Assimetria de Conhecimento entre os polos da relação de troca/transação de pacotes de bens e serviços intensivos em conhecimento, na perspectiva da “Nova Lógica Dominante” de marketing, conforme Stephen Vargo e Robert Lusch. Deriva, por analogia, esta proposição hipotética da Teoria de Assimetria de Informações, da ciência econômica. Afirma a distinção ontológica entre informação e conhecimento, como justificativa para sua proposição. Apresenta conceitos instrumentais de Conhecimento e de Assimetria de Conhecimento, para apoiar os atos epistemológicos de ruptura e construção do objeto, de acordo com Gaston Bachelard e Pierre Bourdieu. Revisa as escolas de pensamento em marketing e os principais paradigmas da pesquisa na disciplina, discutindo a utilidade da proposta teórica para a pesquisa em cada um dos principais paradigmas. Sustenta a relevância da nova teoria para estudos acadêmicos, suas implicações gerenciais e sua importância para os agentes formuladores de políticas. / This thesis constitutes a proposal for a theoretical contribution to the discipline of marketing. It argues that a Knowledge Asymmetry exists between the poles of the exchange/transaction ratio of knowledge-intensive goods and services packages, from the perspective of the "New Dominant Logic" of marketing, according to Stephen Vargo and Robert Lusch. It derives, by analogy, this hypothetical proposition of the Theory of Information Asymmetry, from economic science. It affirms the ontological distinction between information and knowledge, as justification for its proposition. It introduces key concepts of Knowledge Asymmetry, to support the epistemological acts of rupture and construction of the object, according to Gaston Bachelard and Pierre Bourdieu. It reviews the schools of thought in marketing and the main research paradigms in the discipline, discussing the usefulness of the theoretical proposal for research in each of the main paradigms. It maintains the relevance of the new theory for academic studies, its management implications and its importance for policymakers. / La presente tesis se constituye en una propuesta de contribución teórica para la disciplina de marketing. Defiende que, existe una Asimetría de Conocimiento entre los polos de la relación de intercambio/transacción de paquetes de bienes y servicios intensivos en conocimiento, en la perspectiva de la “Nueva Lógica Dominante” de marketing, conforme Stephen Vargo y Robert Lusch. Deriva, por analogía, esta proposición hipotética de la Teoría de Asimetría de Informaciones, de la ciencia económica. Afirma la distinción ontológica entre información y conocimiento, como justificativa para su proposición. Presenta conceptos instrumentales de Conocimiento y de Asimetría de Conocimiento, para apoyar los actos epistemológicos de ruptura y construcción del objeto, de acuerdo con Gaston Bachelard y Pierre Bourdieu. Revisa las escuelas de pensamiento en marketing y los principales paradigmas de la investigación en la disciplina, discutiendo la utilidad de la propuesta teórica para la investigación en cada uno de los principales paradigmas. Sustenta la relevancia de la nueva teoría para estudios académicos, sus implicaciones gerenciales y su importancia para los agentes formuladores de políticas.

A presente tese constitui-se numa proposta de contribuição teórica para a disciplina de marketing. Defende que, existe uma Assimetria de Conhecimento entre os polos da relação de troca/transação de pacotes de bens e serviços intensivos em conhecimento, na perspectiva da “Nova Lógica Dominante” de marketing, conforme Stephen Vargo e Robert Lusch. Deriva, por analogia, esta proposição hipotética da Teoria de Assimetria de Informações, da ciência econômica. Afirma a distinção ontológica entre informação e conhecimento, como justificativa para sua proposição. Apresenta conceitos instrumentais de Conhecimento e de Assimetria de Conhecimento, para apoiar os atos epistemológicos de ruptura e construção do objeto, de acordo com Gaston Bachelard e Pierre Bourdieu. Revisa as escolas de pensamento em marketing e os principais paradigmas da pesquisa na disciplina, discutindo a utilidade da proposta teórica para a pesquisa em cada um dos principais paradigmas. Sustenta a relevância da nova teoria para estudos acadêmicos, suas implicações gerenciais e sua importância para os agentes formuladores de políticas. / This thesis constitutes a proposal for a theoretical contribution to the discipline of marketing. It argues that a Knowledge Asymmetry exists between the poles of the exchange/transaction ratio of knowledge-intensive goods and services packages, from the perspective of the "New Dominant Logic" of marketing, according to Stephen Vargo and Robert Lusch. It derives, by analogy, this hypothetical proposition of the Theory of Information Asymmetry, from economic science. It affirms the ontological distinction between information and knowledge, as justification for its proposition. It introduces key concepts of Knowledge Asymmetry, to support the epistemological acts of rupture and construction of the object, according to Gaston Bachelard and Pierre Bourdieu. It reviews the schools of thought in marketing and the main research paradigms in the discipline, discussing the usefulness of the theoretical proposal for research in each of the main paradigms. It maintains the relevance of the new theory for academic studies, its management implications and its importance for policymakers. / La presente tesis se constituye en una propuesta de contribución teórica para la disciplina de marketing. Defiende que, existe una Asimetría de Conocimiento entre los polos de la relación de intercambio/transacción de paquetes de bienes y servicios intensivos en conocimiento, en la perspectiva de la “Nueva Lógica Dominante” de marketing, conforme Stephen Vargo y Robert Lusch. Deriva, por analogía, esta proposición hipotética de la Teoría de Asimetría de Informaciones, de la ciencia económica. Afirma la distinción ontológica entre información y conocimiento, como justificativa para su proposición. Presenta conceptos instrumentales de Conocimiento y de Asimetría de Conocimiento, para apoyar los actos epistemológicos de ruptura y construcción del objeto, de acuerdo con Gaston Bachelard y Pierre Bourdieu. Revisa las escuelas de pensamiento en marketing y los principales paradigmas de la investigación en la disciplina, discutiendo la utilidad de la propuesta teórica para la investigación en cada uno de los principales paradigmas. Sustenta la relevancia de la nueva teoría para estudios académicos, sus implicaciones gerenciales y su importancia para los agentes formuladores de políticas.

A presente tese constitui-se numa proposta de contribuição teórica para a disciplina de marketing. Defende que, existe uma Assimetria de Conhecimento entre os polos da relação de troca/transação de pacotes de bens e serviços intensivos em conhecimento, na perspectiva da “Nova Lógica Dominante” de marketing, conforme Stephen Vargo e Robert Lusch. Deriva, por analogia, esta proposição hipotética da Teoria de Assimetria de Informações, da ciência econômica. Afirma a distinção ontológica entre informação e conhecimento, como justificativa para sua proposição. Apresenta conceitos instrumentais de Conhecimento e de Assimetria de Conhecimento, para apoiar os atos epistemológicos de ruptura e construção do objeto, de acordo com Gaston Bachelard e Pierre Bourdieu. Revisa as escolas de pensamento em marketing e os principais paradigmas da pesquisa na disciplina, discutindo a utilidade da proposta teórica para a pesquisa em cada um dos principais paradigmas. Sustenta a relevância da nova teoria para estudos acadêmicos, suas implicações gerenciais e sua importância para os agentes formuladores de políticas. / This thesis constitutes a proposal for a theoretical contribution to the discipline of marketing. It argues that a Knowledge Asymmetry exists between the poles of the exchange/transaction ratio of knowledge-intensive goods and services packages, from the perspective of the "New Dominant Logic" of marketing, according to Stephen Vargo and Robert Lusch. It derives, by analogy, this hypothetical proposition of the Theory of Information Asymmetry, from economic science. It affirms the ontological distinction between information and knowledge, as justification for its proposition. It introduces key concepts of Knowledge Asymmetry, to support the epistemological acts of rupture and construction of the object, according to Gaston Bachelard and Pierre Bourdieu. It reviews the schools of thought in marketing and the main research paradigms in the discipline, discussing the usefulness of the theoretical proposal for research in each of the main paradigms. It maintains the relevance of the new theory for academic studies, its management implications and its importance for policymakers. / La presente tesis se constituye en una propuesta de contribución teórica para la disciplina de marketing. Defiende que, existe una Asimetría de Conocimiento entre los polos de la relación de intercambio/transacción de paquetes de bienes y servicios intensivos en conocimiento, en la perspectiva de la “Nueva Lógica Dominante” de marketing, conforme Stephen Vargo y Robert Lusch. Deriva, por analogía, esta proposición hipotética de la Teoría de Asimetría de Informaciones, de la ciencia económica. Afirma la distinción ontológica entre información y conocimiento, como justificativa para su proposición. Presenta conceptos instrumentales de Conocimiento y de Asimetría de Conocimiento, para apoyar los actos epistemológicos de ruptura y construcción del objeto, de acuerdo con Gaston Bachelard y Pierre Bourdieu. Revisa las escuelas de pensamiento en marketing y los principales paradigmas de la investigación en la disciplina, discutiendo la utilidad de la propuesta teórica para la investigación en cada uno de los principales paradigmas. Sustenta la relevancia de la nueva teoría para estudios académicos, sus implicaciones gerenciales y su importancia para los agentes formuladores de políticas.