The process of conventionalization of institutionalized communicative activity types in argumentative discourse accords the doctor-patient consultation the domain of medical communication under the consultation genre of communicative activity. A close look at the micro linguistic context of doctor-patient communication, evaluating it in the meso-context of the consultation room, one can better understand the macro context of the doctor-patient consultation as a speech event. Using the pragma-dialectical method of analysis, interpretation and evaluation, the paper examines how doctors and patients resolve differences of opinion in dialogues drawn from simulated consultations involving Gusii doctors and Gusii nurses (as HIV, cancer or diabetes patients) at a local county referral hospital in Kenya. The consultations carried out in the Local Ekegusii language were audio recorded before being transcribed and translated for analysis. The analysis explores the argumentative moves exploited by the doctors and the patients in the critical discussion to resolve their difference in opinions in an acceptable and reasonable manner. The paper aims to discuss how choices of speech acts, argument schemes and patterns, and communication attunement strategies are influenced by the sociocultural belief system and institutional context of the doctor-patient interactions during consultations for the simultaneous achievement of rhetorical effectiveness and dialectical reasonableness. The paper explores pragmatic inferences necessitated by the reconstruction of the implicatures and presuppositions in the two principal interactants aiming for rhetorical effectiveness and reasonable resolution of differences in opinion in the process of shared decision making. The paper concludes that any sound analysis, interpretation and evaluation of argumentative moves in doctor-patient consultations must account for the intragroup and intergroup cultural communicative accommodation in the medical encounters.

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Key words: Doctor-patient Communication, Speech act theory, Pragma-dialectic theory, Communicative Accommodation Theory, Pragmatic inferences, Presuppositions, Ekegusii, Implicatures, Argumentative discourse, Attunement, Shared Decision Making.