本研究聚焦门诊医患互动中患者提出自我诊疗选项这一社会与互动现象，关注其序列组织和话轮设计，探究其互动价值和社会规范。语料分析发现患者可以通过“Ｖ 不Ｖ”等多种互动资源提出自我诊疗选项，形成对医生诊疗建议的阻抗。然而，患者也能够通过该语法结构实现对行为决定权的调度和主张，体现对医生权威的尊重，并以此争取表达就诊诉求的机会，从而通过改变互动轨迹、主导序列发展，构建患者自身在医患互动中的主体性。

This study focuses on the social and interactional phenomenon of patients’ self-proposed diagnostic and treatment options, paying attention to its sequence organization and turn design and investigating its interactive value and embodied social norm. Data analyses reveal that a patient might adopt the structure of “V or not V” along with other interactional resources to propose their diagnostic and treatment options, constituting resistance to the doctor’s recommendations. Meanwhile, through this specific turn design, the patient can adjust and manipulate his or her deontic right, display his or her respect for the doctor’s medical authority, and meanwhile bid for opportunities to voice his or her reasons for the clinical visit. Utilizing this grammatical structure of “V or not V”, the patient manages to adjust the trajectory of the current interaction. As a result, it changes the interaction, leads the sequential development, and constructs the patient’s agency in the doctor patient interaction.