Conversation analysis is undoubtedly the most visible and conventionally successful of Garfinkel’... more Conversation analysis is undoubtedly the most visible and conventionally successful of Garfinkel’s legacies. Yet the lineage is complex. This chapter traces it, first, by discussing Garfinkel’s initial interest, as revealed in an early (1948) dissertation proposal, in the domain of human interaction. He specifically addressed analytical problems related to the concision of speech (that it conveys much more than what is said), and the associated context-dependency of meaning, whereby linguistic expressions—later termed indexical expressions—gain their meaning by way of their context. Interaction and speech, in Garfinkel’s early work, were explicated using phenomenological resources, including the study of background expectancies, presuppositions accessed through breaching experiments and other demonstrations, and analysis of the documentary method of interpretation. Harvey Sacks’s approach was more direct, less theoretical, and habilitated the direct study of interaction through a se...
OBJECTIVE To evaluate receipt fidelity of communication training content included in a multifacet... more OBJECTIVE To evaluate receipt fidelity of communication training content included in a multifaceted intervention known to reduce antibiotic over-prescribing for pediatric acute respiratory tract infections (ARTIs), by examining the degree to which clinicians implemented the intended communication behavior changes. METHODS Parents were surveyed regarding clinician communication behaviors immediately after attending 1026 visits by children 6 months to < 11 years old diagnosed with ARTIs by 53 clinicians in 18 pediatric practices. Communication outcomes analyzed were whether clinicians: (A) provided both a combined (negative + positive) treatment recommendation and a contingency plan (full implementation); (B) provided either a combined treatment recommendation or a contingency plan (partial implementation); or (C) provided neither (no implementation). We used mixed effects multinomial logistic regression to determine whether these 3 communication outcomes changed between baseline and the time periods following each of 3 training modules. RESULTS After completing the communication training, the adjusted probability of clinicians fully implementing the intended communication behavior changes increased by an absolute 8.1% compared to baseline (95% Confidence Interval [CI]: 2.4%, 13.8%, p = .005). CONCLUSIONS Our findings support the receipt fidelity of the intervention's communication training content. PRACTICAL IMPLICATIONS Clinicians can be trained to implement communication behaviors that may aid in reducing antibiotic over-prescribing for ARTIs.
This article considers the large range of empirical research that has emerged under the broad aeg... more This article considers the large range of empirical research that has emerged under the broad aegis of ethnomethodology, in the period between the publication of Studies in Ethnomethodology (1967) and the present day. Starting with a brief overview of Garfinkel's intellectual career, we discuss the relation of ethnomethodology to Schütz's phenomenology, Parsons's systems theory, and Weber's concern with meaning construction. A central concern was with the problem of contextuality, which Garfinkel initially addressed by drawing on, while fashioning in his own way, Mannheim's concern with the documentary method of interpretation. Ethnomethodologically-related studies have proliferated in a variety of domains, including conversation analysis, membership categorization analysis, and (related to Garfinkel's own early work) empirical initiatives in the study of everyday life involving racial, gender and other minoritized groups. Further ethnomethodological studies emerged from legal environments, from social problems and deviance, and in relation to ability differences. Still other investigations concerned instructed action and its ramifications for the sciences, technology and organizations, including the workplace. A longstanding concern for ethnomethodology has been with the conduct of social sciences—how coding is done, how surveys are conducted, and how standardization is achieved. Many of these areas have given rise to thriving subfields, have dedicated journals, and resulted in applications. Few initiatives in sociological theory have resulted in a wider range of innovative research than Garfinkel's and successor studies showing, explicating, and demonstrating the organization of details in social life and their consequences for social order.
Harold Garfinkel's Studies in Ethnomethodology (1967) was published a little more than 50 yea... more Harold Garfinkel's Studies in Ethnomethodology (1967) was published a little more than 50 years ago. Since then, there has been a substantial—although often subterranean—growth in ethnomethodological work and influence. Studies in and appreciation of ethnomethodological work continue to grow, but the breadth and penetration of his insights and inspiration for ongoing research have yet to secure their full measure of recognition. The first part of this chapter reviews the development of Garfinkel’s ethnomethodology, whose origins include both the theorizing of Parsonian sociology and the phenomenology of Alfred Schütz. The authors discuss ethnomethodology’s orientation to the trust conditions making for a stable society, the “documentary method of interpretation,” rules and rule usage, and phenomena of language use and accountability. The second part of the chapter describes ethnomethodology’s legacies—its contributions to such areas or subdisciplines as conversation analysis (CA) and membership categorization analysis (MCA), its distinctive forms of ethnographic inquiry, and its influences on a host of substantive domains. These domains include legal environments, science and technology, workplace and organizational inquiries, survey research, social problems and deviance, disability and atypical interaction, and others. Ethnomethodology especially helped to set the agenda for gender studies, while also developing insights for inquiries into racial and ethnic features of everyday life and experience. Still, there is much of what Garfinkel called “unfinished business,” which means that ethnomethodological inquiries are continuing to intensify and develop.
Within the general framework of agreement on a state of affairs, the matter of the terms of agree... more Within the general framework of agreement on a state of affairs, the matter of the terms of agreement can remain: determining whose view is the more significant or more authoritative with respect to the matter at hand. In this paper we focus on this issue as it is played out in assessment sequences. We examine four practices through which a second speaker can index the independence of an agreeing assessment from that of a first speaker, and in this way can qualify the agreement. We argue that these practices reduce the responsiveness of the second assessment to the first; in this way they resist any claim to epistemic authority that may be indexed by the first speaker in "going first" in assessing some state of affairs.
This paper traces the increasing prominence of women in the White House press corps over the latt... more This paper traces the increasing prominence of women in the White House press corps over the latter half of the 20th century, and considers how this trend toward greater gender balance has impacted the questioning of presidents. Modest gender differences are documented in the topical content of questions, with women journalists slightly favoring domestic policy and private-sphere topics relative to men. More substantial differences are documented in aggressiveness, with women journalists asking more adversarial questions, and more assertive questions at least in the earlier years of the sampling period. The topical content differences are broadly aligned with traditional conceptions of gender, but the stronger differences in aggressiveness run contrary to such conceptions.
ObjectiveTo analyse individual-patient electronic health records to evaluate changes in antibioti... more ObjectiveTo analyse individual-patient electronic health records to evaluate changes in antibiotic (AB) prescribing in England for different age groups, for male and female subjects, and by prescribing indications from 2014 to 2017.MethodsData were analysed for 102 general practices in England that contributed data to the UK Clinical Practice Research Datalink (CPRD) from 2014 to 2017. Prescriptions for all ABs and for broad-spectrum β-lactam ABs were evaluated. Relative rate reductions (RRR) were estimated from a random-effects Poisson model, adjusting for age, gender, and general practice.ResultsTotal AB prescribing declined from 608 prescriptions per 1000 person-years in 2014 to 489 per 1000 person-years in 2017; RRR 6.9% (95% CI 6.6% to 7.1%) per year. Broad-spectrum β-lactam AB prescribing decreased from 221 per 1000 person-years in 2014 to 163 per 1000 person-years in 2017; RRR 9.3% (9.0% to 9.6%) per year. Declines in AB prescribing were similar for men and women but the rate...
In 2016, Discourse Studies published a special issue on the ‘epistemics of epistemics’ comprising... more In 2016, Discourse Studies published a special issue on the ‘epistemics of epistemics’ comprising six papers, all of which took issue with a strand of my research on how knowledge claims are asserted, implemented and contested through facets of turn design and sequence organization. Apparently coordinated through some years of discussion, the critique is nonetheless somewhat confused and confusing. In this article, I take up some of more prominent elements of the critique: (a) my work is ‘cognitivist’ substituting causal psychological analysis for the classic conversation analytic (CA) focus on the normative accountability of social action, (b) my work devalues and indeed flouts basic tenets of CA methodology such as the ‘next-turn proof procedure’, (c) my analysis of epistemic stance introduces unwarranted themes of conflict and hostility into CA thinking, (d) various concepts that I have introduced involve the invocation of ‘hidden orders’ of social conduct that is inimical to the...
To establish: a) feasibility of training GPs in a communication intervention to solicit additiona... more To establish: a) feasibility of training GPs in a communication intervention to solicit additional patient concerns early in the consultation, using specific lexical formulations ("do you have 'any' vs. 'some' other concerns?") noting the impact on consultation length, and b) whether patients attend with multiple concerns and whether they voiced them in the consultation. A mixed-methods three arm RCT feasibility study to assess the feasibility of the communication intervention. Intervention fidelity was high. GPs can be trained to solicit additional concerns early in the consultation (once patients have presented their first concern). Whilst feasible the particular lexical variation of 'any' vs 'some' seemed to have no bearing on the number of patient concerns elicited, on consultation length or on patient satisfaction. The level of missing questionnaire data was low, suggesting patients found completion of questionnaires acceptable. GPs can...
Conversation analysis is undoubtedly the most visible and conventionally successful of Garfinkel’... more Conversation analysis is undoubtedly the most visible and conventionally successful of Garfinkel’s legacies. Yet the lineage is complex. This chapter traces it, first, by discussing Garfinkel’s initial interest, as revealed in an early (1948) dissertation proposal, in the domain of human interaction. He specifically addressed analytical problems related to the concision of speech (that it conveys much more than what is said), and the associated context-dependency of meaning, whereby linguistic expressions—later termed indexical expressions—gain their meaning by way of their context. Interaction and speech, in Garfinkel’s early work, were explicated using phenomenological resources, including the study of background expectancies, presuppositions accessed through breaching experiments and other demonstrations, and analysis of the documentary method of interpretation. Harvey Sacks’s approach was more direct, less theoretical, and habilitated the direct study of interaction through a se...
OBJECTIVE To evaluate receipt fidelity of communication training content included in a multifacet... more OBJECTIVE To evaluate receipt fidelity of communication training content included in a multifaceted intervention known to reduce antibiotic over-prescribing for pediatric acute respiratory tract infections (ARTIs), by examining the degree to which clinicians implemented the intended communication behavior changes. METHODS Parents were surveyed regarding clinician communication behaviors immediately after attending 1026 visits by children 6 months to < 11 years old diagnosed with ARTIs by 53 clinicians in 18 pediatric practices. Communication outcomes analyzed were whether clinicians: (A) provided both a combined (negative + positive) treatment recommendation and a contingency plan (full implementation); (B) provided either a combined treatment recommendation or a contingency plan (partial implementation); or (C) provided neither (no implementation). We used mixed effects multinomial logistic regression to determine whether these 3 communication outcomes changed between baseline and the time periods following each of 3 training modules. RESULTS After completing the communication training, the adjusted probability of clinicians fully implementing the intended communication behavior changes increased by an absolute 8.1% compared to baseline (95% Confidence Interval [CI]: 2.4%, 13.8%, p = .005). CONCLUSIONS Our findings support the receipt fidelity of the intervention's communication training content. PRACTICAL IMPLICATIONS Clinicians can be trained to implement communication behaviors that may aid in reducing antibiotic over-prescribing for ARTIs.
This article considers the large range of empirical research that has emerged under the broad aeg... more This article considers the large range of empirical research that has emerged under the broad aegis of ethnomethodology, in the period between the publication of Studies in Ethnomethodology (1967) and the present day. Starting with a brief overview of Garfinkel's intellectual career, we discuss the relation of ethnomethodology to Schütz's phenomenology, Parsons's systems theory, and Weber's concern with meaning construction. A central concern was with the problem of contextuality, which Garfinkel initially addressed by drawing on, while fashioning in his own way, Mannheim's concern with the documentary method of interpretation. Ethnomethodologically-related studies have proliferated in a variety of domains, including conversation analysis, membership categorization analysis, and (related to Garfinkel's own early work) empirical initiatives in the study of everyday life involving racial, gender and other minoritized groups. Further ethnomethodological studies emerged from legal environments, from social problems and deviance, and in relation to ability differences. Still other investigations concerned instructed action and its ramifications for the sciences, technology and organizations, including the workplace. A longstanding concern for ethnomethodology has been with the conduct of social sciences—how coding is done, how surveys are conducted, and how standardization is achieved. Many of these areas have given rise to thriving subfields, have dedicated journals, and resulted in applications. Few initiatives in sociological theory have resulted in a wider range of innovative research than Garfinkel's and successor studies showing, explicating, and demonstrating the organization of details in social life and their consequences for social order.
Harold Garfinkel's Studies in Ethnomethodology (1967) was published a little more than 50 yea... more Harold Garfinkel's Studies in Ethnomethodology (1967) was published a little more than 50 years ago. Since then, there has been a substantial—although often subterranean—growth in ethnomethodological work and influence. Studies in and appreciation of ethnomethodological work continue to grow, but the breadth and penetration of his insights and inspiration for ongoing research have yet to secure their full measure of recognition. The first part of this chapter reviews the development of Garfinkel’s ethnomethodology, whose origins include both the theorizing of Parsonian sociology and the phenomenology of Alfred Schütz. The authors discuss ethnomethodology’s orientation to the trust conditions making for a stable society, the “documentary method of interpretation,” rules and rule usage, and phenomena of language use and accountability. The second part of the chapter describes ethnomethodology’s legacies—its contributions to such areas or subdisciplines as conversation analysis (CA) and membership categorization analysis (MCA), its distinctive forms of ethnographic inquiry, and its influences on a host of substantive domains. These domains include legal environments, science and technology, workplace and organizational inquiries, survey research, social problems and deviance, disability and atypical interaction, and others. Ethnomethodology especially helped to set the agenda for gender studies, while also developing insights for inquiries into racial and ethnic features of everyday life and experience. Still, there is much of what Garfinkel called “unfinished business,” which means that ethnomethodological inquiries are continuing to intensify and develop.
Within the general framework of agreement on a state of affairs, the matter of the terms of agree... more Within the general framework of agreement on a state of affairs, the matter of the terms of agreement can remain: determining whose view is the more significant or more authoritative with respect to the matter at hand. In this paper we focus on this issue as it is played out in assessment sequences. We examine four practices through which a second speaker can index the independence of an agreeing assessment from that of a first speaker, and in this way can qualify the agreement. We argue that these practices reduce the responsiveness of the second assessment to the first; in this way they resist any claim to epistemic authority that may be indexed by the first speaker in "going first" in assessing some state of affairs.
This paper traces the increasing prominence of women in the White House press corps over the latt... more This paper traces the increasing prominence of women in the White House press corps over the latter half of the 20th century, and considers how this trend toward greater gender balance has impacted the questioning of presidents. Modest gender differences are documented in the topical content of questions, with women journalists slightly favoring domestic policy and private-sphere topics relative to men. More substantial differences are documented in aggressiveness, with women journalists asking more adversarial questions, and more assertive questions at least in the earlier years of the sampling period. The topical content differences are broadly aligned with traditional conceptions of gender, but the stronger differences in aggressiveness run contrary to such conceptions.
ObjectiveTo analyse individual-patient electronic health records to evaluate changes in antibioti... more ObjectiveTo analyse individual-patient electronic health records to evaluate changes in antibiotic (AB) prescribing in England for different age groups, for male and female subjects, and by prescribing indications from 2014 to 2017.MethodsData were analysed for 102 general practices in England that contributed data to the UK Clinical Practice Research Datalink (CPRD) from 2014 to 2017. Prescriptions for all ABs and for broad-spectrum β-lactam ABs were evaluated. Relative rate reductions (RRR) were estimated from a random-effects Poisson model, adjusting for age, gender, and general practice.ResultsTotal AB prescribing declined from 608 prescriptions per 1000 person-years in 2014 to 489 per 1000 person-years in 2017; RRR 6.9% (95% CI 6.6% to 7.1%) per year. Broad-spectrum β-lactam AB prescribing decreased from 221 per 1000 person-years in 2014 to 163 per 1000 person-years in 2017; RRR 9.3% (9.0% to 9.6%) per year. Declines in AB prescribing were similar for men and women but the rate...
In 2016, Discourse Studies published a special issue on the ‘epistemics of epistemics’ comprising... more In 2016, Discourse Studies published a special issue on the ‘epistemics of epistemics’ comprising six papers, all of which took issue with a strand of my research on how knowledge claims are asserted, implemented and contested through facets of turn design and sequence organization. Apparently coordinated through some years of discussion, the critique is nonetheless somewhat confused and confusing. In this article, I take up some of more prominent elements of the critique: (a) my work is ‘cognitivist’ substituting causal psychological analysis for the classic conversation analytic (CA) focus on the normative accountability of social action, (b) my work devalues and indeed flouts basic tenets of CA methodology such as the ‘next-turn proof procedure’, (c) my analysis of epistemic stance introduces unwarranted themes of conflict and hostility into CA thinking, (d) various concepts that I have introduced involve the invocation of ‘hidden orders’ of social conduct that is inimical to the...
To establish: a) feasibility of training GPs in a communication intervention to solicit additiona... more To establish: a) feasibility of training GPs in a communication intervention to solicit additional patient concerns early in the consultation, using specific lexical formulations ("do you have 'any' vs. 'some' other concerns?") noting the impact on consultation length, and b) whether patients attend with multiple concerns and whether they voiced them in the consultation. A mixed-methods three arm RCT feasibility study to assess the feasibility of the communication intervention. Intervention fidelity was high. GPs can be trained to solicit additional concerns early in the consultation (once patients have presented their first concern). Whilst feasible the particular lexical variation of 'any' vs 'some' seemed to have no bearing on the number of patient concerns elicited, on consultation length or on patient satisfaction. The level of missing questionnaire data was low, suggesting patients found completion of questionnaires acceptable. GPs can...
This paper traces the increasing prominence of women in the White House press corps over the latt... more This paper traces the increasing prominence of women in the White House press corps over the latter half of the 20th century, and considers how this trend toward greater gender balance has impacted the questioning of presidents. Modest gender differences are documented in the topical content of questions, with women journalists slightly favoring domestic policy and private-sphere topics relative to men. More substantial differences are documented in aggressiveness, with women journalists asking more adversarial questions, and more assertive questions at least in the earlier years of the sampling period. The topical content differences are broadly aligned with traditional conceptions of gender, but the stronger differences in aggressiveness run contrary to such conceptions.
... authors. We thank Steve Clayman, Gene Lerner, Elinor Ochs, Anita Pomerantz, RobertSanders, Ma... more ... authors. We thank Steve Clayman, Gene Lerner, Elinor Ochs, Anita Pomerantz, RobertSanders, Manny Schegloff, Marja-Leena Sorjonen, anti Sandy Thompson for their comments on earlier drafts of this article. Correspondence ...
This paper considers negative interrogatives—questions beginning with such frames as 'Isn't it', ... more This paper considers negative interrogatives—questions beginning with such frames as 'Isn't it', 'Don't you', 'Shouldn't you' etc. –– as limiting cases of 'questioning'. Using data from news interviews, where questioning is mandatory and the boundary between questions and assertions can be highly sensitive and contested, it suggests that this form of interrogative is recurrently produced as, and treated as, a vehicle for assertions. Further while negative interrogatives are contested as 'assertions', statements accompanied by negative tags are not. This suggests that Bolinger's (Bolinger, Dwight, 1957. Interrogative Structures of American English. University of Alabama Press, Alabama.) claim that the two formats are equivalent is incorrect. Some suggestions are offered as to why the two formats should be differentially treated in terms of their assertiveness. # 2002 Published by Elsevier Science B.V.
ABSTRACT This paper uses a single question form—the negative interrogative—as a window into the i... more ABSTRACT This paper uses a single question form—the negative interrogative—as a window into the increasing aggressiveness of American journalists and hence the increasingly adversarial relationship between press and state in the United States. The negative interrogative in English is a type of yes/no interrogative (e.g., “Isn&amp;#39;t it …”, “Don&amp;#39;t you …”) often understood as asserting rather than merely seeking information. Its frequency in the construction of yes/no questions is an index of the propensity for journalists to depart from a formally neutral posture and express a point of view on the subject of inquiry. Previous quantitative research documented their growing use in US presidential news conferences since the 1950s, with the Nixon Administration as an historical turning point. Here we incorporate a more nuanced qualitative analysis of single cases in use. Beyond their growing frequency, negative interrogatives were increasingly mobilized to raise substantively adversarial matters, increasingly prefaced by adversarial assertions, and increasingly likely to treat such prefaces as presuppositionally given. Together these trends indicate journalists&amp;#39; growing willingness to highlight administration problems and failings and to hold Presidents to account, with Presidents since Nixon facing a harsher climate of journalistic questioning than did their predecessors.
The news interview has become a major vehicle for presenting broad-cast news and political commen... more The news interview has become a major vehicle for presenting broad-cast news and political commentary, and a primary interface between the institutions of journalism and government. This much needed text examines the place of the news interview in Anglo-American ...
BACKGROUND: One-third of outpatient antibiotic prescriptions for pediatric acute respiratory trac... more BACKGROUND: One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program's effectiveness for reducing outpatient antibiotic prescribing for ARTI visits.
This paper conceptualizes the act of diagnosis in primary care as a 'diagnostic moment,’ comprisi... more This paper conceptualizes the act of diagnosis in primary care as a 'diagnostic moment,’ comprising a diagnostic utterance in a 'diagnostic slot,' together with a patient response. Using a dataset of 201 treated conditions drawn from 255 video recorded medical visits with 71 physicians across 33 clinical practices in the Western United States, we investigate the incidence of diagnostic moments, aspects of their verbal design, and patient responsiveness. We find that only 53% of treated conditions in the dataset are associated with a diagnostic moment. Physicians present 66% of these diagnoses as hedged or otherwise doubtful, and deliver 30% of them without gazing at the patient. In the context of these diagnostic moments, patients are non- or minimally responsive 59% of the time. These findings underscore the different significance that may be accorded diagnosis in primary care in contrast to care in other medical contexts. The paper concludes that the analysis of sequences of action which empirically realize diagnosis are underrepresented in the sociology of diagnosis, and that better understanding of the diagnostic moment would enhance our understanding of diagnostic processes in primary care.
This study investigates patient resistance to doctors' treatment recommendations in a cross-natio... more This study investigates patient resistance to doctors' treatment recommendations in a cross-national comparison of primary care. Through this lens, we explore English and American patients' enacted priorities, expectations, and assumptions about treating routine illnesses with prescription versus over-the-counter medications. We perform a detailed analysis of 304 (American) and 393 (English) naturally occurring treatment discussions and conclude that American and English patients tend to use treatment resistance in different prescribing contexts to pursue different ends. While American patients are most likely to resist recommendations for non-prescription treatment and display an expectation for prescription treatment in these interactions, English patients show a high level of resistance to recommendations for all types of treatment and display an expectation of cautious prescribing. These behavioral trends reflect broader structural forces unique to each national context and ultimately maintain distinct cultural norms of good-practice prescribing.
From the earliest studies of doctor-patient interaction (Byrne & Long, 1976), it has been recogni... more From the earliest studies of doctor-patient interaction (Byrne & Long, 1976), it has been recognized that treatment recommendations may be expressed in more or less authoritative ways, based on their design and delivery. There are clear differences between I’m going to start you on X and We can give you X to try and Would you like me to give you X? Yet little is known about this variation, its contexts, or its consequences. In this paper, we develop a basic taxonomy of treatment recommendations in primary
care as a first step toward a more comprehensive investigation. We take as our point of departure the observation that treatment recommendations such as those above represent not only different formulations but also different social actions. We distinguish five main treatment recommendation actions: pronouncements, suggestions, proposals, offers, and assertions. We ask: what are the main dimensions on which these recommendations vary and to what end? And what sorts of factors shape a clinician’s use of one action type over another with respect to recommending a medication in the primary care context?
In this article, we discuss the notion of a 'conversation analytic intervention,' focusing on the... more In this article, we discuss the notion of a 'conversation analytic intervention,' focusing on the role of conversation analysis in the major stages of intervention research, epitomized by the randomized controlled trial, the gold standard for intervention in the medical sciences. These stages embrace development, feasibility and piloting, evaluation, and implementation. We describe how conversation analytic methods are used as part of the first two stages and how a conversation analytic skill base and sensibility must be deployed in managing the last two stages. Through a review of practical requirements for successful, externally-funded intervention research, we provide suggestions for how to maximize the potential for basic, conversation analytic research to eventuate in intervention. Data are in American English. The progressive expansion in the range, quality, and reliability of conversation analytic (CA) findings over recent years has increased confidence that these findings will find significance in real-world applications. These applications are, of course, various. As Antaki (2011) observed, there are numerous ways in which CA findings can be applied, such as toward the establishment of new areas of scholarship or toward a better understanding of macrosocial issues, communication problems, organic/psychological disorders, and the workings of social institutions. When CA is
To determine the association between the format of physicians’ opening questions that solicit pat... more To determine the association between the format of physicians’ opening questions that solicit patients’ presenting concerns and patients’ post-visit evaluations of (i.e., satisfaction with) the affective-relational dimension of physicians’ communication.
Soliciting patients' complete agendas of concerns (aka. 'agenda setting') can improve... more Soliciting patients' complete agendas of concerns (aka. 'agenda setting') can improve patients' health outcomes and satisfaction, and physicians' time management. We assess the distribution, content, and effectiveness of physicians' post-chief-complaint, agenda-setting questions. We coded videotapes/transcripts of 407 primary-, acute-care visits between adults and 85 general-practice physicians operating in 46 community-based clinics in two states representing urban and rural care. Measures are the incidence of physicians' questions, their linguistic format, position within visits, likelihood of being responded to, and the nature of such responses. Physicians' questions designed to solicit concerns additional to chief concerns occurred in only 32% of visits (p<.001). Compared to questions whose communication format explicitly solicited 'questions' (e.g., "Do you have any questions?"), those that were formatted so as to allow for &...
This investigation focused on the information-seeking behaviors of parents (N = 38) whose newborn... more This investigation focused on the information-seeking behaviors of parents (N = 38) whose newborn had received a positive screening result for cystic fibrosis. Roughly half of the participants actively sought information about their child’s potential disease prior to the clinic visit. The most common sources of information were the internet, pediatricians, and family physicians. Analysis of behavior during the clinic visit showed rates of question asking that were judged as low, but comparable to the results of other studies. It was observed that parents would occasionally collaborate in the production of a single question. More educated parents tended to produce such questions more frequently. Importantly, frequency of collaborative questions was positively correlated with enhanced knowledge of cystic fibrosis six weeks after the clinic visit and with apparent dissatisfaction with the counseling interaction.
In the more than 1 billion primary-care visits each year in the United States, the majority of pa... more In the more than 1 billion primary-care visits each year in the United States, the majority of patients bring more than one distinct concern, yet many leave with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;unmet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; concerns (i.e., ones not addressed during visits). Unmet concerns have potentially negative consequences for patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; health, and may pose utilization-based financial burdens to health care systems if patients return to deal with such concerns. One solution to the problem of unmet concerns is the communication skill known as up-front agenda setting, where physicians (after soliciting patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; chief concerns) continue to solicit patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; concerns to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;exhaustion&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; with questions such as &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Are there some other issues you&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;d like to address?&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; Although this skill is trainable and efficacious, it is not yet a panacea. This article uses conversation analysis to demonstrate that patients understand up-front agenda-setting questions in ways that hamper their effectiveness. Specifically, we demonstrate that up-front agenda-setting questions are understood as making relevant &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;new problems&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (i.e., concerns that are either totally new or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;new since last visit,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and in need of diagnosis), and consequently bias answers away from &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;non-new problems&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (i.e., issues related to previously diagnosed concerns, including much of chronic care). Suggestions are made for why this might be so, and for improving up-front agenda setting. Data are 144 videotapes of community-based, acute, primary-care, outpatient visits collected in the United States between adult patients and 20 family-practice physicians.
This chapter contains sections titled: Dimensions of Question DesignCongruent and Cross-cutting P... more This chapter contains sections titled: Dimensions of Question DesignCongruent and Cross-cutting Preferences in Medical QuestioningDimensions of Question Design in Special SituationsConclusionFor Further ReadingNoteDimensions of Question DesignCongruent and Cross-cutting Preferences in Medical QuestioningDimensions of Question Design in Special SituationsConclusionFor Further ReadingNote
This chapter contains sections titled: Origins: Erving GoffmanOrigins: Harold GarfinkelConversati... more This chapter contains sections titled: Origins: Erving GoffmanOrigins: Harold GarfinkelConversation AnalysisThe Sequential Structure of InteractionConversation Analysis: Two Research TraditionsInstitutional CAOrdinary Conversation and Institutional TalkInstitutional Talk: Research ObjectivesFor Further ReadingOrigins: Erving GoffmanOrigins: Harold GarfinkelConversation AnalysisThe Sequential Structure of InteractionConversation Analysis: Two Research TraditionsInstitutional CAOrdinary Conversation and Institutional TalkInstitutional Talk: Research ObjectivesFor Further Reading
This chapter contains sections titled: The Problem of Response CoordinationFormats for Inviting A... more This chapter contains sections titled: The Problem of Response CoordinationFormats for Inviting ApplauseCombinationsRescuing DudsGenerating Applause: The Three-stage RocketResponding to Speeches: Form versus ContentThe Long Half-Lives of Contrasts and ListsConclusionFor Further ReadingThe Problem of Response CoordinationFormats for Inviting ApplauseCombinationsRescuing DudsGenerating Applause: The Three-stage RocketResponding to Speeches: Form versus ContentThe Long Half-Lives of Contrasts and ListsConclusionFor Further Reading
This chapter contains sections titled: The Interactional Management of Diagnosis: Three StudiesTr... more This chapter contains sections titled: The Interactional Management of Diagnosis: Three StudiesTreatment RecommendationsHow Authoritative are Physicians? A Case StudyConclusionFor Further ReadingThe Interactional Management of Diagnosis: Three StudiesTreatment RecommendationsHow Authoritative are Physicians? A Case StudyConclusionFor Further Reading
This collection offers a multifaceted view of the life, research and impact
of Emanuel A. Schegl... more This collection offers a multifaceted view of the life, research and impact
of Emanuel A. Schegloff, the co-originator, with Harvey Sacks and Gail Jefferson, of Conversation Analysis (or CA), and its leading contemporary authority. The first section introduces Schegloff ’s life and work, and, using a series of interviews with him, provides a concise, comprehensive and accessible introduction to the field’s major aims and achievements. Next many of the world’s leading researchers from various disciplines – including Communication, Linguistics, Psycholinguistics, Linguistic Anthropology, and Sociology – build on Schegloff’s foundational research, analyzing encounters from everyday and institutional settings (conducted in English, German, Korean, Mandarin, and Russian) to explicate how conversation and other conduct in interaction are organized. The final section of the book includes reflections on Schegloff ’s contributions by some of his major interlocutors and Schegloff ’s response to them.
In this article, we investigate a puzzle for standard accounts of reference in natural language p... more In this article, we investigate a puzzle for standard accounts of reference in natural language processing, psycholinguistics and pragmatics: occasions where, following an initial reference (e.g., the ice), a subsequent reference is achieved using the same noun phrase (i.e., the ice), as opposed to an anaphoric form (i.e., it). We argue that such non-anaphoric reference can be understood as motivated by a central principle: the expression of agency in interaction. In developing this claim, we draw upon research in what may initially appear a wholly unconnected domain: the marking of epistemic and deontic stance, standardly investigated in linguistics as turn-level grammatical phenomena. Examination of naturally-occurring talk reveals that to analyze such stances solely though the lens of turn-level resources (e.g., modals) is to address only partially the means by which participants make epistemic and deontic claims in everyday discourse. Speakers' use of referential expressions illustrates a normative dimension of grammar that incorporates both form and position, thereby affording speakers the ability to actively depart from this form-position norm through the use of a repeated NP, a grammatical practice that we show is associated with the expression of epistemic and deontic authority. It is argued that interactants can thus be seen to be agentively mobilizing the resources of grammar to accommodate the inescapable temporality of interaction.
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Papers by John Heritage
care as a first step toward a more comprehensive investigation. We take as our point of departure the observation that treatment recommendations such as those above represent not only different formulations but also different social actions. We distinguish five main treatment recommendation actions: pronouncements, suggestions, proposals, offers, and assertions. We ask: what are the main dimensions on which these recommendations vary and to what end? And what sorts of factors shape a clinician’s use of one action type over another with respect to recommending a medication in the primary care context?
patients’ post-visit evaluations of (i.e., satisfaction with) the affective-relational dimension of physicians’ communication.
participants actively sought information about their child’s potential disease prior to the clinic visit. The most common sources of information were the internet, pediatricians, and family physicians. Analysis of behavior during the clinic visit showed rates of question asking that were judged as low, but comparable to the results of other studies. It was observed that parents would occasionally collaborate in the production of a single question. More educated parents tended to produce such questions more frequently. Importantly, frequency of collaborative questions was positively correlated with enhanced knowledge of cystic fibrosis six weeks after the clinic visit and with apparent dissatisfaction with the counseling interaction.
of Emanuel A. Schegloff, the co-originator, with Harvey Sacks and Gail Jefferson, of Conversation Analysis (or CA), and its leading contemporary authority. The first section introduces Schegloff ’s life and work, and, using a series of interviews with him, provides a concise, comprehensive and accessible introduction to the field’s major aims and achievements. Next many of the world’s leading researchers from various disciplines – including Communication, Linguistics, Psycholinguistics, Linguistic Anthropology, and Sociology – build on Schegloff’s foundational research, analyzing encounters from everyday and institutional settings (conducted in English, German, Korean, Mandarin, and Russian) to explicate how conversation and other conduct in interaction are organized. The final section of the book includes reflections on Schegloff ’s contributions by some of his major interlocutors and Schegloff ’s response to them.