This article reviews a range of conversation analytic findings concerning the role of information... more This article reviews a range of conversation analytic findings concerning the role of information imbalances in the organization of conversational sequences. Considering sequences launched from knowing and unknowing epistemic stances, it considers the role of relative epistemic stance and status as warrants for the production of talk and as forces in the process of sequence production and decay.
In reflecting on Emirbayer and Maynard's muscular and invigorating effort to link the traditions ... more In reflecting on Emirbayer and Maynard's muscular and invigorating effort to link the traditions of pragmatism and ethnomethodology, I mean to dwell on a thread that appears and re-appears in their discussion and which, I believe, deserves a little more interrogation. The thread concerns "emergence" or the ways in which human actions can, transcending strict deterministic causality, manifest creativity, novelty and innovation. A commitment to this view, which can easily be traced to the early Renaissance (Cassirer 1963), unites those influenced by Hegelian thought and, not co-incidentally therefore, the pragmatists. Whether expressed in Dewey (1972) critique of the reflex arc concept in psychology, Peirce's ( [c. 1897]]) "interpretant" placed creatively between sign and object, or distinction between the "I" and the "Me," the theme of emergence was a hallmark of pragmatist thought and its later proponents . Moreover it was central to Herbert ), Anselm Strauss (1959) and other symbolic interactionists who were pragmatism's sociological heirs. Blumer, for example, in a blistering critique of Parsonian structural functionalism, observes that: it is just not true that the full expanse of life in a human society, in any human society, is but an expression of pre-established forms of joint action. New situations are constantly arising within the scope of group life that are problematic and for which existing rules are inadequate...Such areas of unprescribed conduct are just as natural, indigenous and recurrent in human group life as are those areas covered by preestablished and faithfully followed prescriptions of joint action. (Blumer 1969, p. 18) Yet, as is widely observed, there is something formulaic and abstract about the pragmatist notion of emergence. It is most often expressed as a "principle" and deployed as a
ABSTRACT This article considers the use of negative polarization in polar (yes/no) questions. It ... more ABSTRACT This article considers the use of negative polarization in polar (yes/no) questions. It argues that question polarity is used to take an epistemic stance toward the probability or improbability of the state of affairs referenced in the question and that taking such a stance is effectively unavoidable. Focusing on negatively polarized questions (NPQs), four main kinds of evidence are adduced that NPQs are associated with the questioner’s stance that the question’s underlying proposition is unlikely: (a) self-repair to reverse or otherwise adjust polarity; (b) evidence from the prior talk from which the question is occasioned; (c) contexts in which a particular state of affairs is relevant but has remained unstated; (d) overall structural organizational features of talk (e.g., conversational closings) that militate against the likelihood of affirmative responses. Finally, the article proposes that question design represents a distinct organizational layer vis-à-vis the preference-organizational characteristics of actions, and it appears to function in distinctive ways in relation to recruitment- and affiliation-relevant questions (e.g., requests, offers, etc.) by comparison with information-seeking questions. Data are drawn from corpora of British and American English conversations.
ABSTRACT This article discusses Kendrick and Drew’s (2016/this issue) conceptualization of recrui... more ABSTRACT This article discusses Kendrick and Drew’s (2016/this issue) conceptualization of recruitment. It is argued that the critical feature of recruitment as a category is its focus on forms of local, here-and-now assistance, which gives recruitment actions a different suite of affordances and constraints than actions soliciting assistance on some future occasion disjoined from the present. It is suggested that these latter actions must be “language heavy” and may be likely to involve heavier impositions than the aims for which recruitment generally functions, thus justifying an enhanced focus on linguistic structure and sequence. Data are in American English.
terms-and-conditions-of-access.pdf This article may be used for research, teaching and private st... more terms-and-conditions-of-access.pdf This article may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
Few authors can have been more fortunate in their commentators than I have been on this occasion,... more Few authors can have been more fortunate in their commentators than I have been on this occasion, and I am deeply grateful for the thoughtful and probing comments of all three (Clift, 2012/this issue; Drew, 2012/this issue; and Sidnell, 2012/this issue). In some respects they may have been too gentle, and in taking this opportunity to react to the many issues they have raised, I should like to amplify some of their suggestions and caveats and add a few of my own. In what follows, I mean to offer some post hoc spin on what is asserted in the two articles to which they are responding, this inevitably taking the form of tacking between the roles of linguistic form and social context in the constitution of action, with an eye on methodological implications. Some readers may feel that linguistic form was shortchanged in "Epistemics in Action" (EinA) (Heritage, 2012a/this issue): After all, English speakers, together with speakers of many other languages, do in fact deploy interrogative morphosyntax in polar questions and, given the effort allocated to this, surely, as Zipf (1949) taught, there must be some interactional benefit? As noted in EinA, however, the fact is that many languages do not deploy interrogative morphosyntax in polar questions and get along quite well without it. Similarly, as also noted in EinA, evidence for the K-"questioning" interactional import of (rising) intonation is murky, to put it mildly. In this context, it can be useful to recognize that departures from the default "readings" of declarative and interrogative syntax are quite asymmetric. While numerous declarative utterances enact requests for information, relatively few interrogative ones enact assertions. This suggests that while declarative syntax may be a less reliable indicator of assertions, interrogative syntax is relatively more reliable as an indicator of information requests (leaving aside the many "indirect" actions that are also managed via interrogative syntax). Thus, from a probabilistic point of view, while the "epistemic ticker" can never be switched off, it can be "guided" by syntax. If the heuristic is of the "fast and frugal" kind , we should expect some clustering of Correspondence should be sent to John Heritage,
This paper uses a single question form*the negative interrogative*as a window into the increasing... more 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't it. . .'', ''Don'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' 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.
This article reviews a range of conversation analytic findings concerning the role of information... more This article reviews a range of conversation analytic findings concerning the role of information imbalances in the organization of conversational sequences. Considering sequences launched from knowing and unknowing epistemic stances, it considers the role of relative epistemic stance and status as warrants for the production of talk and as forces in the process of sequence production and decay.
In reflecting on Emirbayer and Maynard's muscular and invigorating effort to link the traditions ... more In reflecting on Emirbayer and Maynard's muscular and invigorating effort to link the traditions of pragmatism and ethnomethodology, I mean to dwell on a thread that appears and re-appears in their discussion and which, I believe, deserves a little more interrogation. The thread concerns "emergence" or the ways in which human actions can, transcending strict deterministic causality, manifest creativity, novelty and innovation. A commitment to this view, which can easily be traced to the early Renaissance (Cassirer 1963), unites those influenced by Hegelian thought and, not co-incidentally therefore, the pragmatists. Whether expressed in Dewey (1972) critique of the reflex arc concept in psychology, Peirce's ( [c. 1897]]) "interpretant" placed creatively between sign and object, or distinction between the "I" and the "Me," the theme of emergence was a hallmark of pragmatist thought and its later proponents . Moreover it was central to Herbert ), Anselm Strauss (1959) and other symbolic interactionists who were pragmatism's sociological heirs. Blumer, for example, in a blistering critique of Parsonian structural functionalism, observes that: it is just not true that the full expanse of life in a human society, in any human society, is but an expression of pre-established forms of joint action. New situations are constantly arising within the scope of group life that are problematic and for which existing rules are inadequate...Such areas of unprescribed conduct are just as natural, indigenous and recurrent in human group life as are those areas covered by preestablished and faithfully followed prescriptions of joint action. (Blumer 1969, p. 18) Yet, as is widely observed, there is something formulaic and abstract about the pragmatist notion of emergence. It is most often expressed as a "principle" and deployed as a
ABSTRACT This article considers the use of negative polarization in polar (yes/no) questions. It ... more ABSTRACT This article considers the use of negative polarization in polar (yes/no) questions. It argues that question polarity is used to take an epistemic stance toward the probability or improbability of the state of affairs referenced in the question and that taking such a stance is effectively unavoidable. Focusing on negatively polarized questions (NPQs), four main kinds of evidence are adduced that NPQs are associated with the questioner’s stance that the question’s underlying proposition is unlikely: (a) self-repair to reverse or otherwise adjust polarity; (b) evidence from the prior talk from which the question is occasioned; (c) contexts in which a particular state of affairs is relevant but has remained unstated; (d) overall structural organizational features of talk (e.g., conversational closings) that militate against the likelihood of affirmative responses. Finally, the article proposes that question design represents a distinct organizational layer vis-à-vis the preference-organizational characteristics of actions, and it appears to function in distinctive ways in relation to recruitment- and affiliation-relevant questions (e.g., requests, offers, etc.) by comparison with information-seeking questions. Data are drawn from corpora of British and American English conversations.
ABSTRACT This article discusses Kendrick and Drew’s (2016/this issue) conceptualization of recrui... more ABSTRACT This article discusses Kendrick and Drew’s (2016/this issue) conceptualization of recruitment. It is argued that the critical feature of recruitment as a category is its focus on forms of local, here-and-now assistance, which gives recruitment actions a different suite of affordances and constraints than actions soliciting assistance on some future occasion disjoined from the present. It is suggested that these latter actions must be “language heavy” and may be likely to involve heavier impositions than the aims for which recruitment generally functions, thus justifying an enhanced focus on linguistic structure and sequence. Data are in American English.
terms-and-conditions-of-access.pdf This article may be used for research, teaching and private st... more terms-and-conditions-of-access.pdf This article may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
Few authors can have been more fortunate in their commentators than I have been on this occasion,... more Few authors can have been more fortunate in their commentators than I have been on this occasion, and I am deeply grateful for the thoughtful and probing comments of all three (Clift, 2012/this issue; Drew, 2012/this issue; and Sidnell, 2012/this issue). In some respects they may have been too gentle, and in taking this opportunity to react to the many issues they have raised, I should like to amplify some of their suggestions and caveats and add a few of my own. In what follows, I mean to offer some post hoc spin on what is asserted in the two articles to which they are responding, this inevitably taking the form of tacking between the roles of linguistic form and social context in the constitution of action, with an eye on methodological implications. Some readers may feel that linguistic form was shortchanged in "Epistemics in Action" (EinA) (Heritage, 2012a/this issue): After all, English speakers, together with speakers of many other languages, do in fact deploy interrogative morphosyntax in polar questions and, given the effort allocated to this, surely, as Zipf (1949) taught, there must be some interactional benefit? As noted in EinA, however, the fact is that many languages do not deploy interrogative morphosyntax in polar questions and get along quite well without it. Similarly, as also noted in EinA, evidence for the K-"questioning" interactional import of (rising) intonation is murky, to put it mildly. In this context, it can be useful to recognize that departures from the default "readings" of declarative and interrogative syntax are quite asymmetric. While numerous declarative utterances enact requests for information, relatively few interrogative ones enact assertions. This suggests that while declarative syntax may be a less reliable indicator of assertions, interrogative syntax is relatively more reliable as an indicator of information requests (leaving aside the many "indirect" actions that are also managed via interrogative syntax). Thus, from a probabilistic point of view, while the "epistemic ticker" can never be switched off, it can be "guided" by syntax. If the heuristic is of the "fast and frugal" kind , we should expect some clustering of Correspondence should be sent to John Heritage,
This paper uses a single question form*the negative interrogative*as a window into the increasing... more 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't it. . .'', ''Don'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' 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.
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 ...
In news interviews, unlike speeches, lectures or other forms of monologic communication, public f... more In news interviews, unlike speeches, lectures or other forms of monologic communication, public figures overwhelmingly give information and express opinions in response to journalists' questions. The news content that results is thus a joint construction, whether collaborative or conflictual, that emerges from the confluence of the questions journalists choose to put and the responses that those questions engender. 1 For this reason, questioning is central to the practice of news interviewing, and skill in question design is at the heart of the interviewer's (IR) craft. The limits of questioning play a significant part in defining the parameters of the permissible in mass media content, and innovations in question design often embody efforts to redefine these parameters. In designing questions, IRs ordinarily attempt to strike a balance between two competing journalistic norms. On the one hand, IRs are expected to be impartial, objective, unbiased, and disinterested in their questioning of public figures. They are expected to have respect for the facts and the perspectives that interviewees (IE) communicate, and to work to bring these into the public domain. On the other hand, IRs also subscribe to a norm of adversarialness. They should actively challenge their sources, rather than being simply mouthpieces or ciphers for them. This second norm is one that pushes IRs not to let the interview be a kind of platform or soapbox from which public figures can get away with their own spin on events.
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.
The results reveal substantial and significant differences for all indicators, all in the directi... more The results reveal substantial and significant differences for all indicators, all in the direction of increased adversarialness. This pattern suggests that journalists have become much less deferential and more aggressive in their treatment of the U.S. president. Possible factors contributing to this development, and its broader ramifications for the evolving relationship between journalism and government, are also discussed.
This article develops a system for analyzing the aggressiveness of journalists' questions to publ... more This article develops a system for analyzing the aggressiveness of journalists' questions to public figures and applies that system to a sample of presidential news conferences from Eisenhower through Clinton. The primary objective is to use the phenomenon of aggressive questioning as a window into the White House press corps and its evolving relationship to the presidency. Ten features of question design are examined as indicators of four basic dimensions of aggressiveness: (1) initiative, (2) directness, (3) assertiveness, and (4) adversarialness. The results reveal significant trends for all dimensions, all indicating a long-term decline in deference to the president and the rise of a more vigorous and at times adversarial posture. While directness Steven E. Clayman is professor of sociology and communication studies at UCLA, and is coauthor (with John has increased gradually over time and is relatively insensitive to the immediate sociopolitical context, initiative, assertiveness, and adversarialness are more volatile and sensitive to local conditions. The volatile dimensions rose from the late 1960s through the early 1980s, declined from the mid-1980s through the early 1990s, and rose again at century's end. Possible factors contributing to these trends, and their broader ramifications for the evolving relationship between the news media and the presidency, are also discussed.
Presidential journalism is known to have grown substantially more aggressive through the 1970s an... more Presidential journalism is known to have grown substantially more aggressive through the 1970s and beyond, but a definitive explanation for this trend remains elusive. Some suggest that events surrounding Vietnam and Watergate transformed the professional norms of journalism. However, the trend could also be a more superficial and transitory response to other circumstantial factors that converged in the same time period, such as president-level characteristics (the prevalence of Republicans, Washington outsiders, and more vigorous news management efforts), the political environment (the rise of official discord), and the economic environment (a downturn in the business cycle). This study disentangles these various factors and assesses their relative success in explaining trends in journalistic conduct in the postwar era. Data are drawn from a large sample of presidential news conferences from 1953 through 2000, focusing on the aggressiveness of journalists' questions. The results strongly support the normative shift hypothesis, although economic factors have also been consequential. These results suggest a punctuated equilibrium model of journalistic change in relations between the White House press corps and the presidency.
Are members of the White House press corps unified in their treatment of the president at any giv... more Are members of the White House press corps unified in their treatment of the president at any given time, or does their behavior differ by demographic and professional attributes? This study addresses this issue through multidimensional measurement of the aggressiveness of questions put to nine presidents in news conferences. In addition to the familiar print/broadcast distinction, three largely unexamined attributes are explored: (1) organizational status (journalists affiliated with prominent vs. marginal news outlets), (2) interpersonal familiarity (frequent vs. infrequent news conference participants), and (3) gender (male vs. female journalists).
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't it …”, “Don'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' 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?
■ Abstract Working within the functionalist perspective that he did so much to develop, Parsons (... more ■ Abstract Working within the functionalist perspective that he did so much to develop, Parsons (1951) conceptualized the physician-patient relationship according to a normative framework defined by the pattern variable scheme. As Parsons clearly recognized, this normative conceptualization was one that empirical reality at best only approximates. In the 1970s, two major studies established doctor-patient interaction as a viable research domain. In the present review, we consider approaches to the medical interview developing from these initiatives and that have a primary focus on observable features of doctor-patient interaction. Within this orientation, we consider literature dealing with social, moral, and technical dilemmas that physicians and patients face in primary care and the resources that they deploy in solving them. This literature embodies a steady evolution away from a doctor-centered emphasis toward a more balanced focus on the conduct of doctors and patients together.
Few medical visits pass without a significant number of physician questions. In a meta-analysis o... more Few medical visits pass without a significant number of physician questions. In a meta-analysis of the distribution of activities in the medical visit, Roter and Hall (2006, 119) estimate that physician information gathering occupies a little more than 20 percent of the total visit, and studies by West (1984, 81) and by Stivers and Majid (2007) report mean numbers of historytaking questions ranging between 20 and 33, with maximum totals of some eighty questions per visit.
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
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This article uses conversation analysis to develop a typology of questions that physicians use to... more This article uses conversation analysis to develop a typology of questions that physicians use to solicit patients' problems and then tests question-format effects on patients' subsequent problem presentations. Data are videotapes of 302 primary-, acute-, and outpatient-care visits involving 77 physicians in 41 urban and rural clinics, as well as pre-and postvisit questionnaires. The most frequent question formats were general inquiries (62%; e.g., "What can I do for you today?") and requests for confirmation (27%; e.g., "I understand you're having some sinus problems today?"). Compared to confirmatory questions, general inquiries were associated with significantly longer problem presentations (p < .0001) that included more discrete symptoms (p < .0001). Physicians were more likely to use confirmatory questions in the urban setting (p = .003).
This article uses conversation analysis to investigate the problem-presentation phase of 302 visi... more This article uses conversation analysis to investigate the problem-presentation phase of 302 visits between primarycare physicians and patients with acute problems. It analyzes the social-interactional organization of problem presentation, focusing on how participants recognize and negotiate its completion. It argues that physicians and patients mutually orient to the presentation of current symptoms-that is, concrete symptoms presented as somehow being experienced in the here-and-now-as a locus of transition between the patient-controlled problem-presentation phase of the visit and the physician-controlled information-gathering phase. This is a resource for physicians to distinguish between complete and incomplete presentations, and for patients to manipulate this distinction. r
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.
CONTEXT: In primary, acute-care visits, patients frequently present with more than 1 concern. Var... more CONTEXT: In primary, acute-care visits, patients frequently present with more than 1 concern. Various visit factors prevent additional concerns from being articulated and addressed.
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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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.