Introduction : Analyzing turn-initial particles

Peer reviewe

Problems and prospects in the study of physician-patient interaction: 30 years of research

■ 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

The impact of using computer decision-support software in primary care nurse-led telephone triage:Interactional dilemmas and conversational consequences

Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. Although computer decision-support software (CDSS) is increasingly used by nurses to triage patients, little is understood about how interaction is organized in this setting. Specifically any interactional dilemmas this computer-mediated setting invokes; and how these may be consequential for communication with patients. Using conversation analytic methods we undertook a multi-modal analysis of 22 audio-recorded telephone triage nurse-caller interactions from one GP practice in England, including 10 video-recordings of nurses' use of CDSS during triage. We draw on Goffman's theoretical notion of participation frameworks to make sense of these interactions, presenting 'telling cases' of interactional dilemmas nurses faced in meeting patient's needs and accurately documenting the patient's condition within the CDSS. Our findings highlight troubles in the 'interactional workability' of telephone triage exposing difficulties faced in aligning the proximal and wider distal context that structures CDSS-mediated interactions. Patients present with diverse symptoms, understanding of triage consultations, and communication skills which nurses need to negotiate turn-by-turn with CDSS requirements. Nurses therefore need to have sophisticated communication, technological and clinical skills to ensure patients' presenting problems are accurately captured within the CDSS to determine safe triage outcomes. Dilemmas around how nurses manage and record information, and the issues of professional accountability that may ensue, raise questions about the impact of CDSS and its use in supporting nurses to deliver safe and effective patient care

Seeing the way: visual sociology and the distance runner's perspective

Employing visual and autoethnographic data from a two‐year research project on distance runners, this article seeks to examine the activity of seeing in relation to the activity of distance running. One of its methodological aims is to develop the linkage between visual and autoethnographic data in combining an observation‐based narrative and sociological analysis with photographs. This combination aims to convey to the reader not only some of the specific subcultural knowledge and particular ways of seeing, but also something of the runner's embodied feelings and experience of momentum en route. Via the combination of narrative and photographs we seek a more effective way of communicating just how distance runners see and experience their training terrain. The importance of subjecting mundane everyday practices to detailed sociological analysis has been highlighted by many sociologists, including those of an ethnomethodological perspective. Indeed, without the competence of social actors in accomplishing these mundane, routine understandings and practices, it is argued, there would in fact be no social order

Repetition and the prosody-pragmatics interface

Repetition poses certain problems for pragmatics, as evidenced by Sperber and Wilson’s claim that ‘‘the effects of repetition on utterance interpretation are by no means constant’’. This is particularly apposite when we examine repetitions produced in naturally occurring talk. As part of an ongoing study of how phonetics relates to the dynamic evolution of meaning within the sequential organisation of talk-in-interaction, we present a detailed phonetic and pragmatic analysis of a particular kind of self- repetition. The practice of repetition we are concerned with exhibits a range of forms: ‘‘have another go tomorrow . . . have another go tomorrow’’, ‘‘it might do . . . it might do’’, ‘‘it’s a shame . . . it’s a shame’’. The approach we adopt emphasises the necessity of exploring participants’ displayed understandings of pragmatic inferences and attempts not to prejudge the relevance of phonetic (prosodic) parameters. The analysis reveals that speakers draw on a range of phonetic features, including tempo and loudness as well as pitch, in designing these repetitions. The pragmatic function of repetitions designed in this way is to close sequences of talk. Our findings raise a number of theoretical and methodological issues surrounding the prosody– pragmatics interface and participants’ understanding of naturally occurring discourse

Rare, Threatened and Endangered Plants and Animals of Oregon

Extinction is a natural process. Today, however, plant and animal species are disappearing world-wide at an accelerated pace. Based on current trends, half of the species on earth will be extinct within the next 100 years. The major cause of this phenomenon is large-scale destruction of native habitats, which has increased since European settlement began in the mid 1800\u27s - in Oregon and throughout the New World. Once lost, a species can never be recovered, and there is no way of knowing how useful it may have been. We do know that human beings and many of their industries depend on plant and animal products. About 50% of all pharmaceuticals have a natural component as an active ingredient, yet less than one percent of the world\u27s species have been chemically analyzed and tested. Many invertebrates and plants contain undescribed and highly functional compounds. Limnanthes floccosa subsp. grandiflora, or wooly meadow-foam, a rare plant that grows in southwest Oregon, has been recently found to produce a hybrid with the more common member of the genus, Limnanthes alba. This hybrid grows well in the poorly drained soils of the Willamette Valley and produces a valuable oil used for soaps, plastic and rubber production. In addition, the new hybrid meadow-foam does not require the field burning necessary for other crops. This species, and many other Oregon natives, will be lost without intervention. The purpose of this book is to provide land managers, owners and interested parties with a list of those species in Oregon which are in greatest jeopardy

The Trail, 1964-11-05

https://soundideas.pugetsound.edu/thetrail_all/1896/thumbnail.jp

Agenda-setting revisited: When and how do primary-care physicians solicit patients’ additional concerns?

Objective: 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. Methods: 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. Results: Physicians’ questions designed to solicit concerns additional to chief concerns occurred in only 32% of visits (p \u3c .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 ‘concerns’ (e.g., “Any other concerns?”) were significantly more likely to generate some type of agenda item (Chi2 (1, N = 131) = 11.96, p = .001), and to do so more frequently when positioned ‘early’ vs. ‘late’ during visits (Chi2 (1, N = 73) = 4.99, p = .025). Conclusions: Agenda setting is comparatively infrequent. The communication format and position of physicians’ questions affects patients’ provision of additional concerns/questions. Practice implications: Physicians should increase use of optimized forms of agenda setting