Polar answers

Peer reviewe

No no no and other types of multiple sayings in social interaction

Relying on the methodology of conversation analysis, this article examines a practice in ordinary conversation characterized by the resaying of a word, phrase, or sentence. The article shows that multiple sayings such as "No no no" or "Alright alright alright" are systematic in both their positioning relative to the interlocutor's talk and in their function. Specifically, the findings are that multiple sayings are a resource speakers have to display that their turn is addressing an in progress course of action rather than only the just prior utterance. Speakers of multiple sayings communicate their stance that the prior speaker has persisted unnecessarily in the prior course of action and should properly halt course of action

Managing Patient Pressure to Prescribe Antibiotics in the Clinic.

Acute respiratory tract infections (ARTIs) are typically viral; however, in the USA, approximately one-third of adults and 52% of children with ARTIs receive an antibiotic, making antibiotic prescribing for ARTIs a major contributor to the problem of inappropriate prescribing. Relying on a synthesis of work across pediatric and adult primary care, this article shows some of the main ways that patients and parents pressure physicians for antibiotics, whether intentionally or unintentionally, and how physicians combat that pressure. All data are from video recordings of community-based clinical encounters allowing us to see what is happening "on the ground." Strategies that physicians actually use are documented; however, untutored physicians do not rely on these reliably or strategically, leaving substantial room for the deployment of a three-pronged communication strategy that can reduce patient pressure and inappropriate antibiotic prescribing

Non-antibiotic treatment recommendations: delivery formats and implications for parent resistance

This study draws on a database of 570 community-based acute pediatric encounters in the USA and uses conversation analysis as a methodology to identify two formats physicians use to recommend non-antibiotic treatment in acute pediatric care (using a subset of 309 cases): recommendations for particular treatment (e.g., "I'm gonna give her some cough medicine.") and recommendations against particular treatment (e.g., "She doesn't need any antibiotics."). The findings are that the presentation of a specific affirmative recommendation for treatment is less likely to engender parent resistance to a non-antibiotic treatment recommendation than a recommendation against particular treatment even if the physician later offers a recommendation for particular treatment. It is suggested that physicians who provide a specific positive treatment recommendation followed by a negative recommendation are most likely to attain parent alignment and acceptance when recommending a non-antibiotic treatment for a viral upper respiratory illness.Conversation analysis Doctor-patient communication Antibiotic prescribing Pediatric care, USA

Participating in decisions about treatment: overt parent pressure for antibiotic medication in pediatric encounters

This article examines how parents and pediatricians negotiate antibiotic prescribing decisions in cases where parents overtly advocate this medication. Using the methodology of conversation analysis, this paper examines audio and videotaped acute care pediatric encounters and discusses four primary ways in which parents raise antibiotics in pediatric encounters. These formulations vary in their directness with indirect formulations being more common. The article argues that both parents and physicians are oriented to antibiotics as negotiable in and through their interaction. Finally, in contrast with existing research, this study suggests that overtly advocating for antibiotic treatment is relatively unusual; future research will need to incorporate an understanding of the effect of both explicit and implicit ways parents communicate pressure for prescription treatment.Antibiotic prescribing Doctor-parent communication Pediatric consultation United States