The current issue of Register and Context was published on the 14th of July 2009. For submission of papers to our next issue, please consult our Call for papers.
Co-constructing the case: Physicians’ responses to parents’ "candidate diagnoses" in pediatric acute-care office visits
by Pamela Hobbs
Research demonstrates an association between perceived parent pressure to prescribe antibiotics and inappropriate antibiotic prescription by physicians; accordingly, Stivers (2007) sought to determine the sources of these physician perceptions in parents’ communicative behavior. Using the methodology of conversation analysis, Stivers examined data drawn from pediatric office visits. She identified two practices, which she labeled ‘symptoms only’ and ‘candidate diagnosis’; in the first, the parent merely described the child’s symptoms, while in the second the parent added a possible explanation in the form of a diagnosis. She found that where a parent’s ‘candidate diagnosis’ identifies a condition treatable with antibiotics, pediatricians interpret it as displaying the parent’s expectation that antibiotics will be prescribed, even where parents do not intend to convey this expectation. This paper builds on Stivers’ research. While Stivers focuses on the source of physicians’ perceptions in parents’ communicative behavior, I focus on physicians’ displayed understandings. I argue that patient or parent pressure, while interactionally triggered, is actually self imposed, and inheres in the responsibilities of the physician role. Through an analysis of physicians’ displayed understandings, I show how physicians’ orientation to the activity of diagnosing itself exerts pressure that shapes their interpretations of parents’ contributions.
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