Online commentary in acute medical visits: a method of shaping patient expectations.

This paper conceptualizes a type of physician communication, termed 'online commentary'. Online commentary is talk that describes what the physician is seeing, feeling or hearing during physical examination of the patient. Some dimensions of online commentary are described, and its functions in routine and acute medical consultations are distinguished. Using a case study method, the paper focuses on the role of online commentary in pre-empting patient resistance to upcoming 'no problem' diagnostic evaluations which could delegitimize patients' decisions to seek medical assistance, or deprive them of anticipated medical benefits. It is hypothesized that this role for online commentary may be associated with successful physician resistance to implicit or explicit patient demands for inappropriate antibiotic medication.

[1]  Paul Drew,et al.  Figures of speech: Figurative expressions and the management of topic transition in conversation , 1998, Language in Society.

[2]  S. Sefi.  Dilemmas of advice: Aspects of the delivery and reception of advice in interactions between Health Visitors and firsttime mothers , 1992 .

[3]  C. K. Lynn,et al.  The Physical Examination , 1990 .

[4]  Anssi Peräkylä,et al.  Authority and Accountability: The Delivery of Diagnosis in Primary Health Care , 1998 .

[5]  M Lloyd,et al.  Prescribing and referral in general practice: a study of patients' expectations and doctors' actions. , 1994, The British journal of general practice : the journal of the Royal College of General Practitioners.

[6]  G. Jefferson.  Error correction as an interactional resource , 1974, Language in Society.

[7]  L. Henderson.  On the Social System , 1993 .

[8]  N. Britten,et al.  A study of the relationship between patients' attitudes and doctors' prescribing. , 1991, Family practice.

[9]  J. M. Atkinson.  Structures of Social Action: Contents , 1985 .

[10]  J P Mullooly,et al.  Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. , 1997, JAMA.

[11]  J. Hughes,et al.  Trends in antimicrobial drug prescribing among office-based physicians in the United States. , 1995, JAMA.

[12]  C. Heath,et al.  Body movement and speech in medical interaction: Postscript: the use of medical records and computers during the consultation , 1986 .

[13]  Daniel Wikler,et al.  The Sick Role and the Role of the Physician Reconsidered , 1975 .

[14]  T. Stivers,et al.  Prediagnostic Commentary in Veterinarian-Client Interaction , 1998 .

[15]  D. Maynard,et al.  On realization in everyday life : the forecasting of bad news as a social relation , 1996 .

[16]  E. Freidson.  Claims Examined. (Book Reviews: Profession of Medicine. A Study of the Sociology of Applied Knowledge) , 1970 .

[17]  Isaac Kleinman.  Introduction to Clinical Skills: A Patient-Centered Textbook , 1997, Annals of Internal Medicine.

[18]  R H Brook,et al.  The Relationship Between Perceived Parental Expectations and Pediatrician Antimicrobial Prescribing Behavior , 1999, Pediatrics.

[19]  Interaction and grammar: Introduction , 1996 .

[20]  A. Kendon.  Some functions of gaze-direction in two-person conversation , 1977 .

[21]  John P. Mullooly,et al.  Physician-Patient Communication: The Relationship With Malpractice Claims Among Primary Care Physicians and Surgeons , 1997 .

[22]  Johanna Nichols,et al.  Evidentiality: The Linguistic Coding of Epistemology , 1986 .

[23]  Anita M. Pomerantz.  Agreeing and disagreeing with assessments: some features of preferred/dispreferred turn shapes , 1984 .

[24]  J. Kett,et al.  The Social Transformation of American Medicine , 1983 .

[25]  C P Bradley,et al.  Uncomfortable prescribing decisions: a critical incident study. , 1992, BMJ.

[26]  C. Goodwin.  Conversational Organization: Interaction Between Speakers and Hearers , 1981 .

[27]  A. Kendon.  Some functions of gaze-direction in social interaction. , 1967, Acta psychologica.

[28]  P. Byrne,et al.  Doctors talking to patients: A study of the verbal behaviour of general practitioners consulting in their surgeries , 1976 .

[29]  K. Zoppi.  Interviewing as Clinical Conversation , 1997 .

[30]  J. Avorn,et al.  Physician motivations for nonscientific drug prescribing. , 1989, Social science & medicine.