Closing the Deal: A Cross-Cultural Comparison of Treatment Resistance

2018 Health Communication, Volume 33, Issue 11

Clara Bergen, Tanya Stivers, Rebecca K. Barnes, John Heritage, Rose McCabe, Laura Thompson & Merran Toerien

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.

Children’s Responses to Questions in Peer Interaction: A Window into the Ontogenesis of Interactional Competence

2018 Journal of Pragmatics, Volume 124

Tanya Stivers, Jack Sidnell & Clara Bergen

What is it about children’s interactions that is distinctive from adults’ interactions? This article relies on a conversation analytically informed quantitative analysis of video recordings of child–child interaction to address this question. We examined 2000 questions and their responses in spontaneous conversation among three-party groups of same age children between 4–8 years of age to investigate the frequency and distributional patterns related to norms governing question–response sequences. We show that school-age children exhibit similar frequency distributions to adults but respond to questions less often and are slower than adults, with minimal age-related differences. Still more important, we argue, is that children’s responses show a lack of reflexive awareness of the underlying norms. We propose that it is children’s turn designs that lead child interaction to feel distinctive because children at these ages are not differentiating their norm-following from norm-departing responses.

Patient Disclosure of Medical Misdeeds

2013 Journal of Health and Social Behavior, Volume 54, Issue 2

Clara Bergen & Tanya Stivers

Modern patients walk a tightrope between respecting medical authority and acting as knowledgeable advocates regarding health issues, with the agency and responsibilities that come with this. This article uses conversation analysis to explore this balance in relation to patient disclosures of medical misdeeds in video-recorded primary care medical visits (e.g., taking another’s prescription medication or failing to adhere to a healthy lifestyle or prescription regimen). We focus on patient-initiated disclosures. We show that disclosures are used (1) where patients are seeking physician assessment of their behavior, (2) where patients are proposing the etiology of a health problem, and (3) where patients are lobbying for a particular treatment outcome. We argue that disclosures of medical misdeeds are an important but understudied domain of conduct in which patients show awareness of their own agency over, and responsibility for, their healthcare and respect for the physician’s medical authority.

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