Non-antibiotic treatment recommendations: delivery formats and implications for parent resistance
Section snippets
Data and method
The data for this study are video-taped interactions of community practice pediatricians in encounters with parents and children seeking medical attention for upper respiratory illness symptoms (sore throats, fevers, ear pain, nasal congestion, and cough). None had been given antibiotics in the prior 2 weeks. A total of 38 pediatricians from 27 pediatric practices (64% participation rate) and 540 parents and children (83% participation rate) participated in the study which took place between
Background
Stivers (in press) showed that the normative structure of the treatment recommendation activity was such that parent acceptance was due upon completion of the physician's initial treatment recommendation. Moreover, if it was not forthcoming, physicians routinely pursued, or did interactional “work” to secure, this acceptance (see Fig. 1). Further, in the absence of any change in the physician's treatment proposal, parents displayed that a lack of response was indeed a form of passive resistance
Discussion
This paper examined alternative practices that physicians have for delivering their treatment recommendations. Two main practices were identified for recommending treatment: either recommending for or against a medication. Parent behavior in response to these alternative delivery formats suggests several important points: (1) parents display an orientation to the relevance of an affirmative and specific treatment recommendation whether or not a recommendation against a particular treatment has
Acknowledgements
A portion of this paper was presented at the International Communication Association Convention in San Diego, CA in May 2003 and at the National Communication Association Convention in Miami Beach, FL in November 2003. Data collection for this study was supported by Grant #039189 from the Robert Wood Johnson Foundation.
References (65)
Correlation between consumption of antimicrobials in humans and development of resistance in bacteria
International Journal of Antimicrobial Agents
(1999)- et al.
Online commentary in acute medical visitsA method of shaping patient expectations
Social Science & Medicine
(1999) - et al.
Effects of antibiotic treatment in the subset of common-cold patients who have bacteria in nasopharyngeal secretions
The Lancet
(1996) Participating in decisions about treatmentOvert parent pressure for antibiotic medication in pediatric encounters
Social Science & Medicine
(2002)Antimicrobials in children and the problem of drug resistance
American Family Physician
(1996)- et al.
Antibiotic consumption and resistance selection in Streptococcus pneumoniae
Journal of Antimicrobial Chemotherapy
(2002) - et al.
Current attitudes regarding use of antimicrobial agentsResults from physicians’ and parents’ focus group discussions
Clinical Pediatrics
(1998) Antibiotic resistanceThe Iowa experience
American Journal of Managed Care
(2002)- et al.
A community intervention trial to promote judicious antibiotic use and reduce penicillin-resistant Streptococcus pneumoniae carriage in children
Pediatrics
(2001) - et al.
Doctors talking to patientsA study of the verbal behaviours of doctors in the consultation
(1976)
Clinical significance of resistant organisms in otitis media
Pediatric Infectious Disease Journal
Risk factors and course of illness among children with invasive penicillin-resistant Streptococcus pneumoniae. The Streptococcus pneumoniae Working Group
Pediatrics
Talk at work
Analyzing talk at workAn introduction
Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995–1997
American Journal of Public Health
Antimicrobial use in defined populations of infants and young children
Archives of Pediatrics and Adolescent Medicine
Comparison of the response to antimicrobial therapy of penicillin-resistant and penicillin susceptible pneumococcal disease
Pediatric Infectious Diseases Journal
Clinical significance of pneumococcal bacteraemias in a general hospitalA prospective study 1989–1993
Journal of Antimicrobial Chemotherapy
Excessive antibiotic use for acute respiratory infections in the United States
Clinical Infectious Diseases
Antibiotic prescribing for adults with colds, upper respiratory tract infections and bronchitis by ambulatory care physicians
Journal of the American Medical Association
Assessing the impact of antimicrobial resistance
American Journal of Health System Pharmacy
Antibiotics and respiratory infectionsAre patients more satisfied when expectations are met?
The Journal of Family Practice
The delivery and reception of diagnosis and assessment in the general practice consultation
A change-of-state token and aspects of its sequential placement
Garfinkel and ethnomethodology
Dilemmas of adviceAspects of the delivery and reception of advice in interactions between health visitors and first time mothers
Constituting and maintaining activities across sequencesAnd-prefacing as a feature of question design
Language in Society
Health and economic impacts of antimicrobial resistance
Reviews of Infectious Diseases
Antibiotics and upper respiratory infectionDo some folks think there is a cure for the common cold?
The Journal of Family Practice
Racial/ethnic variation in parent expectations for antibioticsImplications for public health Campaigns
Pediatrics
Cited by (141)
Cultures of antibiotic prescribing in medical intensive care
2023, Social Science and MedicinePromoting new pro-environmental behaviors: The effect of combining encouraging and discouraging messages
2023, Journal of Environmental PsychologyFidelity evaluation of the dialogue around respiratory illness treatment (DART) program communication training
2022, Patient Education and Counseling"Do you want us to try to resuscitate?": Conversational practices generating patient decisions regarding cardiopulmonary resuscitation
2022, Patient Education and CounselingNegative stance towards treatment in psychosocial assessments: The role of personalised recommendations in promoting acceptance
2021, Social Science and MedicineCitation Excerpt :This can impact what recommendation practitioners ultimately make (Stivers & Timmermans this issue). Across medical settings, conversation analytic research on treatment negotiation has focused primarily on the treatment recommendation sequence (Stivers and Barnes, 2018; Stivers, 2005, 2005b; Toerien et al., 2013; Wang, 2020; Thompson and McCabe, 2018; Costello and Roberts, 2001), in which a practitioner recommends a course of action (e.g., taking medication), a patient responds to this recommendation, and any subsequent pursuit of a treatment acceptance. This paper takes a different and broader approach to study patient stance towards treatment (see Dalby Landmark, Svennevig & Gulbrandsen, 2016), focusing on all instances in which a patient took an explicitly negative stance cited a reason for that stance, at any stage of the visit.