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

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Abstract

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.

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.

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      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.

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