Søren Beck Nielsen

Stepping into the same river twice: on the discourse context analysis in the LANCHART project

The question of comparability in sociolinguistic studies is both obviously methodologically crucial and rarely addressed. If not addressed at all in sociolinguistic investigations of language change in real time, the analyst will invariably run the risk of comparing inherently different pieces of data material. But the question is, whether it is at all possible to achieve comparability? In this paper we argue that methodological considerations of comparability are necessary ingredients in any study of change in real time, and we present the apparatus used to achieve comparability in the LANCHART study, viz. the so-called Discourse Context Analysis (DCA). The DCA is the basis for the phonetic analysis in the LANCHART study since it selects maximally comparable sections of passages for analysis. However, in this paper it is also shown to function as a fruitful analytic tool in its own right, illuminating changing interactional patterns in sociolinguistic interviews which are likely to reflect changes in how people interact with one another in society at large.

From community to conversation – and back. Exploring the interpersonal potentials of two generic pronouns in Danish

This paper combines a quantitative study of the two most important Danish pronouns used for generic reference, du and man, with interaction analyses. The quantitative study shows an overall increase in the use of generic du at the expense of man. However, a large scale quantitative study alone cannot tell us much about the finer differences between the two variants, let alone come up with explanations for the change in their use. In this paper, we demonstrate a way to supplement a quantitative study with detailed interaction analyses with the aim of interpreting the tendencies demonstrated in the quantitative study. Whereas there is no difference between generic du and man with respect to propositional meaning, our interactional analyses reveal important differences in their interpersonal potentials: Generic du is to a larger degree than man used as a resource for enactment and involvement. This difference between du and man is due to du retaining some of its second person meaning also when used generically, and the rise in the use of generic du is likely to reflect an ongoing process of intimization in the society at large.

Patient initiated presentations of additional concerns

Patients sometimes visit their general practitioners with more than one concern. This article investigates when and how patients initiate presentations of such additional concerns. The study is conversation analytic in its approach and scope. It is based upon video-recordings of naturally occurring general practice consultations in Denmark. Data suggest that Danish patients relatively frequently initiate presentations of additional concerns and defer such initiations until moments when the parties would otherwise engage in closing down the consultations. Additional concerns are introduced in response to the doctor’s possible pre-closing remarks. The parties, thereafter, employ a set of transitional elements: confirmation, preliminary announcement and ratification. This transition enables the parties to recycle the activities of the visit, to discuss and examine yet another concern. Thus, additional concerns are not presented completely unexpectedly or randomly as commonsense understanding sometimes has it; they are introduced at orderly moments and by means of recognizable methods.

Deciding if lifestyle is a problem: GP risk assessments or patient evaluations? A conversation analytic study of preventive consultations in general practice

Objective. The aim of this study is to analyse the interaction between patients and GPs in preventive consultations with an emphasis on how patients answer GPs’ questions about lifestyle, and the conditions these answers impose on the process of establishing agreement about lifestyle as a problem or not. Design. Six general practitioners (GPs) video-recorded 15 annual preventive consultations. From these, 32 excerpts of discussions about lifestyle were analysed using conversation analysis (CA). Results. GPs used an interview format to assess risk in patients’ lifestyles. In some cases patients adhered to this format and answered the GPs’ questions, but in many cases patients gave what we have termed “anticipatory answers”. These answers indicate that the patients anticipate a response from their GPs that would highlight problems with their lifestyle. Typically, in an anticipatory answer, patients bypass the interview format to give their own evaluation of their lifestyle and GPs accept this evaluation. In cases of “no-problem” answers from patients, GPs usually encouraged patients by adding support for current habits. Conclusion. Patients anticipated that GPs might assess their lifestyles as problematic and they incorporated this possibility into their responses. They thereby controlled the definition of their lifestyle as a problem or not. GPs generally did not use the information provided in these answers as a resource for further discussion, but rather relied on standard interview procedures. Staying within the patients’ frame of reference and using the patients’ anticipatory answers might provide GPs with a better point of departure for discussion regarding lifestyle.

How Doctors Manage Consulting Computer Records While Interacting With Patients

ABSTRACT How do general practitioners manage looking up information on patients’ computer records while also interacting with them? Recordings of 52 naturally occurring general practice consultations in Denmark show doctors turning toward their computers (a) without any kind of explanation, (b) accompanied with an explicit explanation of the upcoming reading, or (c) accompanied by a question to the patient that simultaneously serves as an allusion to what kind of information they are looking for. Doctors’ explicit explanations may be used to suspend the verbal interaction with the patient, whereas alluding questions may be used to manage the computer consultation while continuing the verbal interaction. Data are in Danish with English translation.

Dealing with Explicit Patient Demands for Antibiotics in a Clinical Setting

This chapter is a conversation analytic single-case study of a video-recorded general practice consultation. This consultation represents a case where a patient, uninformed about appropriate use of antibiotics, puts a doctor under substantial pressure to prescribe penicillin by requesting it explicitly as the reason for his visit. Yet, the doctor exploits conversational structures in ways that enable her to turn the situation into one where the patient is properly diagnosed and explained the difference between viral and bacterial infections and the risks of unnecessary use of antibiotics. Thus, the study informs of how doctors can deal with demanding patients.

‘And how long have you been sick?’: The discursive construction of symptom duration during acute general practice visits and its implications for ‘doctorability’:

This study uses Conversation Analysis to investigate how doctors and patients talk about the duration of patients’ symptoms during acute general practice consultations in Denmark. Both parties treat it important to address and reach shared understanding about this issue, and it is the subject of much clarification and negotiation. Mentioning the duration of symptoms may be patient-initiated from the very outset of the consultation, as part of the problem presentation, or doctor-solicited in the subsequent interaction. Analysis reveals that in both cases, patients use concepts that stress relative duration as part of efforts to legitimise their visits. Legitimisation by such means is most evident in connection with doctor-solicited mention of duration of symptoms. Patients treat doctors’ questions as preferring an answer, which confirms that they have been sick for a long time. Overall, the study provides insight about the huge impact that discussions about time have for conversational organisation during consultations. It also shows how a shared understanding of the duration of symptoms is treated as a precondition for medical decisions and entitlements.

Risking Antimicrobial Resistance: A One Health Study of Antibiotic Use and Its Societal Aspects

This chapter introduces readers to the content, aim, and organization of this edited volume. The anthology addresses a significant threat to public health: the potentially fatal risk of antimicrobial resistance as caused by excessive use of antibiotics in health care and the veterinary sector. In this chapter, we outline its three main, recurring perspectives: ‘One Health’, the Danish context, and the social and human factors. The One Health perspective refers to a shared paradigm, which acknowledges the mutual impact of human and animal antibiotic consumption. Human and veterinary biological processes resemble and interact with each other, and so excessive use in either sector needs to be restrained. The Danish context, we argue, is particularly suited for ‘text book’ scrutiny as it exhibits a lower general level of antibiotic resistance than many other countries in spite of being, for instance, a country with significant veterinary production. We similarly argue that social science and humanities offer valuable, if not essential, perspectives to the issue of antimicrobial resistance. One of these perspectives is unfolded in details in the chapter, namely the concept of risk which informs all of the volume’s subsequent empirical studies.

Concluding Remarks on ‘Risking Antimicrobial Resistance’

This chapter concludes this edited volume. Altogether, the volume has elucidated a series of factors that might contribute to the relative low consumption of antibiotics in Denmark. Some of these factors concern how general practitioners restrain antibiotic prescriptions even when under pressure from patients. Other factors concern the regulatory system that limits the amount of antimicrobials that the individual pig producer must use in production, and the biosecurity concern among Danish pig producers that help in protecting pigs against infections. However, the studies in this volume have also pointed to room for improvement in the respective spheres. For example, official guidelines are difficult to translate into clinical practice for doctors in the primary sector, and pig farmers feel stigmatized as a result of the public debate about their use of antibiotics. Finally, this chapter concludes that a broad palette of social scientific methods, such as the one which has been invoked in this book, is necessary in order to accomplish a satisfactory understanding of all the social factors that impact excessive use of antibiotics, lead to resistance, and endanger public health.

‘If you don’t get better, you may come back here’: Proposing conditioned follow-ups to the doctor’s office

Previous research has established that conversationalists treat “arrangement making” as closure implicative contributions. This study adds “conditioned arrangement making” to the list with an examination of how general practitioners propose conditioned follow-ups to patients, that is, the opportunity to return to the clinic if their condition does not improve or if it should worsen. The data consists of 52 audio-/video-recorded naturally occurring general practice consultations in Denmark. Using the conversation analytic method, the paper examines why the hypotheticality of this particular kind of proposition making is a resource for practitioners in terms of accomplishing progression towards termination of the consultation, and also in terms of accomplishing agreement upon appropriate, responsible and reassuring treatment plans. Among other things, conditioned follow-up propositions enable doctors to communicate “no problem” diagnoses while preserving care continuity. The study, therefore, contributes to the understanding of how use of grammatical formats such as conditional clauses influences institutional interaction.