"Are you otherwise fit and well?": Past medical history questions in UK paediatric consultations.

Accurate diagnosis and treatment depend upon detailed knowledge of both the child's presenting symptoms and their past medical history. However, the process of soliciting past medical history has never been subject to systematic scrutiny in actual clinical practice. OBJECTIVE: To examine the function of the question "are you otherwise fit and well?" to elicit a child's general medical history in UK paediatric allergy outpatient consultations. METHODS: Examination of 30 video-recorded UK paediatric outpatient consultations involving children (2-10 years), caregivers, and one doctor. We identified, transcribed, and interrogated 13 examples, deploying the systematic and rigorous method of conversation analysis to elucidate the question's micro-design elements and their consequences for the consultation's trajectory. RESULTS: Asking "Are you otherwise fit and well?" is built to efficiently solicit a problem-free report of good health. Nonetheless patients can and do raise other relevant matters. In practice, the question initiates several interactional matters simultaneously: establishing/resolving (mis)understandings of "fitness" and "wellness"; negotiating opportunities for children's participation; and importantly, a shift towards discussing more general wellbeing. CONCLUSION: Past medical history questions unavoidably generate broader interactional matters which are skilfully resolved in real-time between clinicians, caregivers, and children. PRACTICE IMPLICATIONS: Clinical training could be greatly enhanced by integrating insights into the interactional consequences of asking questions, particularly in the complex multiparty environment of paediatrics. While the question 'Are you otherwise fit and well' clearly serves an important function, clinicians should be alert to the possible problems it might raise, especially when directed towards younger children.

Understanding mixed emotions in organized helping through emotionography.

Introduction: Emotionography studies emotion: (a) as it occurs naturally in display, reception, attribution, and avowal; (b) within and across diverse stretches of interaction and varied institutional contexts; (c) grounded purposefully in the perspectives of the interactants as those perspectives are displayed in real-time through unfolding talk; (d) using materials that are recorded and transcribed in sufficient precision to capture the granularity consequential for the interactants. We overview contemporary research on "mixed emotion" highlighting theoretical and methodological issues and explore the potential of emotionography as a generative alternative. Methods: The analysis will use contemporary conversation analysis and discursive psychology to illuminate the workings of organized helping using a collection of recordings from a child protection helpline all of which include laughter alongside crying. Results: Analysis shows, on the one hand, how crying and upset display the caller's stance on the trouble being reported, and mark its action-relevant severity; on the other, how laughter manages ongoing parallel issues such as advice resistance. We show that the "mixture" is public and pragmatic, displaying different concerns and stances, and dealing with different issues; all is in the service of action. Discussion: When analyzing the specifics of interaction, the concept of "mixed emotion" loses clarity, and it is more accurate to observe competing pragmatic endeavors being pursued in an intricately coordinated fashion. These practices would not be captured by conventional emotion measurement tools such as scales, vignettes, or retrospective interviews. Broader implications for theories of emotion and methods of emotion research are discussed.

Authority in therapeutic interaction: A conversation analytic study.

A paradigmatic shift toward postmodern, collaborative practice in family therapy raises questions about how therapists can use professional authority to facilitate change and how clients can assert their knowledge and agency. We used conversation analysis to investigate how the authority to know and to determine here-and-now action (i.e., who does what, and how, in therapy) was negotiated and accomplished in 10 sessions of emotion-focused therapy involving chair work. Therapists were observed to rely on a particular interactional sequence structure: stepwise entry into a directive, in which directives were preceded by a question-answer sequence. We show how instances where clients' views were elicited prior to the delivery of a directive resulted in different interactional consequences from instances where therapists straightforwardly directed clients to perform some action. The study offers evidence concerning how therapists can facilitate chair work collaboratively and responsively.

How and why children instigate talk in pediatric allergy consultations: A conversation analytic account.

Involving children in their healthcare encounter is a national and international priority. While existing research has examined the ways in which children are recruited to participate in the consultation, no work has examined whether and how children instigate talk, and the extent to which their contributions are successful. This paper presents a conversation analysis of a selection of 10 out of 30 video recordings in which children aged 4-10 years instigate talk during consultations they attend with their parents/carers at a UK pediatric clinic. The analysis reveals for the first time that children do successfully instigate talk without being asked or selected in 22 episodes during their consultation with the doctor. Children most frequently address their parent/carer (16/22). They capitalize on specific contexts within the consultation to instigate talk, for example: history-taking questions about what they ate or how they reacted (10/22); or discussions surrounding the child's feelings or sensations following the skin-prick testing (7/22) - aspects of experience to which they have access. Children's non-solicited talk necessarily occurs when they are not currently active participators and children engage in extra interactional work including various verbal strategies (summons and prosodic variations) and non-verbal resources (tapping and gaze) to break into the interaction. The benefits of their contributions include the opportunity to affirm the child's role as a legitimate contributor, and the potential for additional medically-relevant information to arise which could enrich the clinical process. Our analysis shows that the previously overlooked phenomenon of children instigating talk, although not common, can play a crucial role in the consultation. We suggest that strategies to increase such involvement have the potential to augment the healthcare process. Our findings offer a critical baseline for the introduction of new consultations models, such as digital appointments, which may exclude some children completely.

Shaming interrogatives: Admonishments, the social psychology of emotion, and discursive practices of behaviour modification in family mealtimes.

This paper contributes to the study of admonishments, the operation of shaming in family interaction, and more broadly presses the virtue of a discursive psychological reconsideration of the social psychology of emotion. It examines the methodological basis of contemporary research on shame in experimental and qualitative social psychology, illustrated through the Test of Self-Conscious Affect (TOSCA) and qualitative work using shame narratives. Doubts are raised about how these methods can throw light on shaming practices in natural situations. The study uses a collection of video recordings of family mealtimes, focusing on admonishment sequences in which parents address the interrogatives 'what are you doing' or 'what did I say' to a 'misbehaving' child. Despite the interrogative syntax, rather than soliciting information we show that these interrogative forms pursue behaviour change by publicly highlighting both the problem behaviour and the child's active and intentional production of that behaviour. This is the sense in which the practice can be understood as shaming. Although this practice prosecutes shaming, ways in which the children can ignore, push back, or rework parents' actions are highlighted. This study contributes to a broader consideration of how enduring behavioural change can be approached as a parents' project.

How clients solicit medication changes in psychiatry.

In psychiatry, practitioners are encouraged to adopt a patient-centred approach that emphasises shared decision-making. In this article, we investigate how clients with severe mental illnesses (e.g. schizophrenia) advocate for their treatment preferences in psychiatric consultations. The study uses Conversation Analysis to examine audio-recorded medication check appointments in a comprehensive treatment programme known as assertive community treatment (ACT). The analysis shows that clients solicit medication changes at activity boundaries and design them in one of the following ways: reporting a physical problem; reporting a medication problem; explicitly requesting a medication change; and demanding a change. These formats put pressure on the psychiatrist to respond by either offering a solution to the client's problem or by accepting or rejecting the client's request. Through a detailed analysis of clients' communicative behaviours, we show that, in soliciting a medication change, clients ordinarily respect boundaries of medical authority and present themselves as 'good' patients who are reliable witnesses of their own experiences. Overall, the paper advances our understanding of patient advocacy in psychiatry and mental health interactions more generally.

Beware the 'Loughborough School' of Social Psychology? Interaction and the politics of intervention.

The authors explain the attractions of applying discursive psychology (DP) and conversation analysis (CA) by reporting three different examples of their engagement with practitioners and clients. Along the way, a case is made for separating DP/CA from other kinds of qualitative analysis in social psychology, and for deconstructing some commonly held misunderstandings and caricatures of DP/CA.

Threats: power, family mealtimes, and social influence.

One of the most basic topics in social psychology is the way one agent influences the behaviour of another. This paper will focus on threats, which are an intensified form of attempted behavioural influence. Despite the centrality to the project of social psychology, little attention has been paid to threats. This paper will start to rectify this oversight. It reviews early examples of the way social psychology handles threats and highlights key limitations and presuppositions about the nature and role of threats. By contrast, we subject them to a programme of empirical research. Data comprise video records of a collection of family mealtimes that include preschool children. Threats are recurrent in this material. A preliminary conceptualization of features of candidate threats from this corpus will be used as an analytic start point. A series of examples are used to explicate basic features and dimensions that build the action of threatening. The basic structure of the threats uses a conditional logic: if the recipient continues problem action/does not initiate required action then negative consequences will be produced by the speaker. Further analysis clarifies how threats differ from warnings and admonishments. Sequential analysis suggests threats set up basic response options of compliance or defiance. However, recipients of threats can evade these options by, for example, reworking the unpleasant upshot specified in the threat, or producing barely minimal compliance. The implications for broader social psychological concerns are explored in a discussion of power, resistance, and asymmetry; the paper ends by reconsidering the way social influence can be studied in social psychology.

Discursive psychology as a qualitative approach for analysing interaction in medical settings.

PURPOSE: To introduce some features of the perspective of discursive psychology that may be useful for studying interaction in a range of medical settings. OVERVIEW: Discursive psychology considers the way psychological words and displays play a practical part in the activities that are performed in particular settings. It offers a way of understanding the role of psychological issues that is distinct from, and is sometimes obscured by, traditional social cognitive approaches. The approach is illustrated by the example of crying on a child protection helpline. The way crying is built from different elements, the way these elements are organised, and the way they are receipted are all highlighted. Crying is both performing and potentially disrupting actions. The virtues of high quality transcription, and of understanding the way crying is situated in the turn organisations of conversation, are demonstrated. EVALUATION: Discursive psychology involves particular ways of considering reliability and validity. The broader potential for such an approach in medical settings is discussed.