Presenting the problem in pediatric encounters: "symptoms only" versus "candidate diagnosis" presentations.
This article examines 2 practices that are used to present children's problems to their pediatricians in acute care encounters. Using the methodology of conversation analysis, this article examines the alternative stances embodied by problem presentations, which offer "symptoms only" versus problem presentations, which also include a "candidate diagnosis." This article suggests that parents who offer only symptoms in their problem presentations are hearable as adopting a stance that they are primarily seeking medical evaluations of their children. By contrast, a parent who includes a candidate diagnosis of the problem is hearable as adopting a stance that he or she is seeking confirmation of the diagnosis and treatment for that illness condition. This communication practice may be treated by physicians as placing pressure on them to prescribe treatment-in particular antibiotic treatment. The implications of this are discussed.
Department of Pediatrics-General Pediatrics, University of California at Los Angeles, 90095-1752, USA. tstivers@ucla.edu
Tanya
T
Stivers
D000208:Acute Disease; D002648:Child; D003142:Communication; D003933:Diagnosis; D006801:Humans; D010290:Parents / Q000523:psychology*; D010372:Pediatrics; D010817:Physician-Patient Relations; D014481:United States