Conversation Analysis

7. Unmet Concerns

Take, for example, the observation made earlier that the word ‘any’ in a yes/no question means that the question is designed for a ‘no’ answer, as in "Do you have any other conditions that you know of?" The consequences of this are multiple.

  • Clinicians will be understood by patients to be conveying their expectations of a ‘yes’ or ’no’ response by their use, or lack of use, of ‘any.’
  • In taking a history for an acute condition, the shift to a ‘no’-inviting question format may be understood by the patient as indexing a question about a more serious or consequential symptom (e.g., "Any blood in the stool?").
  • In some contexts, patients may be induced to believe that the clinician would actually prefer the answer to be ‘no,’ as in "Anything else?" towards the end of a fifteen minute visit.

To test this latter hypothesis in relation to patients' unmet concerns, Heritage et al (2007) asked clinicians to vary a follow-up question inviting additional concerns at the end of the patient's presentation of the principal concern. The question was: "Is there something/anything else you would like to address in the visit today?" They found that, among those who had listed additional concerns in a pre-visit survey, patients were nearly twice as likely to respond affirmatively to the "something" version of the question than the "anything" version (90.3% vs 53.1%). Relative to non-intervention cases, the "something" version of the question reduced the likelihood of patients ending the visit with unmet concerns by 78%, while the outcomes from the "anything" version of the question could not be statistically distinguished from the control cases.

Consider this…

Consider how the significance of particular interactional practices is validated within the conversation analysis method. Illustrate your response by reference to the argument that the word 'any' in a question is tilted towards, and invites, a 'no' response.

The significance of interactional practices are investigated by (i) looking at how actions in which they occur are responded to; and (ii) at the contexts in which these questions are produced.

In the case of the claim that questions containing the word 'any' are tilted towards a 'no' response, the finding is that (i) persons are more likely to respond 'no' to questions containing the word 'any' than the same question with the alternative word 'some,' and (ii) that questions containing the word 'any' are more likely to occur when asked about symptoms that the physician has no a priori reason to suppose are present, for example in comprehensive history taking.