Conversation Analysis

8. Prescribing Decisions

CA techniques have been extensively employed in studies of antibiotic prescribing decisions by Stivers, Mangione-Smith and colleagues. The background of these studies is that physicians' perceptions of patient pressure for antibiotics are associated with inappropriate prescribing (Mangione-Smith et al., 1999). Interactional conduct was found to influence these perceptions strongly. Two studies found that patients (or in pediatric contexts, parents) who present their concern with a 'candidate diagnosis' are frequently perceived to want antibiotic treatment for the condition, and that this is associated with increased rates of inappropriate prescribing (Stivers et al., 2003; Mangione-Smith et al., 2006). Parents' resistance to a non-antibiotic treatment plan was also found to have the same effect (Mangione-Smith et al., 2006).

Physician behaviors were also found to be influential in this process. When physicians explicitly ruled out antibiotic treatment (e.g., "This is something that antibiotics won't fix"), patients' resistance to the treatment plan was enhanced (Mangione-Smith et al., 2006). On the other hand, 'online commentary' about physical exam findings that was reassuring about what the physician was encountering reduced patient resistance to the treatment plan, leading to less inappropriate antibiotic prescriptions (Heritage and Stivers,1999; Mangione-Smith et al., 2003).

Siimilar results showing the relevance of interaction in decisions to go ahead with tympanstomy surgery have also been reported (Kleinman et al., 1997; Boyd, 1998; Heritage et al., 2001).

Boyd E. A. (1998). Bureaucratic authority in the 'company of equals:' The interactional management of medical peer review. American Sociological Review 63(2): 200-224.
Heritage J., Boyd E.A., Kleinman L. (2001). Subverting criteria: The role of precedent in decisions to finance surgery. Sociology of Health and Illness 23(5): 701-728.