'Breast cancer won't kill ya in the breast': Broaching a rationale for chemotherapy during the surgical consultation for early-stage breast cancer.

OBJECTIVE: To examine how, and for what interactional purpose, a surgeon raises the risk of death with an early-stage breast cancer patient. METHOD: Single-case analysis of a recorded surgical consultation, using conversation analysis. RESULTS: The surgeon not only negotiates the surgical treatment decision with the patient, she provides an overview of what her non-surgical treatment is likely to entail. Analysis reveals how the surgeon addresses interactional challenges when providing this overview, including how to broach the rationale for administering chemotherapy, the possibility that cancer could spread to vital organs and prove fatal. To do this, the surgeon orients to the possibility that the patient has misconceptions about her risk of dying from breast cancer. She uses negatively-formulated assertions to invoke these possible misconceptions, making correction relevant and providing a point of entry into delicate interactional territory. CONCLUSION: The surgeon draws upon possible patient misconceptions to broach the rationale for administering adjuvant chemotherapy. PRACTICE IMPLICATIONS: The surgical consultation is typically the first treatment-related consultation newly-diagnosed breast cancer patients have and represents an opportunity to educate patients and prepare them for future treatment decisions. The challenges of providing and receiving such overviews, and how they may influence future treatment decisions, merit consideration.

'I've heard wonderful things about you': how patients compliment surgeons.

This investigation was motivated by physician reports that patient compliments often raise 'red flags' for them, raising questions about whether compliments are being used in the service of achieving some kind of advantage. Our goal was to understand physician discomfort with patient compliments through analyses of audiotaped surgeon-patient encounters. Using conversation analysis, we demonstrate that both the placement and design of compliments are consequential for how surgeons hear and respond to them. The compliments offered after treatment recommendations are neither designed nor positioned to pursue institutional agendas and are responded to in ways that are largely consistent with compliment responses in everyday interaction, but include modifications that preserve surgeons' expertise. In contrast, some compliments offered before treatment recommendations pursue specific treatments and engender surgeons' resistance. Other compliments offered before treatment recommendations do not overtly pursue institutionally-relevant agendas-for example, compliments offered in the opening phase of the visit. We show how these compliments may but need not foreshadow a patient's upcoming agenda. This work extends our understanding of the interactional functions of compliments, and of the resources patients use to pursue desired outcomes in encounters with healthcare professionals.

Pre-emptive resistance: patients' participation in diagnostic sense-making activities.

In medical clinic visits, patients do more than convey information about their symptoms and problems so doctors can diagnose and treat them. Patients may also show how they have made sense of their health problems and may press doctors to interpret their problems in certain ways. Using conversation analysis, we analyse a practice patients use early in the medical visit to show that relatively benign or commonplace interpretations of their symptoms are implausible. In this practice, which we term pre-emptive resistance, patients raise candidate explanations for their symptoms and then report circumstances that undermine these explanations. By raising candidate explanations on their own and providing evidence against them, patients call for doctors to restrict the range of diagnostic hypotheses they might otherwise consider. However, the practice does not compel doctors to transparently indicate whether they will do so. Patients also display their ability to recognise and weigh the evidence for common, easily remedied causes of their symptoms. By presenting evidence against them, they show doctors the relevance of more serious diagnostic interpretations without pressing for them outright.

Beyond 'doctor and patient': developments in the study of healthcare interactions.

Three decades of conversation analytic investigations of medical interaction have produced a rich collection of findings of sociological interest, from a diverse array of encounters. This paper briefly outlines the development of this field to provide a context for the special issue. The paper discusses how studies of doctor-patient interaction have revealed the ways in which participants organise the medical visit to accomplish tasks such as diagnosing and recommending treatment for illness, and how doctors and patients address various interactional issues and dilemmas that arise as they undertake these tasks. It then highlights a growing number of CA studies that explore medical settings and activities beyond the doctor-patient encounter. In doing so, it charts the distinctive interactional practices that emerge, for example, where participants are engaging in hands-on treatment, medical practitioners are interacting with one another, or various technologies are employed during the encounter. Finally, papers in this special issue are introduced and shown to build upon this latter tradition. The papers address distinctive practical problems and institutional dilemmas that arise in healthcare encounters and medical settings beyond dyadic doctor-patient interaction, with a focus on the participants' orientations to policy, their distinctive modes of participation, and the use of technology.