Talk on Cough: Symptom, Sign and Significance in Acute Primary Care

  • Johanna LindellEmail author


This chapter is a conversation analytic study of patients’ complaints about cough during general practice consultations, which is among the most common reasons for prescribing antibiotics. Many of these infections tend to be viral, and so the antibiotic prescriptions may be completely ineffective for the individual patient, but pose a great risk for public health. This chapter looks into cases where patients reiterate the cough complaints following a non-severe diagnosis. This reiteration could be heard as pressure for antibiotics. However, the study concludes that patients do not necessarily intend this, and that doctors can assure them without the offering of a prescription.


  1. Beach, W. A., Easter, D. W., Good, J. S., & Pigeron, E. (2005). Disclosing and responding to cancer “fears” during oncology interviews. Social Science & Medicine, 60, 893–910. Scholar
  2. Cals, J. W., Hood, K., Aaftink, N., Hopstaken, R. M., Francis, N. A., Dinant, G. J., & Butler, C. C. (2009). Predictors of patient-initiated reconsultation for lower respiratory tract infections in general practice. British Journal of General Practice, 59, 761–764. Scholar
  3. Drew, P. (2006). Misalignments in“after-hours” calls to a British GP’s practice: A study in telephone medicine. Studies in Interactional Sociolinguistics, 20, 416.Google Scholar
  4. Frankel, R. M. (2001). Clinical care and conversational contingencies: The role of patients’ self-diagnosis in medical encounters. Text, 21, 83–11.CrossRefGoogle Scholar
  5. Heath, C. (1992). The delivery and reception of diagnosis in the general practice consultation. In P. Drew & J. Heritage (Eds.), Talk at work, interaction in institutional settings. Cambridge: Cambridge University Press.Google Scholar
  6. Heinemann, T., Lindström, A., & Steensig, J. (2011). Addressing epistemic incongruence in question–answer sequences through the use of epistemic adverbs. In T. Stivers, L. Mondada, & J. Steensig (Eds.), The morality of knowledge in conversation (pp. 107–130). Cambridge: Cambridge University Press. Scholar
  7. Heritage, J., & Maynard, D. W. (Eds.). (2006). Communication in medical care: Interaction between primary care physicians and patients. Cambridge: Cambridge University Press.Google Scholar
  8. Heritage, J., & Robinson, J. D. (2006). The structure of patients’ presenting concerns: Physicians’ opening questions. Health Communication, 19, 89–102. Scholar
  9. Heritage, J., Robinson, J. D., Elliott, M. N., Beckett, M., & Wilkes, M. (2007). Reducing patients’ unmet concerns in primary care: The difference one word can make. Journal of General Internal Medicine, 22(10), 1429–1433. Scholar
  10. Ijäs-Kallio, T., Ruusuvuori, J., & Peräkylä, A. (2011). Patient involvement in problem presentation and diagnosis delivery in primary care. Communication & Medicine, 7.
  11. Mangione-Smith, R., Elliott, M. N., Stivers, T., McDonald, L. L., & Heritage, J. (2006). Ruling out the need for antibiotics: Are we sending the right message? Archives of Pediatrics & Adolescent Medicine, 160, 945–952.CrossRefGoogle Scholar
  12. Maynard, D. W., & Frankel, R. M. (2006). On diagnostic rationality: Bad news, good news, and the symptom residue. In J. Heritage & D. W. Maynard (Eds.), Communication in medical care (pp. 248–278). Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  13. Mishler, E. G. (1984). The discourse of medicine: The dialectics of medical interviews. Norwood, NJ: Ablex. pp. Xii, n.d.Google Scholar
  14. Nevile, M. (2006). Making sequentiality salient: And-prefacing in the talk of airline pilots. Discourse Studies, 8(2), 279–302.CrossRefGoogle Scholar
  15. Nielsen, S. B. (2012). Patient initiated presentations of additional concerns. Discourse Studies, 14, 549–565.CrossRefGoogle Scholar
  16. Nielsen, S. B. (2015). “And how long have you been sick?”: The discursive construction of symptom duration during acute general practice visits and its implications for “doctorability.” Time & Society.
  17. Nielsen, S. B. (2018). Dealing with explicit patient demands for antibiotics in a clinical setting. In C. S. Jensen, S. B. Nielsen, & L. Fynbo (Eds.), Risking antimicrobial resistance (pp. 61–77). Cham, Switzerland: Palgrave Macmillan.Google Scholar
  18. Peräkylä, A. (1998). Authority and accountability: The delivery of diagnosis in primary health care. Social Psychology Quarterly, 61(4), 301–320.CrossRefGoogle Scholar
  19. Peräkylä, A. (2002). Agency and authority: Extended responses to diagnostic statements in primary care encounters. Research on Language & Social Interaction, 35, 219–247. Scholar
  20. Raymond, G. (2004). Prompting action: The stand-alone “So” in ordinary conversation. Research on Language & Social Interaction, 37, 185–218. Scholar
  21. Robinson, J. D. (2003). An interactional structure of medical activities during acute visits and its implications for patients’ participation. Health Communication, 15, 27–59. Scholar
  22. Schegloff, E. A., & Sacks, H. (1973). Opening up closings. Semiotica, 8(4), 289–327.CrossRefGoogle Scholar
  23. Stivers, T. (2007). Prescribing under pressure: Parent-physician conversations and antibiotics. Oxford: Oxford University Press.CrossRefGoogle Scholar
  24. Wigton, R. S., Darr, C. A., Corbett, K. K., Nickol, D. R., & Gonzales, R. (2008). How do community practitioners decide whether to prescribe antibiotics for acute respiratory tract infections? Journal of General Internal Medicine, 23, 1615–1620. Scholar

Copyright information

© The Author(s) 2019

Authors and Affiliations

  1. 1.Department of Nordic Studies and LinguisticsUniversity of CopenhagenCopenhagenDenmark

Personalised recommendations