Dealing with Explicit Patient Demands for Antibiotics in a Clinical Setting

  • Søren Beck NielsenEmail author


This chapter is a conversation analytic single-case study of a video-recorded general practice consultation. This consultation represents a case where a patient, uninformed about appropriate use of antibiotics, puts a doctor under substantial pressure to prescribe penicillin by requesting it explicitly as the reason for his visit. Yet, the doctor exploits conversational structures in ways that enable her to turn the situation into one where the patient is properly diagnosed and explained the difference between viral and bacterial infections and the risks of unnecessary use of antibiotics. Thus, the study informs of how doctors can deal with demanding patients.


  1. Ashworth, M., White, P., Jongsma, H., Schofield, P., & Armstrong, D. (2016). Antibiotic prescribing and patient satisfaction in primary care in England: Cross-sectional analysis of national patient survey data and prescribing data. British Journal of General Practice, 66(642), e40–e46.CrossRefGoogle Scholar
  2. Bakhtin, M. M. (1986). Speech genres and other late essays. Austin: University of Texas Press.Google Scholar
  3. Beck Nielsen, S. (2011). Keeping the gate ajar during openings of general practice consultations. Communication & Medicine, 8(3), 235–245.Google Scholar
  4. Beck Nielsen, S. (2016). How doctors manage consulting computer records while interacting with patients. Research on Language and Social Interaction, 41(1), 58–74.CrossRefGoogle Scholar
  5. Britten, N., & Ukoumunne, O. (1997). The influence of patients’ hopes of receiving a prescription on doctors’ perceptions and the decision to prescribe: A questionnaire survey. BMJ, 6; 315(7121), 1506–1510.CrossRefGoogle Scholar
  6. Caiata-Zufferey, M., & Schulz, P. J. (2012). Physicians’ communicative strategies in interacting with internet-informed patients: Results from a qualitative study. Health Communication, 27(8), 738–749.CrossRefGoogle Scholar
  7. Costelloe, C., Martin Williams, O., Montgomery, A. A., Dayan, C., & Alastair, H. D. (2014). Antibiotic prescribing in primary care and antimicrobial resistance in patients admitted to hospital with urinary tract infection: A controlled observational pilot study. Antibiotics, 3(1), 29–38.CrossRefGoogle Scholar
  8. Danmap. (2014). Use of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from food animals, food and humans in Denmark. Available from:
  9. Danmap. (2015). Use of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from food animals, food and humans in Denmark. Available from:
  10. Fox, B., & Heinemann, T. (2016). Rethinking format: An examination of requests. Language in Society, 45(4), 499–531.CrossRefGoogle Scholar
  11. Gill, V. T. (2005). Patient ‘demand’ for medical interventions: Exerting pressure for an offer in a primary care clinic visit. Research on Language and Social Interaction, 38(4), 451–479.CrossRefGoogle Scholar
  12. Glenn, P. (2003). Laughter in interaction. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  13. Hansen, E., & Heltoft, L. (2011). Grammatik over det danske sprog: Syntaktiske og semantiske enheder. København: Det Danske Sprog- og litteraturselskab.Google Scholar
  14. Heritage, J., Elliott, M., Stivers, T., Richardson, A., & Mangione-Smith, R. (2010). Reducing inappropriate antibiotics prescribing: The role of online commentary on physical examination findings. Patient Education and Counseling, 81, 119–125.CrossRefGoogle Scholar
  15. Jefferson, G. (1984). On stepwise transition from talk about trouble to inappropriately next-positioned matters. In J. Maxwell & J. Heritage (Eds.), Structures of social action. Studies in conversation analysis (pp. 191–222). Cambridge: Cambridge University Press.Google Scholar
  16. Mangione-Smith, R., Elliott, M., Stivers, T., McDonald, L., Heritage, J., & McGlynn, E. A. (2004). Racial/ethnic variation in parent expectations for antibiotics: Implications for public health campaigns. Pediatrics, 113(5), e385–e394.CrossRefGoogle Scholar
  17. Mangione Smith, R., Zhou, C., Robinson, J. D., Taylor, J. A., Elliott, M. N., & Heritage, J. (2015). Communication practices and antibiotic use for acute respiratory tract infections in children. Annals of Family Medicine, 13, 221–227.CrossRefGoogle Scholar
  18. Mustafa, M., Wood, F., Butler, C. C., & Elwyn, G. (2014). Managing expectations of antibiotics for upper respiratory tract infections: A qualitative study. Annals of Family Medicine, 12(1), 29–36.CrossRefGoogle Scholar
  19. Pedersen, K. M., Andersen, J. S., & Søndergaard, J. (2012). General practice and primary health care in Denmark. Journal of the American Board of Family Medicine, 25, 34–38.CrossRefGoogle Scholar
  20. Pomerantz, A. (1986). Extreme case formulations: A way of legitimizing claims. Human Studies, 9(2–3), 219–229.CrossRefGoogle Scholar
  21. Rollnick, S., Seale, C., Rees, M., Butler, C., Kinnersley, P., & Anderson, L. (2001). Inside the routine general practice consultation: An observational study of consultations for sore throats. Family Practice, 18(5), 506–510.CrossRefGoogle Scholar
  22. Sacks, H. (1992). Lectures on conversation (Vol. 1). Malden, MA: Blackwell.Google Scholar
  23. Schegloff, E. A. (1993). Reflections on quantification in the study of conversation. Research on Language and Social Interaction, 26(1), 99–128.CrossRefGoogle Scholar
  24. Stivers, T. (2007). Prescribing under pressure: Parent-physician conversations and antibiotics. Oxford: Oxford University Press.CrossRefGoogle Scholar
  25. Stivers, T., Mangione-Smith, R., Elliott, M., McDonald, L., & Heritage, J. (2003). Why do physicians think parents expect antibiotics? What parents report vs. what physicians believe. Journal of Family Practice, 52(2), 140–148.Google Scholar
  26. Strøby Jensen, C. (2018). Governing the consumption of antimicrobials: The Danish model for using antimicrobials in a comparative perspective. In C. Strøby Jensen, S. B. Nielsen, & L. Fynbo (Eds.), Risking antimicrobial resistance (pp. 25–40). Cham, Switzerland: Palgrave Macmillan.Google Scholar
  27. Suchman, L. A. (2009). Human-machine reconfigurations. Plans and situated actions (2nd ed.). Cambridge: Cambridge University Press.Google Scholar
  28. Timmermans, S., & Oh, H. (2010). The continued social transformation of the medical profession. The continued social transformation of the medical profession. Journal of Health and Social Behavior, 51(S), 94–106.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2019

Authors and Affiliations

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

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