John Heritage

John Heritage
University of California, Los Angeles | UCLA · Department of Sociology

PhD

About

161
Publications
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21,331
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July 1988 - present
University of California, Los Angeles
Position
  • Professor (Full)

Publications

Publications (161)
Chapter
Full-text available
This paper synthesizes research on how speakers formulate questions in a particular institutional environment: U.S. presidential news conferences. The objective is to use variations in aggressive questioning as a window into the institution of American journalism and its evolving relationship to the state. Data span a half-century of news conferenc...
Article
Objective To evaluate communication training content fidelity included in a multifaceted intervention known to reduce antibiotic over-prescribing for pediatric acute respiratory illnesses (ARTIs), by examining the degree to which clinicians implemented the intended communication behavior changes. Methods Parents were surveyed regarding clinician c...
Article
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In this article, we investigate a puzzle for standard accounts of reference in natural language processing, psycholinguistics and pragmatics: occasions where, following an initial reference (e.g., the ice ), a subsequent reference is achieved using the same noun phrase (i.e., the ice ), as opposed to an anaphoric form (i.e., it ). We argue that suc...
Article
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We reflect on the affordances and challenges of interactional data in the analysis of long-term institutional change. To this end we draw on our studies of direct encounters between journalists and politicians in news interviews and presidential news conferences and in particular the use of question design as a window into the evolution of journali...
Article
This article considers the use of negative polarization in polar (yes/no) questions. It argues that question polarity is used to take an epistemic stance toward the probability or improbability of the state of affairs referenced in the question and that taking such a stance is effectively unavoidable. Focusing on negatively polarized questions (NPQ...
Article
This study expands and refines the argument presented by Heritage and Raymond by demonstrating that the orientation to probability in question design can intersect with a second orientation toward the positive or negative desirability—or valence—of the state of affairs inquired into. In most cases, the orientations to probability and to positively...
Preprint
Full-text available
In this article, we investigate a puzzle for standard accounts of reference in natural language processing, psycholinguistics and pragmatics: occasions where, following an initial reference (e.g., the ice), a subsequent reference is achieved using the same noun phrase (i.e., the ice), as opposed to an anaphoric form (i.e., it). We argue that such n...
Article
Full-text available
Background: One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program's effectiveness for reducing outpatient antibiotic prescribing for ARTI visits. Methods: In this stepped-wedge clinical trial run from November 2015 to June 2018, we ran...
Article
Variety, complexity and uncertainty in the therapy outcomes of cancer illness make the treatment recommendation (TR) in oncology a “monumentally difficult task”. Previous studies have distinguished unilateral and bilateral formats of treatment recommendations, accordingly to whether, or to what extent, the patient’s perspective is included in the c...
Article
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This paper traces the increasing prominence of women in the White House press corps over the latter half of the 20 th century, and considers how this trend toward greater gender balance has impacted the questioning of presidents. Modest gender differences are documented in the topical content of questions, with women journalists slightly favoring d...
Preprint
This paper traces the increasing prominence of women in the White House press corps over the latter half of the 20 th century, and considers how this trend toward greater gender balance has impacted the questioning of presidents. Modest gender differences are documented in the topical content of questions, with women journalists slightly favoring d...
Article
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Goffman (1971) proposed that apologies are, or at least should be, proportional to the offenses they are designed to remediate. In a previous quantitative study (Heritage & Raymond 2016), we found mixed support for such a principle of proportionality. The present article aims to unpack some of the difficulties encountered in that largely positivist...
Article
Objectives: to establish: a) feasibility of training GPs in a communication intervention to solicit additional patient concerns early in the consultation, using specific lexical formulations (“do you have ‘any’ vs. ‘some’ other concerns?”) noting the impact on consultation length, and b) whether patients attend with multiple concerns and whether th...
Article
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In 2016, Discourse Studies published a special issue on the 'epistemics of epistemics' comprising six papers, all of which took issue with a strand of my research on how knowledge claims are asserted, implemented and contested through facets of turn design and sequence organization. Apparently coordinated through some years of discussion, the criti...
Preprint
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This chapter examines the English turn-initial particles oh and well. It begins with a consideration of their distinctive usages and functions in three basic sequential positions (first, second and third), arguing that both exhibit what Schegloff (1996) terms 'positional sensitivity'. The chapter then considers some larger contrasts between the two...
Article
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This study investigates patient resistance to doctors’ treatment recommendations in a cross-national comparison of primary care. Through this lens, we explore English and American patients’ enacted priorities, expectations, and assumptions about treating routine illnesses with prescription versus over-the-counter medications. We perform a detailed...
Article
From the earliest studies of doctor-patient interaction (Byrne & Long, 1976), it has been recognized that treatment recommendations may be expressed in more or less authoritative ways, based on their design and delivery. There are clear differences between I'm going to start you on X and We can give you X to try and Would you like me to give you X?...
Chapter
Full-text available
This chapter examines three particles that have epistemic functions in English and Mandarin: turn-initial 'oh' in English, turn-initial 'ou' in Mandarin, and turn-final 'a' in Mandarin. It is argued that while ou and oh converge in registering a 'change of state' of information, orientation or awareness, turn-final a is used to register a contrast...
Article
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This paper describes a communication practice called “online commentary” that is in widespread use in primary care in the USA. Online commentary is talk by a clinician that describes what he or she is finding in the course of the physical examination of the patient. The paper reviews the primary features of online commentary, with a special focus o...
Article
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Conversation and discourse analyses were used to examine medical problem presentation in pediatric care. Healthcare visits involving children with ASD and typically developing children were analyzed. We examined how children’s communicative and epistemic capabilities, and their opportunities to be socialized into a competent patient role are intera...
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This article discusses Kendrick and Drew’s (2016/this issue) conceptualization of recruitment. It is argued that the critical feature of recruitment as a category is its focus on forms of local, here-and-now assistance, which gives recruitment actions a different suite of affordances and constraints than actions soliciting assistance on some future...
Article
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This paper presents evidence that the discourse particle well functions as a generalized procedural alert that the turn it prefaces will privilege its speaker's perspectives, interests or project relative to the expectations for action established in the prior turn or sequence. Using data from a corpus of 748 well-prefaced turns, a range of context...
Article
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In the more than 1 billion primary-care visits each year in the United States, the majority of patients bring more than one distinct concern, yet many leave with "unmet" concerns (i.e., ones not addressed during visits). Unmet concerns have potentially negative consequences for patients' health, and may pose utilization-based financial burdens to h...
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We consider here Goffman's proposal of proportionality between virtual offenses and remedial actions, based on the examination of 102 cases of explicit apologies. To this end, we offer a typology of the primary apology formats within the dataset, together with a broad categorization of the types of virtual offenses to which these apologies are addr...
Article
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This study examined relationships between provider communication practices, antibiotic prescribing, and parent care ratings during pediatric visits for acute respiratory tract infection (ARTI). A cross-sectional study was conducted of 1,285 pediatric visits motivated by ARTI symptoms. Children were seen by 1 of 28 pediatric providers representing 1...
Article
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We investigated how provider vaccine communication behaviors influence parental vaccination acceptance and visit experience. In a cross-sectional observational study, we videotaped provider-parent vaccine discussions (n = 111). We coded visits for the format providers used for initiating the vaccine discussion (participatory vs presumptive), parent...
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In this article, we discuss the notion of a ‘conversation analytic intervention,’ focusing on the role of conversation analysis in the major stages of intervention research, epitomized by the randomized controlled trial, the gold standard for intervention in the medical sciences. These stages embrace development, feasibility and piloting, evaluatio...
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The implementation and ascription of 'first actions' has until recently been an understudied area within conversation analysis. Recently, exploratory studies in the domains of epistemics and deontics have led to a revival of interest in this problem. This paper addresses the same issue through the lens of 'benefactives' and its relevance to the pro...
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Objective: To characterize provider-parent vaccine communication and determine the influence of specific provider communication practices on parent resistance to vaccine recommendations. Methods: We conducted a cross-sectional observational study in which we videotaped provider-parent vaccine discussions during health supervision visits. Parents...
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This article reviews arguments that, in the process of action formation and ascription, the relative status of the participants with respect to a projected action can adjust or trump the action stance conveyed by the linguistic form of the utterance. In general, congruency between status and stance is preferred, and linguistic form is a fairly reli...
Article
This paper considers a recent and growing body of research into turn-initial objects, and describes some of the difficulties associated with their analysis. It suggests that they particularly cluster around 'expectation canceling' functions: in first position to manage the connectedness or otherwise of a current turn to the previous one, and in sec...
Article
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This paper uses a single question form—the negative interrogative—as a window into the increasing aggressiveness of American journalists and hence the increasingly adversarial relationship between press and state in the United States. The negative interrogative in English is a type of yes/no interrogative (e.g., “Isn't it …”, “Don't you …”) often u...
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In this article we examine some sequences of teacher–student interaction in which a teacher generates and acts on formative assessment data. We look at the teacher's practices of question construction and her decisions about in situ next pedagogical steps made in real time to support and further student learning. Our observations are guided by the...
Article
Building upon Sacks' ideas concerning the social organization of subjective experience, this chapter presents a case study on the ways in which a British community nurse responds to her client's disclosures concerning difficulties in bonding with her newborn daughter. Over a series of weekly home visits, the nurse attempts to reassure her client th...
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Introduction Background Epistemic Stance and Epistemic Status Managing the Boundaries of Epistemic Domains Epistemics and Action Formation Epistemics and Sequence Organization Conclusions Directions for Future Research
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This paper considers the relationship between Melvin Pollner’s sociology of mundane reasoning and conversation analysis. We suggest, first, that Pollner’s revolutionary view of the role of accounts in everyday life provides a basic framework for understanding how norms of conversational organization are sustained across time periods ranging from th...
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This article considers the role of grammatical form in the construction of social action, focusing on turns that either assert or request information. It is argued that the epistemic status of a speaker consistently takes precedence over a turn's morphosyntactically displayed epistemic stance in the constitution of the action a turn is implementing...
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This article reviews a range of conversation analytic findings concerning the role of information imbalances in the organization of conversational sequences. Considering sequences launched from knowing and unknowing epistemic stances, it considers the role of relative epistemic stance and status as warrants for the production of talk and as forces...
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Are members of the White House press corps unified in their treatment of the president at any given time, or does their behavior differ by demographic and professional attributes? This study addresses this issue through multidimensional measurement of the aggressiveness of questions put to nine presidents (1953–2000) in news conferences. In additio...
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This article identifies some of the challenges of implementing patient-centeredness in multiparty clinical visits. Specifically, it describes four interview practices with which clinicians address these challenges in a US outpatient tertiary care pediatric pain clinic. Using the qualitative method of conversation analysis, we analyze clinicians' ch...
Preprint
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Since the publication of the now classic paper "A simplest systematics for the organization of turn-taking in conversation" in Language (Sacks, Schegloff, and Jefferson 1974) the study of turn-transition between speakers has assumed an ever-increasing significance in research on spoken interaction. This has motivated studies that embrace the role o...
Chapter
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In the 1970s, two major studies established the systematic study of doctor–patient interaction as a viable research domain. The first, conducted by Korsch and Negrete (1972) at the Children’s Hospital of Los Angeles was based on observations of 800 pediatric acute care visits and used a modifield version of Bales’ (1950) Interaction Process Analysi...
Article
This paper examines occasions in which speakers initiate repair in the midst of, or at/after the possible completion of, a question, and by virtue of this come to pose “one question after another.” The data are drawn from ordinary and institutional contexts, though questions from the latter constitute the large majority of cases examined below. Unl...
Chapter
In this chapter we reconsider the design, implementation and dissemination of an NIH-funded study of unmet patient concerns that we conducted in 2005–6 and published in 2007 (Heritage et al., 2007). The study took an aspect of preference organisation that has, to our knowledge, never been systematically studied, and applied it to a well-known probl...
Article
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Presidential journalism is known to have grown substantially more aggressive through the 1970s and beyond, but a definitive explanation for this trend remains elusive. Some suggest that events surrounding Vietnam and Watergate transformed the professional norms of journalism. However, the trend could also be a more superficial and transi- tory resp...
Book
Talk in Action examines the language, identity, and interaction of social institutions, introducing students to the research methodology of Conversation Analysis. • Features a unique focus on real-world applications of CA by examining four institutional domains: calls to emergency numbers, doctor-patient interaction, courtroom trials, and mass comm...
Chapter
Calling 911 is Not Like Ordering a PizzaThe Genuineness Issue: Is There Really a Problem?Accomplishing Genuineness: Epistemic Access, Inferential Cautiousness, and Motivational ProprietyThe Relevance Issue: Is It a Matter of Public Safety?Opening the Gates: Promising Assistance and Saying “Thank You”Conclusion For Further Reading
Chapter
Background on Dispute Resolution ProceedingsThe Disputants: Description and Story Telling as Implicit NegotiationThe “Neutral” Third Party: Facilitation in ActionConclusion For Further ReadingNotes
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“Known” Problems: Routine Illnesses“Known” Problems: Recurrent Illnesses“Unknown” ProblemsConclusion For Further Reading
Chapter
Conceptual PreliminariesOvert ResistanceCovert ResistanceA Case Study in Resistance and PursuitConclusion For Further Reading
Chapter
Significance of Turn TakingThe Turn-Taking System in OverviewConstructing QuestionsConstructing AnswersDepartures from the Question-Answer FrameworkInstitutional Functions of the Turn-Taking SystemConclusion For Further Reading
Chapter
The Interactional Management of Diagnosis: Three StudiesTreatment RecommendationsHow Authoritative are Physicians? A Case StudyConclusion For Further Reading
Chapter
What is “Institutional Talk”?Dimensions of Distinctiveness in Institutional TalkConclusion For Further ReadingNotes
Chapter
Two Views of Talk and Social Context: The Bucket versus the Yellow Brick RoadMethods of Talking: A Simplest CaseA Logic of Questions and AnswersThe Sequential Organization of Questions and Answers: Four InstitutionsConclusion For Further ReadingNotes
Chapter
Two Norms of Journalism: Objectivity and AdversarialnessDimensions of AdversarialnessDefensible QuestioningMaximizing AdversarialnessSlipping Outside the Neutralistic CircleJournalistic Questioning in Historical ContextConclusion For Further Reading
Chapter
Acute Care VisitsThe Importance of Problem PresentationThe Brevity of Problem PresentationProblem Presentation: The Doctor's DilemmaThe Transition from Problem Presentation to History TakingConclusion For Further Reading
Chapter
language and interaction - ignored in conventional analyses of occupational worlds;study of interaction - analysis of domains of social life;conversation analytic (CA) research - established presence in field of medicine;mass media research diversification - studies of campaign debates, radio call-in shows, and talk shows;doctor–patient interaction...
Chapter
Emotion Displays and Information TransferResponding to Emotion DisplaysLabeling Callers' EmotionsAngry CallersExtended Conflict: The Case of a Failed Emergency CallCoda: The Emergency Call as an AchievementFor Further Reading
Chapter
Dimensions of Question DesignCongruent and Cross-cutting Preferences in Medical QuestioningDimensions of Question Design in Special SituationsConclusion For Further ReadingNote
Chapter
Goffman's conception of interaction order - existence of a distinct institutional order;interaction–institution interface - lines of influence that operate in both directions;visibility of institutional activities - arising through modifications through which ordinary conversational interaction managed;growing significance of CA, approach to intera...
Chapter
The Problem of Response CoordinationFormats for Inviting ApplauseCombinationsRescuing DudsGenerating Applause: The Three-stage RocketResponding to Speeches: Form versus ContentThe Long Half-Lives of Contrasts and ListsConclusion For Further Reading
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The Trial Examination as a Form of TalkThe Dynamics of Examination and Cross-ExaminationResisting Attorneys' QuestionsResisting Material EvidenceConclusion For Further Reading
Chapter
Background: Public Safety Communication CentersThe Overall Structure of Emergency CallsOpenings: Constraints on ContributionsRequests for Help: Special Patterns of InferenceConclusion For Further ReadingNote
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Origins: Erving GoffmanOrigins: Harold GarfinkelConversation AnalysisThe Sequential Structure of InteractionConversation Analysis: Two Research TraditionsInstitutional CAOrdinary Conversation and Institutional TalkInstitutional Talk: Research Objectives For Further Reading
Chapter
General Features of Jury DeliberationsA Case Study: Background on the Frontline CaseAccountability for Pro-Conviction versus Pro-Acquittal JurorsThe Crystallization of Rationales for AcquittalConverting Jurors and Achieving an Accountable “Not Guilty” VerdictConclusion For Further Reading
Article
This study investigates the relationship of 'online commentary' (contemporaneous physician comments about physical examination [PE] findings) with (i) parent questioning of the treatment recommendation and (ii) inappropriate antibiotic prescribing. A nested cross-sectional study of 522 encounters motivated by upper respiratory symptoms in 27 Califo...
Article
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Physicians need strategies for addressing patient requests for medically inappropriate tests and treatments. We examined communication processes that physicians use to deal with patient requests of questionable appropriateness. Data come from audio-recorded visits and postvisit questionnaires of standardized patient visits to primary care offices i...
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This chapter, written by John Heritage, provides an overview of the author's main findings on questioning in doctor-patient interactions. Heritage pays particular attention to the way that questions in medical contexts are designed to communicate information about doctors' expectations and beliefs and thereby limit the way that patients can appropr...
Chapter
Background Conversation AnalysisOrders of AnalysisThe Interaction Order as an InstitutionThe Interaction Order and Societal InstitutionsConclusion AcknowledgmentBibliography
Article
The objective of this study was to examine the separate contributions of patients and physicians to their communication regarding cancer screening. Research design and subjects: The authors conducted a cross-sectional analysis of survey data collected from 63 community-based primary care physicians and 904 of their female patients in Los Angeles. P...
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Full-text available
terms-and-conditions-of-access.pdf This article may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or...
Article
To measure the length of time spent discussing all aspects of new prescriptions and guideline-recommended aspects of counseling, and to evaluate factors associated with duration of discussion. We analyzed tape recordings in which 181 patients received 234 new medication prescriptions from 16 family physicians, 18 internists, and 11 cardiologists in...
Article
This paper examines how clinicians promote pediatric patients' symptom accounts at the beginning of visits in three pediatric tertiary care clinics at a university hospital in the United States: pain, gastroenterology and neurology. Quantitative and qualitative data were collected for 69 patient-parent pairs, including videotaped intake visits. Two...
Article
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Two studies examined vocal affect in medical providers’ and patients’ content-filtered (CF) speech. A digital methodology for content-filtering and a set of reliable global affect rating scales for CF voice were developed. In Study 1, ratings of affect in physicians’ CF voice correlated with patients’ satisfaction, perceptions of choice/control, me...