Merran Toerien

• Professor (Associate) at University of York

Research based on recordings made across numerous specialties and geographical locations has characterized doctors' solicitations of patients' reasons for the visit as normative. However, in our dataset of 132 audio-recordings of consultations in Chinese primary and secondary care, it was as common for patients to self-initiate giving the reason fo...

Using conversation analysis, this paper investigates when patients exercise their right to refuse treatment in neurology outpatient consultations recorded in the UK's National Health Service in 2012 (n = 224). NHS patients have a right to refuse treatment. However, there are good reasons to suppose that this may be difficult to exercise in practice...

How does ordering a test fit into new-problem medical consultations? Robinson (2003) has shown that there are four main activities in new problem consultations in primary care (establishing the reason for the visit, gathering information, delivering a diagnosis, recommending treatment), but he speculates that other types of medical consultation may...

Background We report follow-on research from our previous qualitative analysis of how neurologists offer patients choice in practice. This focus reflects the NHS’s emphasis on ‘patient choice’ and the lack of evidence-based guidance on how to enact it. Our primary study identified practices for offering choice, which we called ‘patient view elicito...

The normative view that patients should be offered more choice both within and beyond the UK’s National Health Service (NHS) has been increasingly endorsed. However, there is very little research on whether - and how - this is enacted in practice. Based on 223 recordings of neurology outpatient consultations and participants’ subsequent self-report...

The UK’s Royal College of Surgeons (2016) has argued that health professionals must replace a ‘paternalistic’ approach to consent with ‘informed choice’. We engage with these guidelines through analysis of neurology consultations in two UK-based neuroscience centres, where informed choice has been advocated for over a decade. Based on 223 recorded...

This article examines the use of just-formulated advisings in ordinary, naturally occurring sequences of unsolicited advice giving when produced in response to troubles-tellings. Drawing on two examples from our broader collection, we demonstrate that such advisings are employed in response to advice resistance and function to minimize proposed cou...

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...

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?...

Recommendations can be implied by asserting some generalization about a treatment’s benefit without overtly directing the patient to take it. Focusing on a collection of assertions in UK neurology consultations, this paper shows that these are overwhelmingly receipted as ‘merely’ doing informing, and argues that this is made possible by their ambig...

Public health and rights-based approaches to abortion advocacy are well established. Feminists are, however, increasingly using a broader framework of ‘reproductive justice’, which considers the intersecting conditions that serve to enhance or hinder women’s reproductive freedoms, including their capacities to decide about the outcome of their preg...

Aim Recent public policy documents have emphasised the need for healthcare practitioners to give patients choice. As part of a larger qualitative project investigating how neurologists give patients choices, we explored whether evidence of patient choice is associated with higher patient satisfaction. Method Fourteen neurologists and 223 patients w...

The NHS is committed to offering patients more choice. Yet even within the NHS, the meaning of patient choice ranges from legal ‘rights to choose’ to the ambition of establishing clinical practice as a ‘partnership’ between doctor and patient. In the absence of detailed guidance, we focused on precisely how to engage patients in decision-making. O...

This paper reports findings from the first study based on recordings of advisory interviews with benefits claimants in the United Kingdom. Previous econometric analysis found that programmes for unemployed people delivered through private sector Employment Zones (EZs) were more effective than their public sector equivalents, delivered through Jobce...

We report on a study commissioned by the UK government of the ways in which advisers conduct mandatory interviews with unemployment benefits claimants. Among other results, we identified practices in soliciting claimants’ job goals and job plans that were more, or less, effective in achieving desired outcomes during these interactions. Moreover, we...

The aim of the study was to investigate how doctors considered and experienced the concept of equipoise while recruiting patients to randomized controlled trials (RCTs). In-depth interviews with 32 doctors in six publicly funded pragmatic RCTs explored their perceptions of equipoise as they undertook RCT recruitment. The RCTs varied in size, durati...

Recruitment of sufficient participants in an efficient manner is still widely acknowledged to be a major challenge to the mounting and completion of randomised controlled trials (RCTs). Few recruitment interventions have involved staff undertaking recruitment. This study aimed i) to understand the recruitment process from the perspective of recruit...

Electronic patient records (EPRs) are increasingly being viewed as key to high quality chronic disease management, and have been advocated for epilepsy care. Whether EPRs can really deliver on their promise, however, remains a matter of debate. In this focused review, I highlight one set of risks associated with EPR use: risks to the interaction be...

This article compares two practices for initiating treatment decision-making, evident in audio-recorded consultations between a neurologist and 13 patients in two hospital clinics in the UK. We call these 'recommending' and 'option-listing'. The former entails making a proposal to do something; the latter entails the construction of a list of optio...

The principle of personalisation is widespread across the UK's public sector, but precisely what this means is unclear. A number of theoretical typologies have been proposed but there has been little empirical study of how personalisation is translated into practice on the frontline. We address this gap through analysis of a unique dataset: over 20...

Context: With the routinization of evidence-based medicine and of the randomized-controlled trial (RCT), more patients are becoming 'sites of evidence production' yet, little is known about how they are recruited as participants; there is some evidence that 'substantively valid consent' is difficult to achieve. Objective: To explore the views an...

This article draws on naturally occurring talk-in-interaction to explore the use of unrepaired indexicals—specifically he, she, and they—to refer to third persons when there is no prior full-form reference. We show some of the local resources that participants use to understand the referent but focus predominantly on how locally initial indexicals...

Using conversation analysis (CA), we studied conversations between one United Kingdom-based epilepsy specialist and 13 patients with seizures in whom there was uncertainty about the diagnosis and for whom different treatment and investigational options were being considered. In line with recent communication guidance, the specialist offered some fo...

With the economic downturn of 2009, Jobcentre Plus, the UK service that gives employment advice and administers unemployment benefits, has come under increased media scrutiny. Can it deliver the personalised service it purports to offer, given the 90 per cent increase in number of claimants arriving at its doors? The media have been sceptical, even...

The primary aim of the study was to identify those techniques and styles used by advisers during Work Focused Interviews (WFIs) that were most effective in moving people closer to work, and to make recommendations concerning effective practice in WFIs. The findings highlight the importance of an interview style that is collaborative, directive, pro...

This report presents findings from an exploratory comparison of interactions between personal advisers and older and younger clients during Work Focused Interviews (WFIs). The study used the method of Conversation Analysis to explore a set of video and audio recordings of WFIs taking place in Jobcentre Plus offices. The study compared the structure...

Poor recruitment and retention of participants in randomised controlled trials (RCTs) is problematic but common. Clear and detailed reporting of participant flow is essential to assess the generalisability and comparability of RCTs. Despite improved reporting since the implementation of the CONSORT statement, important problems remain. This paper a...

Randomized controlled trials (RCTs) are considered the optimum method for evaluating health care interventions, yet many fail to recruit sufficient participants in a timely manner. The ProtecT (Prostate testing for cancer and Treatment) study employed qualitative research methods as part of a complex intervention to improve recruitment to the RCT....

Introduction: Strategies to improve recruitment to RCTs (randomised controlled trials) are limited. The ProtecT (Prostate testing for cancer and Treatment) study successfully developed a complex intervention based on qualitative research methods to increase recruitment rates. The Quartet study (Qualitative Research to Improve Recruitment to RCTs)...

To consider the reasons and context for test ordering by doctors when faced with an undiagnosed complaint in primary or secondary care. We reviewed any study of any design that discussed factors that may affect a doctor's decision to order a test. Articles were located through searches of electronic databases, authors' files on diagnostic methodolo...

Building on Hochschild's path-breaking analysis of service providers' `emotional labour', this article demonstrates some of the interactional skills required for emotional labour to be performed. Using conversation analysis (CA), we examine a single case from a database of recorded beauty salon interactions. The episode was chosen because it makes...

Research on emotional labour in the workplace — including beauty salons — has relied on workers' reports of emotional labour; few researchers have examined workers' moment-by-moment workday experience to explicate the practices of emotional labour in action. Using conversation analysis (CA) of a single interaction between a client and a beauty ther...

Although womens body hair removal is strongly normative across contemporary Western cultures, only two studies of mundane depilation have been published, and they were based on data from the US (Basow, 1991) and Australia (Tiggemann & Kenyon, 1998), respectively. The present survey, comprised of a sample of 678 women, extends this work. We investig...

Women's body hair removal is highly normative across contemporary western cultures. Nevertheless, little is known about the production and maintenance of this norm. Drawing on qualitative survey data from 678 women in the UK, this study offers two explanations: First, hairlessness and hairiness are predominantly constructed as positive and negative...

Women's body hair removal is strongly normative within contemporary Western culture. Although often trivialised, and seldom the subject of academic study, the hairlessness norm powerfully endorses the assumption that a woman's body is unacceptable if unaltered; its very normativity points to a socio-cultural presumption that hairlessness is the app...

The aim of this article is to show that tensions between conflicting accounts of masculinity need not only be ‘resolved’ by individual men, but can have a collective ‘resolution’. We argue that the ‘real man’ - by drawing together the ‘macho’ and ‘new man’ discourses - represents one such ‘integrated’ discourse of masculinity available to men. Our...