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Conversation Analysis

5. CA in Action

Example 8a

In what follows we can examine a series of sub-sequences in this passage of interaction.

01 Doc: tch D'you smoke?, h
02 Pat: Hm mm.
03 (5.0)
04 Doc: Alcohol use?
05 (1.0)
06 Pat Hm:: moderate I’d say

The sequence begins with a "yes/no" (or polar) question about smoking, to which the patient responds negatively with a brief headshake, and a dismissive "hm mm" (a minimized version of "no"). At this point, the clinician turns to the question of alcohol. His initial question "Alcohol use?" is devoid of a verb and is elliptical as between the polar question "Do you use alcohol?" and the more presupposing "How much alcohol do you use?" This design allows the clinician to circumvent the "yes/no" question, while permitting the patient to decide how to frame a response. After a one second silence (a substantial period of time in an engaged state of interaction) during which the patient assumed a 'thinking' facial expression, the patient articulates a sound which conveys pensiveness ("hm::"), and then offers an estimate ("moderate"), concluding her turn with "I'd say" which retroactively presents her response as an estimate, albeit a 'considered' one. Though presented as a 'considered opinion,' and in scalar terms, the patient's estimate is unanchored to any objective referent. The scene is now set for a pattern of questioning that will be familiar to primary care physicians: an attempt to extract a quantitative estimate from the patient.