UCLA

Pediatric medical visits represent a unique opportunity for studying uncertainty, authority, and agency. In these visits medical authority and parental authority converge on a common goal — the child’s best interests. However, physicians and parents do not always agree on what courses of action are best. Physicians may disagree with parents but nevertheless rely on them to carry out treatment plans. Parents may challenge medical authority but nevertheless rely on physicians for access to the medical goods and services that they need to care for their child. In these points of departure medical authority and parental authority collide; and when the child’s problem is non-routine like a seizure the stakes can be particularly high. This dissertation explores the physician-parent partnership in a particular context: pediatric neurology visits for overnight vEEG testing. I adopt a conversation analytic approach to examine interactions between physicians and parents during these encounters, paying particular attention to the themes of uncertainty, authority, and agency. I find that parents and physicians use (un)certainty to accomplish specific interactional goals. Parents can invoke uncertainty as an account for their conduct when they have somehow challenged medical authority, thus mitigating damage to the physician-family partnership; and physicians can modulate the certainty of diagnoses, treatment efficacy, and other aspects of the child’s condition and care as a means of exerting control over visit outcomes. In the context of news deliveries, I find that the relative rights to ascribe valence to news in pediatric neurology diverge from those observed in everyday life, and this causes problems in the delivery and reception of good news. In these encounters, physicians prioritize conveying the facts of the news over characterizing its valence, but parents tend to treat both components as necessary before they are willing to assess the news. When physicians fail to provide either component, parents orient to news deliveries as incomplete. This not only causes difficulties in parents’ reception of the news but also leads to protracted news deliveries. Taken together, these findings suggest an enduring orientation to medical authority as a legitimate property of the physician-family partnership.