Negotiating Who Presents the Problem: Next Speaker Selection in Pediatric Encounters

Using audioand videotapes of acute pediatric encounters, this study (a) identifies pediatricians’ practices of next speaker selection when soliciting the problem presentation, (b) identifies factors that bear on next speaker selection, and (c) examines the consequences of physicians’ selection practices for who ultimately presents the problem. Although doctors most frequently select children as problem presenters, parents are the most likely to actually present the child’s problem. However, parents nonetheless orient to their children’s rights to answer questions that select them as next speaker. Thus, the actual problem presenter emerges as the result of a process of interactional negotiation rather than dominance or control. This study also suggests communication resources that may increase the child’s participation in presenting the problem.