Food insecurity affects 45% of the population of Boston (USA), with Black and Hispanic families at a disproportionate risk (Greater Boston Food Bank, 2024). When Boston Mayor Michelle Wu replaced the City’s Office of Food Access with the Office of Food Justice in 2021, public discussions sought to understand exactly what “food justice” is, which populations the programming would target, and what specific policies the government would institute. To better understand the rationale and material outcomes of this municipal rebranding project, I take a discourse-ethnographic approach (Krzyzanowski 2017) in examining Food Justice policy documents, discourse, and educational initiatives in schools and communities. In this presentation, I examine interactional data from a television program in which four experts discuss food justice in Boston. I first investigate how a definition of food justice is discursively negotiated among participants, highlighting the intersecting discourses they draw on (e.g., race, class, culture, climate, education) and how they differ in connecting the concepts of “culturally relevant” and/but/yet “healthy” food. I then consider discourse strategies employed to construct individual expertise on the topic, including stancetaking (Du Bois & Kärkkäinenin 2012, Kiesling 2022) in personal narratives and references to specific food items and preparations. I find that while no participant admits having faced food insecurity themselves, each discursively constructs a shared social history with Boston’s food insecure communities to advocate for specific policies aimed at guaranteeing a stable food supply to the city’s inhabitants. I conclude by suggesting implications and applications of this analysis for public policy practitioners.

Context. Advice as a speech event often poses a threat to the recipient’s “face”—the public self-image one seeks to maintain in social contact (Goffman, 1955; Brown & Levinson, 1987). This challenge is amplified in clinical settings, where advice delivery is influenced by knowledge and power imbalances between doctors and patients, as well as the sensitivity of the topics discussed.
Aim. This study investigates how general practitioners (GPs) employ politeness strategies to manage various face-threats posed by providing unsolicited weight loss advice in routine medical appointments.
Data and Methods. We analysed 185 recorded consultations in which GPs delivered opportunistic weight loss advice to patients living with obesity (Aveyard et al., 2016). The data were transcribed using Jeffersonian conventions, and conversation and discourse analyses were applied to study facework in GPs’ turns.
Results. Our findings reveal that GPs employed a variety of face-saving strategies to address different types of face-threats associated with weight loss advice. Negative politeness strategies were used in topic initiation where they served to reduce GPs’ personal responsibility for broaching a sensitive topic. These strategies also helped minimise the imposition on the patient and mitigate potential critical implications. Positive politeness was primarily used when suggesting future actions, framing weight loss as a shared goal and a collaborative effort between the GP and the patient.
Conclusion. Politeness strategies employed by GPs help mitigate the face-threats of weight loss advice delivery, making these conversations less fraught for both parties and potentially enhancing patient engagement with recommendations.

Final outcome letters responding to NHS complaints are a common source of complainant dissatisfaction. They occur at the end of an often long journey of interactions between complaints handler and complainant and frequently have a significant negative impact on the complainant’s view of their overall complaint experience, even where earlier encounters have been positively evaluated. Reasons for these negative evaluations are typically linked to discourse features of the written communication, such as poorly framed apologies. This paper demonstrates the value of seeing the written response letters as the final turn in a conversational exchange and applying interactional principles to the problematic discourse features.

The ‘Real Complaints’ project (Rhys et al 2024) combined conversation analysis of complaints encounters with complainant appraisals of those encounters through diarising and interviews. In our analysis of our spoken data, we focused on the interactional concept of affiliation, building on Pino’s observation that what exactly recipients affiliate with in the prior speaker’s turn matters for interactional outcomes (Pino 2022). Our micro analysis of the affiliation practices in our data revealed both the interpersonal priorities of complainants, and the significant negative impact of the absence of affiliation with these priorities by call handlers (Benwell et al 2023).

This paper draws on these insights from our spoken data analysis and shows how we can apply the concept of affiliation to the written response letters to better understand how and why complainant dissatisfaction arises and thereby improve practice.

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References
Benwell, B., Erofeeva, M., & Rhys, C. S. (2023). Why affiliation matters: A conversation analysis of complaints calls to the NHS. Patient education and counseling, 119, 1-11. Article 108077. Advance online publication. https://doi.org/10.1016/j.pec.2023.108077

Pino, M. (2022) ‘Hurting and Blaming: Two Components in the Action Formation of Complaints About Absent Parties, Research on Language & Social Interaction 55 (2022) 260–278. https://doi.org/10.1080/08351813.2022.2101298.

Rhys, C. S., Benwell, B., Erofeeva, M., & Simmons, R. (2024). Harnessing the power of language to enhance patient experience of the NHS complaint journey in Northern Ireland: a mixed-methods study. Health and Social Care Delivery Research, 12(33), 1-129. https://doi.org/10.3310/NRGA3207

Listening is considered an essential skill in patient work. Medical textbooks and editorials remind doctors that listening is key to understanding the patient’s symptoms and their meaning, paving way to better care outcomes and patient satisfaction rates. However, little is written about how to listen and how listening can be displayed in patient interaction. In this study, our aim was to conceptualize professional listening in doctor’s consultations by reflecting authentic practices of displaying listening on various theories of skillful listening. Firstly, we employed conversation analysis to identify doctors’ practices of displaying in ten consultations with patients with stage IV pancreatic cancer. Then, we analyzed deviant cases in which the doctor’s listening practices did not seem appropriate or successful in terms of orienting towards the patient. Finally, we formed a theoretical model of professional listening in doctor’s consultations.

In our model, we divided doctors’ practices of displaying listening into three domains: 1) active listening, 2) empathetic listening, and 3) listening as a medical expert. The practices of active listening display focus and attention, encouraging the patient to continue talking. The practices of empathetic listening express agreement and willingness to collaborate with the patient, validating the patient’s feelings and experiences. Listening as a medical expert, in turn, entails harnessing medical knowledge so that it responds to the patient’s epistemic and emotional needs. In this presentation, we will demonstrate the use of these practices when handling highly sensitive topics such as incurability and dying.

Penicillins are the most common cause of drug-induced anaphylaxis worldwide, yet penicillin allergy status is seldom clinically tested and therefore reliant on patient/caregiver report. Managing the risk of harm when prescribing antimicrobials is fraught with uncertainties: patients may not always be truly allergic and medical records may not be accurate. The aim of this study was to investigate how conversations about drug allergy risks unfold when prescribing for common infections.

We screened 156 acute primary care consultations for adult patients presenting with upper respiratory concerns in England and Sweden to identify all cases where drug allergies were raised. We used conversation-analytic methods to make systematic observations on how the topic was initiated; the activity context; the patient’s response and any subsequent mention of drug allergy; identifying recurrent patterns within and across the two datasets.

In both datasets, drug allergies were raised in just over one third of consultations most often via questions conveying a bias towards a ‘no allergy’ outcome. When asked during information gathering, the question was sometimes misunderstood as asking about allergies in general. In the majority of cases, no allergies were reported, yet patients often qualified their ‘no allergy’ answers displaying uncertainty. Patients who did report allergies were seldom questioned about the nature of their symptoms. Where patient allergy status was contested or neglected by clinicians and brought to the interactional surface, work was done by both parties to maintain neutrality or display cautiousness around differing territories of knowledge.

Our analysis reveals common interactional problems faced by prescribing professionals when managing the risk of patient harm from drug allergies when prescribing antimicrobials.

The study was done in collaboration with Rebecca Barnes. It is one of several studies in the research project Antibiotic prescription in Swedish primary care consultations. Principal investigator: Anna Lindström. Uppsala University. PhD student: Klara Bertils, Uppsala University. Affiliated researchers: John Heritage, University of California, Los Angeles, Rebecca Barnes, University of Oxford and Thomas Tängdén, Uppsala University. The research project was partially funded by Uppsala Antibiotic Center.