TY - JOUR T1 - When ‘yes’ means ‘no’: why the small details of clinical interactions matter JF - British Journal of General Practice JO - Br J Gen Pract SP - 410 LP - 411 DO - 10.3399/bjgp18X698441 VL - 68 IS - 674 AU - Deborah Swinglehurst AU - Sarah Atkins Y1 - 2018/09/01 UR - http://bjgp.org/content/68/674/410.abstract N2 - We welcome the inclusion in this month’s BJGP of the article by Albury et al, which employs Conversation Analysis (CA) to understand how weight-loss interventions can be introduced effectively into the discourse of general practice consultations.1 It shows how the initial spoken responses of patients who are offered weight-loss management services by their GP, demonstrate strikingly consistent patterns in relation to subsequent uptake of these services. Somewhat surprisingly, ‘yes’ or ‘yeah’ responses did not have a significant association with attendance. On the other hand, responses prefaced with ‘oh’ (for example,’oh right, I’ll try anything’) did have an association with attendance at weight-management services.The findings demonstrate how bringing together evidence from a large number of audiorecorded consultations (226 recordings in this study) in this kind of research can challenge some of the assumptions we might otherwise make about our talk. The study is unusual as it took place within the context of a trial, enabling the researchers to integrate their analysis with statistical data about actual attendance at the suggested service. They have demonstrated, in a nuanced way that these interactional patterns are relatively predictable. We make the case that the empirical study of interaction, though time-consuming, is crucial if we are to provide communication skills guidance to practitioners and students that is effective for real-life practice and takes full account of the consultation as a co-constructed accomplishment.CA is the study of naturally-occurring interaction. It has a long tradition in medical settings but remains poorly … ER -