Between standardization and individualization: The role of interaction in developmental milestone tracking during pediatric visits

• In Event: Research in Ethnomethodology and Conversation Analysis: Interactions in Institutional Settings I

Abstract

Much of modern medical practice is caught between two opposing ideals: that of standardization as driven by the principle of evidence-based medicine and that of individualization as driven by the principle of patient-centered care. Developmental tracking, the practice of monitoring children’s developmental milestones during pediatric well-child visits, is one such practice: The ultimate goal is for a system of developmental tracking that is simultaneously equal and collaborative: where children are evaluated with the same unifying framework regardless of circumstance, and where physicians are also attentive and responsive to individual circumstances. In this study, I examine the feasibility of this goal by analyzing developmental tracking as it is actually implemented via parent–doctor conversations. I draw from 111 video recordings of well-child visits and rely on conversation analysis and qualitative methods to argue that whether and how developmental concerns are addressed is driven, in part, by factors beyond the concerns’ medical significance. Evidence for this claim is drawn from a comparison of two types of developmental concerns: parent-driven and emergent. I find that parent-driven concerns are more addressable than emergent ones because of how they are structured—given the principles of turn structure, sequence organization, and institutional context—and how they are framed—given parents’ interactional projects. This, I argue, has implications for our understanding of developmental tracking and similar practices; Despite medical professionals’ best efforts, more assertive parents are likely to receive more direct responses from physicians to their concerns and, potentially, more likely to receive recommendations than less assertive parents given similar concerns.

Author

• Natalia Toledo Melendez, University of California-Los Angeles