When Surgeons Advise Against Surgery

This article examines the significant interactional work undertaken by orthopedic surgeons in the delivery of recommendations not for surgery-recommendations against surgery or for nonsurgical treatment. Surgeons recurrently use a number of features prior to these recommendations: Projecting turns, parenthetical remarks, brightsides, logical inferences and syllogisms, general case/usual course descriptions, and turns that display the relevance of surgery. Through these features, surgeons manage, and treat as relevant, issues of anticipated patient resistance, legitimacy, and accountability when making recommendations that do not align with their professional identities.