II) ANALYTICAL PART

43
Chapter Five
THEORETICAL PRELIMINARIES
For most doctors whose first language is not English communication with
colleagues at international conferences or when working abroad does not
pose a great problem, as the medical language used is fairly universal.
However, when faced with English-speaking patients in the consulting room
different vocabulary and language is required.
Mria !y"rffy
5.1 Research Objectives
#he purpose of the present thesis is to present the findings obtained during
my research in the field of doctor-patient interaction. $s the motto suggests, the
study attempts to address not only the community of native speakers but also
those whose mother tongue is other than English. %ts theoretical interest concerns
&the intent of obtaining knowledge about the linguistic processes in the
interaction' ()ynn *++,-. %ts practical aim is to help doctors and medical
students
*
who wish to work in English speaking countries (or with users of
English- and find it meaningful to learn more about the rules which play part in
medical interviews.
%n accordance with some of the current trends in linguistics (.wales, *++/0
1hatia, *++2-, % view the meica! i"tervie# as a isc$%rse &e"re, which is
characterised, besides many other factors,
3
&by a set of communicative purpose(s-
identified and mutually understood by the members of the professional or
academic community in which it regularly occurs' (1hatia *++24 *2-. 5espite the
fact that the medical interview encompasses several distinguishable s%b'&e"res,
such as doctor-doctor consultation or doctor-nurse dialogues, it is $ct$r'patie"t
c$mm%"icati$" which is regarded as the most significant instance of the genre
under scrutiny.
#o use Hallidayan (*++6- terms (ie! $( isc$%rse, te"$r $( isc$%rse,
and m$e $( isc$%rse, the 5-7 interview can be described as a type of talk
between doctors and their clients, which normally takes place in the surgery and
which e8plores multiple health issues (field of discourse-. %t is usually spoken
44
face-to-face communication (mode of discourse-, with high level of formality
and detachment (tenor of discourse-. %ts main communicative purpose is to make
a c$rrect ia&"$sis and to pursue the m$st e((icie"t treatme"t for the patient.
$s Holmes (*++3- e8plains, researchers studying spoken communication,
its rules, and significant features should direct their attention to a number of
factors which influence conversation. 1asically, she distinguishes four factors
that are always relevant for the particular discourse genre4 the participa"ts, the
s$cia! setti"&, the t$pic, and the (%"cti$" (i.e. the purpose and aim of the
interaction- (Holmes *++34 **-.
1ased on these assumptions, doctor-patient communication can be
generally defined as verbal interaction usually involving two speakers9listeners
(doctor and patient-,
2
whose social relationship can be conceptualised as
asymmetrical. %t is set in the hospital, health centre, or the consulting room of the
doctor, and involves a variety of sub:ects, ranging from very serious to less
serious. #he final choice of the topic depends on the function that the medical
encounter tends to fulfill, and it can also be influenced by the particular medical
branch (see the analyses below-. .ince the main purpose of doctor-patient
communication is to enable the doctor to gather reliable information to help the
patient, it includes issues such as medical history, family and social history,
complaints, pain, body temperature, physical e8amination, etc. 5iscussing these
topics should result in effective medical or psychotherapeutic treatment.
6
$s is obvious from the above definition, &this type of talk is, to a certain
e8tent, prep!a""e and it proceeds according to certain, more or less #e!!
e(i"e r%!es or customs& ()ynn *++,4 *6, my emphasis-. 5octor-patient
communication is thus not identical to ordinary everyday conversation between
equal participants. %t should be understood as a representative e8ample of
i"stit%ti$"a! ta!) (for details see 5rew and Heritage *++3-. ;onsequently,
a conversation between a doctor and a patient about the price of a new 5<5
system, which takes place, for e8ample, on the bus on their way home from work,
cannot be regarded as an instance of the discourse genre under analysis. #he
dialogic conte8t of such talk is different than the one presented above, and it
serves different communicative purposes.
45
5-7 communication is an important process particularly in those cases
where the diagnosis and following treatment is based primarily on the
information acquired from such interaction. %f we take into consideration the
e8amples of patient e8periences described in the $merican $cademy on 7hysician
and 7atient,
,
it can be seen that even the smallest misunderstanding or inadequate
interpretation of the patient =s symptoms during the medical encounter may have a
fatal impact on the client=s health. #hus the relationship between the doctor and
the person who relies on him9her sometimes emerges as a question of death or
life, especially in serious cases of cancer and other deadly diseases (7aget *+>2-.
?
%f $ @ational ;urriculum For Medical .tudents
A
in the Bnited .tates is
followed, it is evident that more and more medical schools, universities, and
other health institutions have realised the importance of understanding the
process associated with doctor-patient interviews. %n the ;Cech Depublic,
however, as has already been discussed above (see ;hapter 6 &;ontribution of
;Cech .cience'-, both students and teachers of medicine suffer from an absence
of te8tbooks on medical interviews, and doctor-patient communication as
a university sub:ect has often been neglected. $ similar lack of interest in the
process of medical encounters has also been recorded in other European countries
(e.g. @orway-.
$lthough the aim of the presented dissertation is to contribute to the
apprehension of doctor-patient communication, my research into this kind of
interaction is not comple8, it is only partial. )hat is focussed on here are some
sociolinguistic and pragmatic aspects, for e8ample p$!ite"ess or as*mmetr*.
#hese features are characteristic of the relationship between doctors and their
patients, and &they reflect the process of change which, through increased access
to information, is redifining the roles of doctors and patients' (Humphreys 3//34
,-, as it has often been claimed.
>

$s a result, it is crucial to comment on the matter with the intention of
either supporting or challenging the following hypothesis4
H*p$thesis 1
46
Technical innovation has created conditions for profound social change. It has
altered the traditional asymmetry of doctor-patient relationship in favour of the
patient.
)ith regard to what has been stated in the theoretical part of the thesis
(see ;hapter * &%mportance of 5-7 ;ommunication Desearch' and ;hapter 3
&History of 5-7 ;ommunication Desearch'-, % also hypothesise that4
H*p$thesis +
Besides the development of technology, it is the more patient-centred approach
on the part of the doctor that is contributing to the reduction of hierarchies and
the redefinition of roles. This process of change is reflected in the employment of
linguistic strategies used by both the doctor and the patient, especially as regards
the function of speech acts, the use of medical terminology, and the
manifestation of politeness.
5.+ C$rp%s ,escripti$"
#he most challenging and time consuming task to satisfy the needs of the
analysis was to find relevant authentic language material.
#o obtain naturally e8isting data can be difficult, due to the
personal involvement of the speakers as well as the subsequent
transcription and tagging of the spoken te8ts by linguists,
namely because participants need not always agree with the
publication of their private conversation, and the division and
tagging such te8ts usually becomes a very demanding task,
even for linguistically minded people. (Brbanov 3//64 *2-
#o obtain naturally e8isting data of doctor-patient communication is even
more problematic, due to the ethica! c$"sierati$"s involved (Humphreys 3//3-.
1oth doctors and patients are often, for reasons of confidentiality, against
recording their interviews. )hen they are willing to participate in the research,
and finally allow the researcher to record their consultations, specific
requirements, including the change of names, must be followed.
47
#he language material for the present inquiry is taken from the corpus of
conversational te8ts recorded in consulting rooms throughout !reat 1ritain and
the Bnited .tates during *++/s, available in the book English for Doctors edited
by Mria !y"rffy in 3//* (see the 1ibliography-. #he corpus (;orpus %- in its
entirety represents a%the"tic (ace't$'(ace meica! c$"versati$". %t consists
roughly of about one hundred transcripts of spontaneous doctor-patient
interviews, which are further divided into *2 units, each of them based on
a different medical branch.
#he fact that all the ma:or medical disciplines are included is the biggest
advantage of the source material. For the purposes of the analysis five of them,
namely I"ter"a! Meici"e, Obstetrics a" -*"aec$!$&*, Paeiatrics,
Ot$'rhi"$'!ar*"&$!$&*, and Orth$paeics, have been intentionally chosen.
Each branch comprises ten medical encounters, meaning there are ,/ dialogues
under e8amination, the total number of turns being A3,. #he total word stock of
the analysed material is around *3,/// words.
#he reason for including the five medical disciplines is that they represent
different types of the genre under consideration0 in other words, different
manifestations of social reality. #hus the corpus gives us an opportunity for the
.c$mm%"icative c$mparis$"/, i.e. a comparative analysis of doctor-patient
interviews in different medical settings. .uch an approach, as % hope, could either
support or contradict the hypothesis (e.g. MEllerov, Hoffmannov, and
.chneiderov *++3- that4
H*p$thesis 0
Different dialogic contexts of particular medical disciplines shape the meaning
and the character of doctor-patient dialogues taking place within the medical
disciplines.
Moreover, the approach may also reveal a more comprehensive picture of doctor-
patient communication and the process of its change.
%t must be added that the corpus under analysis also has its limitations.
Firstly, it is necessary to mention the incompleteness of some dialogues.
#herefore, those linguists who would like to study, for e8ample, the structural
48
organisation of doctor-patient dialogues in detail will probably miss certain
phases of the medical encounter (relating to the patient, terminating-. .econdly,
the dialogues are not tagged0 there are only Frough= transcripts available. Finally,
the editor does not include complete sociolinguistic information about the
participants whose interviews she had recorded. #heir age is sometimes unknown.
)e also lack details about their social status.
@evertheless, the advantages of the chosen language source prevail.
%t presents naturally occurring data and prepares a background for the above
mentioned &communicative comparison', which has not been used, to the best of
my knowledge, as a methodological approach.
+
.ince the corpus includes spoken
5-7 conversations, the results of the analysis are relevant only for the
conversational te8ts. #he validity of all the suggested conclusions in the thesis is
largely limited by the e8tent of the corpus data.
#o balance the weak points of the corpus edited by Mria !y"rffy (3//*-,
one more source of language material has to be taken into consideration.
$ second corpus of recordings of medical dialogues that has been worked with
(;orpus %%- was prepared by Goy 7arkinson and published as one part of her
Manual of English for the Overseas Doctor
*/
(see the 1ibliography- in *++>. #he
second corpus contains authentic spoken te8ts and is of the same length as the
first one (i.e. A3, turns-. #he total siCe of te8t under e8amination amounts to
*/,/// words.
$lthough the second corpus does not include all the medical branches, and
it is not tagged,
**
the advantage is that it presents complete medical encounters. %t
also offers information about age, social status, and other relevant factors which
form important background knowledge for any sociolinguistic analysis (Holmes
*++>-. However, any conclusion offered in this dissertation is based on the data
e8cerpted from ;orpus %. ;orpus %% has only been chosen with the aim of
comparing the information provided, and is used to increase the degree of
ob:ectivity of the selected research material.
49
5.0 Meth$s $( A"a!*sis
$ccording to )ynn (for details see ;hapter 2 &Methodology of 5octor-
7atient ;ommunication Desearch'-, there are two ma:or approaches to doctor-
patient relationship research4 'Hthe s$ci$!i"&%istic appr$ach (of which
ethnomethodological conversation analysis is quite typical- and the meica!
appr$ach (of which 1ales= %nteraction 7rocess $nalysis and 1yrne I Jong=s
method are typical-' ()ynn *++,4 */, my emphasis-. %n his book The Linguistics
of Doctor-Patient Communication. An analysis of the methodology of doctor-
patient communication research (*++,-, )ynn comments on the strengths and
weaknesses of both of them, and concludes his analysis by suggesting
a c$mbi"ati$" $( the t#$ meth$$!$&ies. % share his point of view by trying to
combine the qualitative aspects of conversation analysis with the quantitative
aspects of the medical approach.
#he actual analysis of the thesis is organised in three main sections (?->-,
each of them focussing on a different linguistic tool9device. ;hapter ? starts by
discussing the (%"cti$" $( speech acts in doctor-patient conversation. %n the first
part of the chapter, the methods of asking and roles of questions are analysed.
#he second part of the chapter develops the discussion by dealing with the
function of other speech acts4 statements, answers, reactives, and directives.
;hapter A describes the %se $( meica! termi"$!$&*. %n ;hapter > my findings
are summarised by researching the phenomenon of p$!ite"ess a" its !a"&%a&e
ma"i(estati$" in doctor-patient interviews. $ll these levels of analysis have been
chosen since they, as it is believed, most distinctly reflect the process of change
&in maintaining or challenging the asymmetry which is said to be characteristic of
the doctor-patient relationship' (Humphreys 3//34 ,-.
Each chapter is organised in a similar order. First of all, there is an attempt
to consult the most recently published books and articles touching the topic of the
linguistic tool9device under e8amination, so that % am able to establish a
background with which my own findings could be compared. .econdly, from ,/
dialogues of the first corpus, the investigated material (speech acts, medical
terms, politeness devices- is sampled. #hirdly, doctor-initiated and patient-
50
initiated samples are distinguished and classified according to their place
(phase-
*3
within the dialogue.
My quantitative findings are offered in the form of tables and figures. #he
tables present absolute and relative frequencies of the distribution between
doctors and patients. #hey also give information about the statistics within
particular medical branches with regard to the phases of the doctor-patient talk.
Moreover, % offer results of the F-test,
*2
which reveals the significance of
distinctions between the medical disciplines. ;orrelation
*6
between particular
variables (participants, medical branches, phases- has also been calculated.
*,

$fter that the qualitative interpretation of the quantitative findings
follows. #he conte8t of the interview is discussed, and the roles and strategies of
doctors and patients during the talk are compared. #he functions of particular
turns and interactional sequences are interpreted, and % analyse how they
contribute to the relationships of the encounter and to the structural organisation
of the discourse.
%n the part titled &;omparison of .amples', my findings are either
supported or contradicted by comparing the results of the first sample (e8cerpted
from ;orpus %- with the results of the second sample (e8cerpted from ;orpus %%-.
#he statistical programme that is used for this comparison is chi-square,
*?
which proves how similar or different the analysed samples are. 7ossible
differences and obscurities are discussed, and the te8t is supplemented with
transparent e8amples taken from both corpora. Each chapter is summarised with a
chart stressing the most important findings in relation to symmetry and9or
asymmetry.
#he thesis is divided into two books. #he analytical part of the first book
has been briefly described. $side from the three main sections, it also contains
the final conclusions with the summary of the most important results of the work,
notes, and information about the bibliography. #he bibliography section is
further divided into three parts4 printed sources, internet sources, and
internet dictionaries and encyclopaedias. #he second book consists of two
supplementary materials. #he first presents e8amples of the individual te8ts of
both corpora. #he second offers a list of medical terminology used throughout
the thesis.
51
5.1 ,e(i"iti$"s a" Termi"$!$&*
1efore presenting the analysis, it is necessary to define the terms used
throughout my research. For stylistic purposes, in order not to repeat the same
sets of words, such combinations as doctor-patient interaction doctor-patient
communication doctor-patient discourse doctor-patient conversation doctor-
patient tal! and doctor-patient intervie" are used interchangeably.
*A
$lthough %
am well aware of sometimes big differences in their meanings in different
conte8ts, for e8ample conversation viewed as an informal way of spoken
communication, it is not necessary to distinguish between them in this work.
#he terms medical intervie", medical encounter and medical consultation are
also used interchangeably.
)hen the sociolinguistic approach is discussed, % take advantage of using
such terms as ethnomethodological conversation analysis, or its short forms,
conversation analysis and analysis of conversation. $ll these terms should be
understood as &a symbiosis of approaches towards the interpretation of the
dialogue structure and its interactive, interpretative meaning' (Brbanov 3//24
**-. #he applied methodology is thus fully interdisciplinary and % do agree with
the words of Dichard !wyn, who claims4
% am critical of the social scientific ritual of delimiting
Fmethodology= as some kind of sacrosanct orthodo8y K like its
Fmodels=, methodology too is a tool, not an end itself. Method,
it seems to me, should be implicit in acts of description and
analysis rather than cocooned within its own ideological space.
(!wyn 3//3, &%ntroduction'-

%t is also important to add that besides the technical vocabulary listed above,
a large number of linguistic terms have been used in the dissertation (see the !lossary of
Jinguistic #erms-. #heir definitions are taken over from several sources4 The Cam#ridge
Encyclopaedia of the English Language by 5avid ;DL.#$J, Pragmatics by !eorge
LBJE, Linguistics by H. 5. )%55M).M@ and $ociolinguistics by 1ernard .7MJ.NL
(for details see the 1ibliography-.
52
5.5 N$tes
* %n my research, % have cooperated with several medical doctors and students,
especially NvOtoslava 7apePov, M.5., and Gan 7apeP.
3 1hatia (*++2- mentions content (i.e. topic-, form (i.e. the choice of words-,
intended audience (i.e. the participants-, medium or channel (i.e. written,
spoken, face-to-face, telephone conversation, etc.-.
2 $ conversation in the surgery of a paediatrician frequently involves three
speakers4 doctor, patient, parent.
6 $side from this very general model of doctor-patient communication, we
could also distinguish some minor sub-genres depending upon different
settings or conte8ts in which they are used. % can mention, for e8ample,
dialogues between doctors and their clients performed on the phone, or
cases when doctors visit patients at home. However, these instances of
doctor-patient communication have not been taken into consideration
within the narrow confines of the thesis.
, $vailable online4Qhttp499www.physicianpatient.or9e8pR//*.html S, cited **. 2.
3//6.
? $ commonly quoted e8ample concerns one doctor, who failed to recognise
spine cancer in his patient, although he was repeatedly informed about the
possibility of this diagnosis. #hat failure had disastrous consequences, and
eventually led to the death of the patient.
A $vailable online4Qhttp499www.$M.$.org9humed9;$M9c>.doc S, cited **. 2.
3//6.
> %n a speech in @ovember 3//* the president of the !eneral Medical ;ouncil,
.ir 5onald %rvine said4 &)e live in the information age. For the first time
in history any of us can interrogate the database of medicine directly
through the internet rather than through doctors H %nformation is power.'
#his information is acquired in Humphreys (3//3-.
+ #his term (originally &komunikativnT komparatistika&- was used for the first
time by MEllerov, Hoffmannov, and .chneiderov in their collection
Mluven% &e'tina v autentic!(ch te)tech U.poken ;Cech in $uthentic #e8tsV
(*++34 */2-. %n their opinion, the comparison of different medical branches
53
should become the perspective of future research within the doctor-patient
interaction.
*/ #he very first edition of this Manual was published in *+?+. % use its new (the
fifth- edition, &which has been completely revised with many new case
histories' (7arkinson, &7reface'-.
** #he fact that both corpora are not tagged is not crucially important for the
research in the levels of analysis % have decided to elaborate. $lthough it is
sometimes necessary to understand the phonic level of the interaction
(e.g. in the cases of politeness-, % have not been interested in the prosodic
realisation of the linguistic tools used in doctor-patient communication.
Moreover, % could always consult the recordings of the investigated
material.
*3 #here are more ways to structure the medical encounter. For e8ample, 1yrne
and Jong (*+A?- distinguish si8 phases4
*. relating to the patient0
3. discovering the reason for attendance0
2. conducting a verbal or physical e8amination or both0
6. consideration of the patient=s condition0
,. detailing treatment of further investigation0
?. terminating.
Heath (*++3-, on the other hand, distinguishes only two sections4
*. the interview (information gathering phase-0
3. diagnose and management of the condition.
For the purposes of my analysis % distinguish three basic phases4 history-
ta!ing e)amination treatment.
*2 &F test K test of whether two samples have the same standard deviation with
specified confidence level. .amples may be of different siCes.'
$vailable online4Qwww.isi8sigma.com9dictionary9F-test-,3,.htm S, cited
**. 2. 3//6.
54
*6 &;orrelation is a measure of the relation between two or more variables.
;orrelation coefficiants (% use 7earson- can range from -*.// to W*.//. #he
value of K*.// represents a perfect negative correlation while a value of
W*.// represents a perfect positive correlation.'
$vailable online4Qwww.statsoftinc.com9te8tbook9stathome.html S, cited **.
2. 3//6.
*, For other details about the F-test and correlation, see also, for instance,
Deiterov (3///-.
*? ;hi square is a non-parametric test of statistical significance for bivariate
tabular analysis (also known as crossbreaks-. $ny appropriately performed
test of statistical significance lets you know the degree of confidence you
can have in accepting or re:ecting an hypothesis. #ypically, the hypothesis
tested with chi square is whether or not two different samples (of people,
te8ts, whatever- are different enough in some characteristic or aspect of
their behavior that we can generaliCe from our samples that the
populations from which our samples are drawn are also different in the
behavior or characteristic.
$vailable online4Qhttp499www.georgetown.edu.html S, cited **. 3. 3//,.
*A #he word doctor is used to refer to a person with an M.5. degree.
55
Chapter Si2
F3NCTION OF SPEECH ACTS IN ,'P COMM3NICATION
7erhaps the most vivid point of convergence between language and social
organiCation arises at the level of speech acts. H because activities or speech
events are built out of particular component actions, speech acts are arguably
central to the analysis of all forms of interaction.
5rew I Heritage
4.1 I"tr$%cti$"
#he aim of ;hapter ? is to analyse the function and the character of speech
acts in doctor-patient interaction. #he chapter consists of two main parts.
#he first section describes the role of questions and methods of asking.
#he second section is devoted to a more thorough e8amination of other speech
acts and their sequential properties. $lthough more studies dealing with the topic
have been published in recent years (!wyn 3//3, Humphreys 3//3-, my findings,
as has been discussed in the introductory part of the thesis (see ,.3-, are based on
a comparative analysis of various medical disciplines.
My approach is grounded in the speech act theory as proposed by $ustin
(*+?3- and elaborated on by .earle (*+?+-. )ith respect to the classification of
speech acts, % have drawn upon several sources, namely #odd (*+>2- and
5=$ndrade (n.d.-. ;oncerning the sequential organisation, the findings of the
1irmingham discourse analysts (e.g. ;oulthard *+AA- and the turn-taking analysis
of .acks, .chegloff, and Gefferson (*+A6- have been consulted. For the
background description of the interaction in institutional settings % refer to 5rew
and Heritage (*++3-.
%n accordance with the research which has already been performed, %
understand speech acts as acts of communication &performed by the use of
language, either in speech or writing, involving re(ere"ce5 ($rce5 and e((ect'
()iddowson *++?4 *2*-. #hese acts are usually classified into five categories,
namely ec!arati$"s, represe"tatives, e2pressives, irectives, and c$mmissives
(e.g. .earle *+A?-. $ distinction is also made between irect speech acts and
i"irect speech acts.
*

56
5espite what the motto at the beginning of the chapter suggests, the speech
act theory has been heavily criticised.
3
;onversation analysts have specifically
argued that speech act theorists &do not address a cultural, or conte8tual,
sociological analysis', and that &the basic unit of analysis used is the self-
contained action rather than the interaction unit, where conte8t and the role of all
the participants are important' (#odd *+>24 *?*-. @evertheless, % still find this
approach useful as it contributes to a broader view of how power and asymmetry
are distributed in the medical encounter.
%n order to satisfy the specific needs of doctor-patient communication,
#odd=s classification of speech acts has been adopted.
2
$s a result, five
categories4 stateme"ts (E8ample *-, 6%esti$"s (E8ample 3-, a"s#ers (E8ample
2-, irectives (E8ample 6-, and reactives (E8ample ,-, have been distinguished.
#he distinction between answers and reactives consists in the fact that the
reactives usually follow the answers and are provided by doctors, who use them
to acknowledge the answers provided by patients.
E2amp!e 1
54 $ome of the slides that *+ll ta!e from you today "ill #e loo!ed at in clinic and
from these *+ll decide "hether you re,uire treatment or not.
E2amp!e +
54 Could you descri#e "hat the vomiting is li!e Mrs $mith for e)ample does
clear your lap and land on the floor-
E2amp!e 0
54 .as it managerial / did you have a lot of responsi#ility-
P7 es, I was in charge of a large department.
E2amp!e 1
54 0o" let me have a loo! at you. !it down open your mouth head slightly
forward. Let me put this tongue depressor on your tongue.
E2amp!e 5
54 1ave you #een a#road to any tropical or developing countries recently-
57
74 2es * 3ust came #ac! from Thailand a fe" months ago.
,7 I see.
;ompared to .earl=s classification, there are a few differences in my
approach. @oticeably, besides others, two speech acts, namely e2pressives and
c$mmissives, have been e8cluded from the analysis. $lthough speech acts of
these types do emerge in doctor-patient talk, their occurrence is not conspicuous
and is rather infrequent (E8amples ? and A-. $s #odd (*+>24 *?*- maintains4
&.trong emotion is not considered appropriate H and actions such as vowing and
e8asperation tend to be played down and absorbed into other acts.'
E2amp!e 4
54 Do you have a 3o# at the moment-
74 0o *+ve 3ust #een made redundant.
,7 "h, I am sorry. .hat "as your 3o#-
74 * "as des!-#ound *+m afraid. (e8pressive-
E2amp!e 8
74 Oh Than! 4od5 0o sign of cancer5 0o sign at all-
54 2es that+s right. 6ut listen for a moment. 7 *n the future you really must try to
stop smo!ing as long as you !eep smo!ing you can get more trou#le "ith your
voice and one day it could turn nasty.
P7 "h, yes, Doctor. I am trying # *+ve cut do"n a lot #ut you !no" it+s not easy.
(commissive-
4.+ R$!e $( 9%esti$"s i" ,'P C$mm%"icati$"
$s has been stated above, this section of ;hapter ? concentrates on the
role of questions and methods of asking, especially how they contribute to
asymmetry, the characteristic feature of the relationship between doctors and
their patients (Mishler *+>6, #odd and Fisher *+>2, MEllerov 3//3-. Moreover,
it discusses some differences and obscurities in previous research (e.g. Norsch,
!oCCi, Francis *+?>, )est *+>2, $insworth-<aughn *++>-, and offers a possible
e8planation.
58
&$sking questions is a very important part of your visit to the doctor. 1y
asking questions your doctor can help clear up doubts, concerns, or worries. %t is
an important way in which you can get things straight.' (Doter and Hall *++34
*/6-. $s is obvious, questions are the focal point of any medical encounter. #heir
centrality is rooted in the fact that they constitute key mechanisms &by which
power can be e8ercised and resisted' (Humphreys 3//34 3-. For these reasons
questions have often been discussed separately from other speech acts
(e.g. Frankel *++/-. #he structure of the presented chapter follows this trend.
4.+.1 A"a!*sis
From ,/ dialogues consisting of A3, turns, 2A6 questions have been
e8cerpted. %n accordance with the research which has been done before ()est
*+>2, Humphreys 3//3-, % understand the ,uestion (E8amples >, +- as &Hany
utterance requiring a response within the conte8t of the interaction, regardless of
form (interrogative, declarative, etc.-0 any formal question0 and any utterance that
receives a response as though it were a question' (Humphreys, 3//34 3/-. #he
e8cerpted questions have been categorised into three groups, namely *es:"$
6%esti$"s (L9@-, either:$r 6%esti$"s (E9M-, and $pe" 6%esti$"s.
6
Furthermore,
doctor-initiated and patient-initiated questions have been distinguished and
classified according to their place (phase- within the dialogue.
E2amp!e ;
,7 $ow long have you been smoking%
74 $ince * "as a#out fourteen.
E2amp!e <
,7 !o, you say that you are having problems with bleeding or bruising.
74 2es * am.
My classification of questions draws on Xuirk et al. (*+>,4 >/6-, who
distinguish three ma:or classes of questions according to the different answers
e8pected4 =ES:NO 6%esti$"s, i.e. those that e8pect affirmation or negation
59
(E8ample */-0 ALTERNATI>E 6%esti$"s, i.e. those that e8pect as the reply one
of two or more options presented in the question (E8ample **-0 ?H'6%esti$"s,
i.e. those that typically e8pect a reply from an open range of replies (E8ample
*3-.
E2amp!e 1@
,7 $ave your waters broken yet%
74 2es a#out a half an hour ago.
E2amp!e 11
,7 &re they very painful or do you 'ust feel tightening across the tummy%
74 They+re really #ecoming ,uite sore no".
E2amp!e 1+
,7 $ow often are your contractions coming%
74 A#out every ten minutes at the moment.
#he reason that different terminology for particular question categories is
used in my analyses ($J#ED@$#%<E questions K E9M questions, )H-questions K
M7E@ questions- rests in the fact that researchers studying doctor-patient
communication (e.g. Humphreys 3//3, Doter and Hall *++3- frequently apply the
same classification as is adopted in the thesis. @evertheless, the definitions of
E9M questions and M7E@ questions correspond to those proposed by Xuirk et al.
(*+>,- for $J#ED@$#%<E and )H-questions (see further in section ,.6-.
.tenstr"m (*+>6- applies a different classification of questions. Bnlike
Xuirk et al. (*+>,-, who base their categories on semantic and formal criteria,
.tenstr"m (*+>6- classifies questions with regard to their form and function.
Function refers to what type of D (response- is required4
QX4 identifyS asks for identification (of the referent of the
)H-word-0 QX4 polarS requires a polarity decision0
QX4 confirmS asks for confirmation of what is proposed in X0
QX4 acknowledgeS asks for acknowledgement of the
information proffered. (.tenstr"m *+>64 *,3-
60
$s regards le8ico-grammatical forms, .tenstr"m (*+>64 *,3- distinguishes
the following categories of questions4 #h 6%esti$"s, a!ter"ative 6%esti$"s,
*es:"$ 6%esti$"s, ta& 6%esti$"s (E8ample *2-, ec!arative 6%esti$"s (E8ample
*6-, ec!arative A ta& (E8ample *,- and ec!arative A pr$mpter (E8ample *?-.
E8amples of these categories e8cerpted from the material that has been
researched in the presented thesis are supplemented below.
E2amp!e 10
,7 It(s the right side that bleeds more, isn(t it%
74 2es
E2amp!e 11
,7 our wife is at home, is she%
74 2es "ith my t"o youngest children.
E2amp!e 15
,7 !o you say that you are having problems with bleeding or bruising.
74 2es * am.
E2amp!e 14
M7 I(ve heard different views on this, you know.
54 That+s ,uite true Mrs $mith.
.tenstr"m=s typology of questions is more subtle than Xuirk et al.=s.
However, her approach has not been adopted in the dissertation as it would be
difficult to organise its quantification. $ functional description of questions by
#sui (*++3- has not been applied for the same reason.
,
#he results of the quantitative analysis are offered in the form of ten tables
below. #ables *, 3, 2, 6, ,, and ? present absolute and relative frequencies of the
distribution of questions between doctors and patients. #hey also give
information about the number (percentage- of questions in particular medical
specialities with regard to the question types and phases of the 5-7 talk. #ables A,
>, +, and */ offer results of the F-test.
?

61
% have also calculated correlation between particular variables
(participants, medical specialities, question types, and phases-. However, the only
significant correlation (rY/.22- is between the participants and phases of the
encounter. For e8ample, patients usually raise their questions during the phase of
e8amination and treatment. #here are no patient-initiated questions asked during
the history-taking phase. Mther correlation is not as important.
Tab!e 17 Abs$!%te Fre6%e"c* $( 9%esti$"s i" ,'P I"tervie#s
A#s. Particip Phase 9%esti$" T*pe T$ta!
D P 1ist E)am Treat 280 E8O Open
*nternal ++ * 36 A? / 62 3> 3+ 1@@
4ynaec. ?, * / ?6 3 2? > 33 44
Paed. >> 6 *2 A+ / 6, > 2+ <+
O9L ,, > * ?* * ,/ A ? 40
Orthop. 6A ? / 6A ? 3, * 3A 50
T$ta! 051 +@ 0; 0+8 < 1<< 5+ 1+0 081
Tab!e +7 Re!ative Fre6%e"c* $( 9%esti$"s i" ,'P I"tervie#s
: Particip Phase 9%esti$" T*pe T$ta!
D P 1ist E)am Treat 280 E8O Open
*nternal ++ * 36 A? / 62 3> 3+ +8
4ynaec. +> 3 / +A 2 ,, *3 22 18
Paed. +? 6 *6 >? / 6+ + 63 +5
O9L >A *2 3 +? 3 A+ ** */ 18
Orthop. >+ ** / >+ ** 6A 3 ,* 11
T$ta! <5 5 1@ ;8 0 50 11 00 1@@
Tab!e 07 Abs$!%te Fre6%e"c* $( ,$ct$r'I"itiate 9%esti$"s
A#s. Phase 9%esti$" T*pe T$ta!
1ist E)am Treat 280 E8O Open
*nternal 36 A, / 62 3> 3> <<
4ynaec. / ?6 * 2? > 3* 45
Paed. *2 A, / 6, > 2, ;;
O9L * ,6 / 63 A ? 55
Orthop. / 6A / 33 * 36 18
T$ta! 0; 015 1 1;; 5+ 111 051
62
Tab!e 17 Re!ative Fre6%e"c* $( ,$ct$r'I"itiate 9%esti$"s
: Phase 9%esti$" T*pe T$ta!
1ist E)am Treat 280 E8O Open
*nternal A 3* / *3 > > +;
4ynaec. / *> / */ 3 ? 1;
Paed. 6 3* / *2 3 */ +5
O9L / *? / *3 3 3 14
Orthop. / *2 / ? / A 10
T$ta! 11 ;< @ 50 11 00 1@@
Tab!e 57 Abs$!%te Fre6%e"c* $( Patie"t'I"itiate 9%esti$"s
A#s. Phase 9%esti$" T*pe T$ta!
1ist E)am Treat 280 E8O Open
*nternal / * / / / * 1
4ynaec. / / * / / * 1
Paed. / 6 / / / 6 1
O9L / A * > / / ;
Orthop. / / ? 2 / 2 4
T$ta! @ 1+ ; 11 @ < +@
Tab!e 47 Re!ative Fre6%e"c* $( Patie"t'I"itiate 9%esti$"s
: Phase 9%esti$" T*pe T$ta!
1ist E)am Treat 280 E8O Open
*nternal / , / / / , 5
4ynaec. / / , / / , 5
Paed. / 3/ / / / 3/ +@
O9L / 2, , 6/ / / 1@
Orthop. / / 2/ *, / *, 0@
T$ta! @ 4@ 1@ 11 @ < 1@@
Tab!es 85 ;5 <5 1@7 Res%!ts $( the F'testB
A
; Participa"t
-*"aec. Pae. ORL Orth$p.
I"ter"a! 3,//E-/>Z *,//E-**Z 6,//E-3,Z 3,//E-33Z
-*"aec. 3,//E-/,Z >,//E-*6Z 2,//E-*3Z
Pae. 3,//E-/,Z /,///3Z
ORL /,A2
63
; 9%esti$" T*pe
-*"aec. Pae. ORL Orth$p.
I"ter"a! /,33 /,3 /,/3Z /,*6
-*"aec. /,A2 /,//6Z /,,3
Pae. /,//*Z /,A3
ORL /,//*Z
; Phase
-*"aec. Pae. ORL Orth$p.
I"ter"a! A,//E-*2Z /,/,Z *,//E-**Z /,/3Z
-*"aec. *,//E-/>Z /,A? 6,//E-/?Z
Pae. *,//E-/AZ /,6>
ORL 3,//E-/?Z
; 9%esti$" T*pe
E2ami"ati$" Treatme"t
Hist$r* /,? /,,?
E2ami"ati$" /,2A
4.+.+ Fi"i"&s
#he importance of questions and answers in 5-7 dialogues is :ustified
because they &introduce, develop and dissolve topics' (7aget *+>24 A*-,
>
and help
to reach the correct diagnoses and treatment. .tatistics % have tried to elaborate
on show that as many as ?6+ turns (+/[- out of A3, are formed solely by
questions or answers. Mut of 2A6 questions, 2,6 (+,[- are initiated by doctors,
only 3/ (,[- are initiated by patients (see #ables *, 3-. *++ (,2[- belong to L9@
questions, ,3 (*6[- to E9M questions, and *32 (22[- to open questions (see
#ables *, 3, and Figure *-. 2> questions (*/[- appear during the history-taking
phase, 23A (>A[- during the e8amination phase, and + (2[- during the treatment
phase (see #ables *, 3, and Figure 3-.
64
;onsidering the findings of previous researchers ($insworth-<aughn *++>,
)est *+>2-, these results are surprising. #he greatest difference is in the
distribution of questions and answers between doctors and patients. $s )est
points out, only +[ of all questions in her material are patient-initiated. #he
relative frequency of patient-initiated questions in the corpus studied by
$insworth-<aughn is much higher (6/[-. #hus, the very first problem which
needs to be solved is to find an e8planation for this divergence.
Mne might suspect that the distinction could be closely connected with the
conte8t of the particular medical branch under e8amination. 7atients, as non-
professionals, are not acquainted with any of these disciplines, they lack the
knowledge of medical terminology,
+
and hardly understand the process of
e8amination and following treatment. However, for some reasons, one may still
believe that certain medical branches (e.g. 7aediatrics or MDJ- are easier to
become familiar with than to understand, for instance, %nternal Medicine or
Mrthopaedics.
*/
$s a result, patients are more confident and would rather ask
more questions when visiting a paediatrician or an oto-rhino-laryngologist than
when seeing an internist.
.uch hypothesis would be acceptable if there was no evidence against it.
Bnfortunately, both )est and $insworth-<aughn worked with collections of
dialogues between patients and their family practitioners, i.e. within the same
medical branch. .till, their findings were considerably different. Furthermore, the
correlation (rY/.3- that has been calculated for my material proves there is no
direct correspondence between the medical branch and participants, and even
some results of the F-test (e.g. the comparison of MDJ and Mrthopaedics with
65
regard to participants, FY/.A2- show that we cannot take the proposed assumption
for granted.
$lso worth possible investigation is whether the asymmetrical features in
the distribution could not be sought in the differences in se8, race, and age of
doctors and patients who are studied. However, according to )est (*+>24 >>-4
&@either se8 nor race (of physician or patient- seemed to influence the
distribution of questions between parties.' .he also claims that the very same
conclusion works for the category of age. ;onsequently, the e8planation must be
looked for somewhere else.
#he interpretation of 5-7 questions and answers in the corpus that has
been worked with proves that most questions patients ask take place when they
really feel deeply concerned about a medical issue. Bsually they must undergo an
operation (E8amples *A and *>-, and they want doctors to e8plain the operation
in detail. #hey want information about what it involves, whether it is dangerous
or not, what possible complications they may e8pect. .imply, patients wish to
hear that the surgical intervention will help them and there is nothing to fear. %t
does not matter whether such dialogues take place in consulting rooms of MDJ
practitioners or orthopaedic specialists. %t does not matter of which age, se8, or
race doctors and their patients are.
**
#he most important element that should be
taken into consideration when solving the problem of the distribution of 5-7
questions is the level of patient=s an8iety concerning his9her health problems and
their treatment.
E2amp!e 18
54 2ou+ve got a deviated nasal septum. This part of your nose is cartilage and
instead of #eing straight it+s t"isted and the t"ist is #loc!ing you on the left side.
*+m pleased to say "e can fi) it for you. .e can put it right "ith an operation to
straighten up your nose as there are nomodicenes or ta#lets really that "ill help.
P7 Is it a big operation%
54 0o not too #ig. *t+s ,uite common. *f you agree "e+ll #ring you into hospital
the day #efore the operation. 2ou can usually go home the day after your
operation or possi#ly the second day after that. .e do it under a general
anaesthetic. *t+s done through your nostrils there+s no cuts on your face.
P7 )o black eyes%
66
54 0ot for this operation. .hen you "a!e up from anaesthetic you+ll pro#a#ly
have a #andage up #oth nostrils overnight so you see you+ll have to #reathe
through your mouth that night. .ould you li!e the operation-
P7 *ill it work%
54 2es "e can say that "e can ma!e things a lot #etter than they are no". (Mto-
rhino-laryngology-
E2amp!e 1;
54 Mrs. .allis * have the results of your <-rays. These sho" you have severe
osteoarthritis of your left hip. This is due to a congenital dislocation of the hip
"hich you+ve had since #irth. * thin! the #est treatment for you "ould #e an
operation to replace your left hip.
P7 Tell me, Doctor, is that a ma'or operation%
54 2es it is undou#tedly. 6ut you are having so much trou#le * do not thin! there
is any other alternative.
P7 I(m very worried about this, Doctor. *hat does the operation involve%
54 *t is a ma3or operation "hich "ould re,uire you to #e in hospital for a#out t"o
"ee!s. 2ou=ll come to hospital a day or t"o #efore surgery so that "e can e)amine
you and chec! that you are fit for an anaesthetic. The operation itself involves
,uite a long cut on the outside of your thigh and then the "orn part of your hip
"ill #e cut a"ay and replaced "ith a metal and plastic 3oint. This should ma!e
you more comforta#le and your hip less stiff. 6ut of course as "ith any
operation there+s a small ris! of complications.
P7 *hat are those complications, Doctor%
(Mrthopaedics-
4.+.+.1 ,$ct$r'I"itiate 9%esti$"s
$s has been mentioned above, doctor-initiated questions are more
numerous than those initiated by patients. Mut of 2,6 doctor-initiated questions,
*>> (,2[- can be classified as L9@ questions, ,3 (*,[- as E9M questions, and
**6 (23[- as open questions (see #ables 2, 6, and Figure 2>. 2> (**[- take place
during the history-taking phase, 2*, (>+[- during the e8amination phase, and
only * (/[- during the treatment phase (see #ables 2, 6, and Figure 6-.
67
Bnlike patients (see ?.3.3.3-, doctors freely take advantage of using all
question types. 1ecause the correlation between the question type and the
participant is quite low (/./2-, there is no significant correspondence between
these two attributes of the consultation. )hat is significant, however, is the fact
that *//[ of doctor-initiated questions are asked during the history-taking and
e8amination section. .ince doctors have on the average only eight minutes to
&establish rapport, discover the reason for a patient=s visit, verbally and
physically e8amine the patient, discuss the patient=s condition, establish a
treatment plan, and terminate the e8change' (7aget *+>24 ,+-, these two parts are
reserved solely for the gathering of information and to concentrate and diagnose
responsibly.
)e may see that there is only one doctor-initiated question asked during
the treatment phase in my corpus (E8ample *+-. #his question appears after a
long speech by the doctor concerning the possible treatment, and invites a
female patient to raise any questions concerning her problems. $s the correlation
proves (rY/.22-, there is a relation between participants and phases in their
dialogue. #he treatment section is used by doctors to e8plain the process of
treatment or therapy, and for patients to ask additional questions about their
diagnosis and following cure (E8ample 3/-.
E2amp!e 1<
,7 *ould you like to ask me any +uestions,%
74 Doctor * "onder ho" * got these "arts.
68
E2amp!e +@
P7 Is it a big operation%
54 0o not too #ig. *t+s ,uite common.
%n addition to what has been mentioned about the role of doctor-initiated
questions during the treatment section, some recent studies refer to a specific
sequence of doctor=s talk, which repeatedly appears throughout each medical
consultation, especially during the treatment phase (e.g. Humphreys 3//3-. #he
sequence consists of a rhetorical question, an answer, and final i"terpretati$".
$s Humphreys (3//34 26- points out4
#his Xuestion-$nswer-%nterpretation sequence places the
patient in a position where they could, if they wished, question
not only the treatment offered, but the thinking behind it.
#herefore, this strategy is significant in balancing the
asymmetry between doctors and patients.
Mn the other hand, )allen, )aitCkin, and .toeckle (*+A+- point out that &less
than *[ of total time in information e8change between patient and physician is
spent on physicians e8planations to patients',
*3
and that the 5-7 interviews are
strictly asymmetrical. @evertheless, since the interpretation phase is also strongly
rooted in the corpus that has been worked with within all the medical branches
(E8amples 3*, 33, and 32-, % must confirm the findings reported by Goanne
Humphreys.
E2amp!e +1
54 2ou have #een e)posed to the genital "art virus through se)ual contact "ith
some#ody "ho has genital "arts or has the virus in his s!in and the genital area.
?nfortunately * cannot tell you ho" long you have had the virus in your s!in or
"ho you could have caught it from as it does not have to #e your present partner
#ut could have #een from a partner several years ago7 The "arts "ill disappear
"ith treatment #ut unfortunately * can+t give you any guarantee that they "ill
not return.
(!ynaecology-
69
E2amp!e ++
54 The cardiologist "ill inform you a#out the procedure. After you have received
the isotope in3ection you should eat or drin! something containing fat such as
cheese mil! or a sand"ich. This is necessary in order to stimulate the su#stance
#eing passed through the live so that "e can ma!e an accurate image of the
#lood supply to your heart muscles
(%nternal medicine-.
E2amp!e +0
54 .e need to change your tracheotomy tu#e. .e+ve got the ne" ready here "ith
an introducer. Let+s untie these tapes around your nec! and #ring them round.
That+s good. .e have the suction running in case "e need it. .e have to suc! out
your tracheotomy #efore "e ta!e the old tu#e as "e put it in. *t+ll only suc! as "e
pull it out. 0o" ta!e a deep #reath for me and "e+ll pull this tu#e out. 9ight "e
are putting a ne" tu#e in.
(Mto-rhino-laryngology-
4.+.+.+ Patie"t'I"itiate 9%esti$"s
#he distribution of patient-initiated questions in my corpus is as follows4
** of them (,,[- belong to L9@ questions, no question (/[- could be classified
as E9M question, and + (6,[- belong to open questions (see #ables ,, ?, and
Figure ,-. #here are no patient-initiated questions (/[- taking place during the
history-taking phase, *3 questions (?/[- take place during the phase of
e8amination, and > questions (6/[- take place during the phase of treatment (see
#ables ,, ?, and Figure ?-.
70
#here are four important points which we should take into consideration
when interpreting the patient-initiated questions in my corpus. #he first being
that there are very few questions (only 3/- posed by patients. %t is not easy to find
a reliable e8planation, and % align myself with #uckett and colleagues (*+>,-,
who report that many patients do not want to ask questions. &#he lack of question
asking may reflect lack of confidence and skill for many patients K but for some
patients it may reflect true avoidance of or resistance to information' (Doter and
Hall, *++34 */6-.
%nterestingly, no questions are asked during the history-taking phase
(E8ample 36-. $t the beginning of the consultation, the interview is usually in
doctor=s hands. 5octors aim to acquire as much information as possible, and there
is no place for patients to raise their questions, even if they want to. #o keep
this form, doctors make only short pauses so as not to give patients too much
time to ask. #hey also avoid giving them any e8plicit invitation to do so.
$ccording to Humphreys (3//34 2A-4 &#his may indicate a higher degree of
consensus to the conventional roles of doctor and patient.'
E2amp!e +1
74 Doctor * can never #reathe out of my left nostril.
,7 $ave you ever broken your nose%
74 2es last year.
,7 $ave you had any bad colds or high temperatures lately%
74 0o.
,7 &re you otherwise well%
74 2es.
,7 Do you get hay fever in the summer%
74 0o.
,7 *hat(s your 'ob%
74 * "or! in an office.
,7 Is it very dusty%
74 0o not really.
,7 Do you snee-e or have watery stuff coming out of your nose or get an itchy
nose%
71
$nother interesting point to be noted is that there are no E9M questions on
the side of patients. $s the sample of patient-initiated questions is very low, it
cannot be e8plained without difficulty. %n my opinion, the most probable
e8planation could be deduced from the type of information patients look for.
7atients usually raise their questions when they do not understand what doctors
would like to know, what they are actually asking about (E8ample 3,-, when they
need advice (E8ample 3?-, or when they desire direct replies as to relate to their
worries and an8ieties (E8ample 3A-.
%n all these situations L9@ questions (E8ample 3A- or open questions
(E8amples 3, and 3?- are preferred. Most patients, as lay people, do not have
sufficient medical knowledge to offer their doctors more than one alternative, and
therefore it is easier and more natural for them to use the other two question
types. %n addition, some behavioural scientists argue that questions in the form of
either9or force a choice,
*2
and thus patient-initiated questions of this type could
be regarded impolite.
*6
E2amp!e +5
54 .hat is it 8the phlegm8 li!e-
P7 *hat do you mean%
E2amp!e +4
P7 *ell, what should I do in the meantime, Doctor%
54 .ell the important thing is to ma!e sure that he has sufficient fluids7
E2amp!e +8
P7 *ill my hearing get better, Doctor%
54 2es it "ill.
#he last point to be mentioned here is in a sharp contrast with the findings
of Norsch, !oCCi, Francis (*+?>-
*,
and )est and 7age (both in #odd and Fischer
*+>2-, whose results show that there is a tendency to ignore patient-initiated
72
questions. For e8ample, according to )est, only >A[ of questions raised by
patients in her corpus were answered. My findings differ rapidly because all
questions asked by patients in this material, i.e. in all the medical branches under
consideration, are answered.
Here % am inclined to agree with Goanne Humphreys (3//34 6- and her
e8planation that4 &Decent social changes have altered the balance of power
between doctors and patients through increased openness on the part of the
medical profession and greater access to information for patients.' My research,
yielding similar results as hers, lays a possible foundation for such an argument.
However, it is necessary to add that the shape of doctor-patient interaction from
the standpoint of using questions has not been changed in all its aspects, and that
the asymmetrical relationship has been preserved.
4.+.0 C$mparis$" $( Samp!es
#his section of the chapter is assigned for either supporting or
contradicting my findings by comparing the results of the first sample (;orpus %-
with the results of the second sample (;orpus %%-. #he statistical programme used
for this comparison is called chi-square (see ,.,-, which proves whether the
analysed samples are statistically the same or if there is a deviation. $s % believe,
this kind of elaboration could help me to reach a more ob:ective and reliable
conclusion.
*?
#he following passage is processed in a way similar to the previous parts
of the chapter. #he quantitative analysis is presented in the form of tables0 this
time only two tables (#able ** and *3- are offered, one for each sample. #hen %
calculated the chi-square between the two samples, and interpreted its results.
.imilarly, the roles of questions posed by the doctor and the patient are
discussed, and the principal sub:ect of the thesis, the phenomenon of asymmetry,
is pursued. My findings are supplemented with illustrative e8amples taken from
the second corpus.
73
Tab!e 117 Res%!ts Cabs$!%te a" re!ativeD $( the 1
st
Samp!e
Particip Phase 9%esti$" T*pe T$ta!
D P 1ist E)am Treat 280 E8O Open
A#s. 2,6 3/ 2> 23A + *++ ,3 *32 081
: +, , */ >A 2 ,2 *6 22 1@@
Tab!e 1+7 Res%!ts Cabs$!%te a" re!ativeD $( the +
"
Samp!e
Particip Phase 9%esti$" T*pe T$ta!
D P 1ist E)am Treat 280 E8O Open
A#s. 23* 26 ,2 3,, 6A 32> *A *// 055
: +/ */ *, A3 *2 ?A , 3> 1@@
$s the frequency occurrence of the doctor-initiated and the patient-
initiated questions in the second sample reports, its results are very similar to
those calculated for the first sample. Mut of 2,, questions, 23* (+/[- are posed
by doctors, only 26 (*/[- are posed by patients. 32> (?A[- belong to L9@
questions, *A (,[- to E9M questions, and *// (3>[- to open questions. ,2
questions (*,[- appear during the history-taking phase, 3,, (A3[- during the
e8amination phase, and 6A (*2[- during the treatment phase.
.trictly statistically, the computation of chi-square proves that concerning
the total number of questions posed by the participants, both samples are the
same (chi-squareY,,362-. Mn the contrary, with regard to the question types
(chi-squareY**,>/2- and phases of the encounter (chi-squareY2A,*??-, there are
slight differences, although the basic pattern of the question types and the phases
has been preserved.
*A
@evertheless, the similarities prevail, and we may claim
that the second sample confirms the quantitative results of the first sample, and
therefore the reliability of the first corpus is guaranteed.
Jet me now consider :ust a few e8amples taken from the second corpus in
order to show once again how much the results of both samples correspond, and
what such correspondence indicates. $s can be seen in e8amples 3> and 3+,
patient-initiated questions in the second sample perform the same function as in
the first sample0 they are posed when patients desire direct replies to their
worries, when they are an8ious and under stress. #hus, it is really not the age,
se8, and race of the patient, or the medical speciality of the doctor that shapes the
74
conte8t of the situation when patient-initiated questions are posed. %t is, in fact,
the seriousness of the health problem for the patient and his9her family.
E2amp!e +;
P7 Is it serious, Doctor%
54 *t "ill #e if "e leave it so * "ould recommend to have an operation to remove
the gro"th. 2ou "ill #e in hospital for a#out t"o to three "ee!s and then "e+ll see
you for regular chec!-ups.
P7 &ren(t I too old to have an operation%
54 Oh no. Age is no #ar to surgery these days. .e consider each patient
individually. $ome patient are young at ninety and others are old at si)ty.
P7 I won(t have to have a bag, will I%
54 ;ortunately not. After the operation you should have no trou#le "ith your
#o"els. (Man, aged A2-
E2amp!e +<
54 * suspect this may #e tumour of the #reast.
P7 Do you mean breast cancer, Doctor%
54 2es #ut * cannot #e a#solutely sure until the results of the cytology and
mammography are availa#le.
P7 But if it is, shall I lose my breast% I dread that,
54 0o * thin! that is very unli!ely. *t seems to #e ,uite a small cancer so "e
should #e a#le to avoid a mastectomy and treat it #y local e)cision follo"ed #y a
course of radiotherapy if it in fact proves to #e a #reast cancer on the tests.
P7 I don(t care what it is so long as I don(t lose my breast. *ill I need
chemotherapy%
54 That depends on the results from the operation. *f the lymph-nodes in the
armpit have tumour in them then "e usually suggest chemotherapy #ut it "ill
depend very much on ho" you feel a#out chemotherapy.
P7 !hall I be able to keep on working while I(m having the treatment% ou see I
need the money for two young children. ()omen, aged 62-
#here are, of course, other significant parallels. For e8ample, the sequence
of talk with the interpretation phase at the end is also rooted in both samples
(E8ample 2/-. $s well, doctors take advantage of the situation by using several
types of questions, posed especially during the first two parts of the interview
75
(E8ample 2*-0 unlike patients, who do not use E9M questions, and tend to ask
only during the phase of e8amination and treatment (E8ample 23-.
E2amp!e 0@
54 Although the <-rays "ere normal that is not the most sensitive test for this
sort of pro#lem. .hat "e need is a #one scan. *t+s a very simple test. They give
you a small in3ection in your arm and a fe" hours later they scan you "ith a
machine a little #it li!e an <-ray machine. *t doesn+t hurt. The scan sho"s any
areas of #one that are a#normal. *f it sho"s an a#normality in your lo" #ac! then
"e can arrange for the radiotherapy doctors to see you again and give you
treatment 3ust li!e they did "ith your lung.
E2amp!e 01
,7 $ow often do you get them% (open-
74 0early every day.
,7 Is it a sharp pain% (L9@-
74 2es.
,7 Do you get them before you go to bed or after% (E9M-
74 * get them mostly "hen * lie do"n.
E2amp!e 0+
P7 *hat(s that doctor% (open-
54 *t means putting a tu#e into the a#domen and then "ashing fluid in and out to
!eep the to)ic su#stances in the #lood do"n. *t+s not uncomforta#le and you+ll #e
taught to do it yourself for "hen you get home.
P7 $ow long will I have to stay in hospital% (open-
54 2ou+ll #e in for a#out a "ee!. .ithin this method of dialysis you can "al!
a#out and live a reasona#ly normal life.
P7 !hall I have to stop working, Doctor% (L9@-
1esides many parallels, there is also one interesting discrepancy between
the two samples. $s has been already noted above, all patient-initiated questions
are answered by doctors in the first sample. Furthermore, all doctor-initiated
questions are answered by patients in the first sample, as well. Mn the other hand,
and as well quite surprising, there is one question posed by the doctor in the
76
second sample, which is unanswered by the patient (E8ample 22-. Mtherwise, all
questions asked by patients are given responses.
$ccording to )est (*+>24 >+, my emphasis-4
)hen patients failed to answer their physician=s question, it
was often under constraining str%ct%ra! circumstances. For
e8ample, when physicians chained questions together with no
intervening slots for answers, the individual queries that
comprised the chains frequently failed to elicit patients=
responses.
However, the reason for not answering the question in my e8ample is rather
ps*ch$!$&ica! than structural.
#he patient, a ten-year-old girl, has stomach aches, but does not want to
tell the doctor what the main reason is. .he is ashamed of having problems with
one schoolmate, who is very annoying, and keeps calling her names. %n the end,
the doctor, with some help from the girl=s mother, is successful in eliciting the
information he has requested (E8ample 26-, and he then suggests proper
treatment (E8ample 2,-.
E2amp!e 00
54 Do you li!e school-
P7 )o, not much.
54 .hat don+t you li!e a#out it- The teachers the children or the "or!-
P7 "h, I like the teachers and the work.
54 $o you don+t li!e the other children-
P7 ./ulls a face but does not answer.0
E2amp!e 01
,7 Tell me a bit more about school. &bout not liking it. $as it come on in the
last two months%
74 2es there+s a #oy "ho is nasty to me.
,7 $ow% $e calls you names%
M4 4o on. Tell Doctor a#out it.
74 1e tries to put his hand up our dresses.
,7 "h, that is very annoying. ou(ll be going to a new school in a year.
74 2es. An all girls+ school.
77
E2amp!e 05
,7 1irls of this age get tummy pains. I expect all this will simmer down. !he(s
not a disturbed child. 1ood. *ell then, nurse will arrange for the test and come
and see me again in a week(s time when we(ve got the result. But don(t get too
worried. I(m sure it will all clear up.
M4 Than! you Doctor.
$s the last e8ample proves, the proper use of questions is crucial for
successful doctor-patient communication. Mbviously, % have tackled only some
aspects of the roles and methods of asking, especially those that reveal some
evidence about changes in asymmetry within the medical encounter. $s )est
(*+>24 */2- maintains4
#o know, for e8ample, how to educate patients to ask Fbetter=
questions, we first need to know what kind of question patients
do ask. .imilarly, in educating physicians to Fimprove= their
rapport with patients, we will benefit by a knowledge of the
kind of rapport in e8istence.
4.0 Other Speech Acts i" ,'P C$mm%"icati$"
#he purpose of the present section is to develop the discussion started in
the first part of ;hapter ? (pp. ,>-A>-, by e8amining the function and sequential
properties of other speech acts that occur throughout the medical encounter. %n
the previous section % have attempted to reveal the role of questions in doctor-
patient communication. %n this section my analysis is aimed at a"s#ers,
stateme"ts, irectives, and reactives. My investigation is based on the
assumption that results of such research may reveal the process whereby power
and asymmetry are manifested in the interaction.
4.0.1 A"a!*sis
#o follow the form of the previous section, doctor-initiated speech acts and
patient-initiated speech acts have been distinguished and classified according to
the phase within the medical interview. #he results of the quantitative analysis
78
are presented in the form of tables and figures in order to give a more lucid
account of the distribution of speech acts between particular medical branches.
)here the results of the F-test or the computation of correlation allow a
comparison of the medical disciplines under discussion, then such comparison is
elaborated.
Tab!e 17 Abs$!%te Fre6%e"c* $( Speech Acts i" ,'P I"tervie#s
A#s. Particip Phase Speech Act T$ta!
D P 1ist E)am Treat $ta Ans 9ea Dir
*nternal */ +* 33 A+ / A >A , 3 1@1
4ynaec. ,? ?2 / A? 62 6> ?/ 2 > 11<
Paed. 2> ?? 3/ ?A *A 32 ?A 3 *3 1@1
O9L **+ ?* *3 +3 A? +/ ,> ? 3? 1;@
Orthop. ?/ ,> ** A? 2* 6> ,* 6 *, 11;
T$ta! +;0 00< 45 0<@ 148 +14 0+0 +@ 40 4++
Tab!e +7 Re!ative Fre6%e"c* $( Speech Acts i" ,'P I"tervie#s
: Particip Phase Speech Act T$ta!
D P 1ist E)am Treat $ta Ans 9ea Dir
*nternal */ +/ 33 A+ / A >A , 3 14
4ynaec. 6A ,2 / ?6 2? 6/ ,/ 2 A 1<
Paed. 2A ?2 *+ ?, *? 33 ?6 3 *3 18
O9L ?? 26 A ,* 63 ,/ 23 2 *, +<
Orthop. ,* 6+ + ?, 3? 6* 62 2 *2 1<
T$ta! 15 55 1@ 40 +8 05 5+ 0 1@ 1@@
Tab!e 07 Abs$!%te Fre6%e"c* $( ,$ct$r'I"itiate Speech Acts
A#s. Phase Speech Act T$ta!
1ist E)am Treat $ta Ans 9ea Dir
*nternal 2 A / 2 / , 3 1@
4ynaec. / *, 6* 6, / 2 > 54
Paed. > *2 *A 33 3 3 *3 0;
O9L > 2? A, A+ > ? 3? 11<
Orthop. > 3? 3? 26 + 2 *6 4@
T$ta! +8 <8 15< 1;0 1< 1< 4+ +;0
79
Tab!e 17 Re!ative Fre6%e"c* $( ,$ct$r'I"itiate Speech Acts
: Phase Speech Act T$ta!
1ist E)am Treat $ta Ans 9ea Dir
*nternal 2/ A/ / 2/ / ,/ 3/ 1
4ynaec. / 3A A2 >/ / ? *6 +@
Paed. 3* 26 6, ,> , , 23 10
O9L A 2/ ?2 ?? A , 33 1+
Orthop. *6 62 62 ,A *, , 32 +1
T$ta! 1@ 01 54 41 8 8 ++ 1@@
Tab!e 57 Abs$!%te Fre6%e"c* $( Patie"t'I"itiate Speech Acts
A#s. Phase Speech Act T$ta!
1ist E)am Treat $ta Ans 9ea Dir
*nternal *+ A3 / 6 >A / / <1
4ynaec. / ?* 3 2 ?/ / / 40
Paed. *3 ,6 / * ?, / / 44
O9L 6 ,? * ** ,/ / / 41
Orthop. 2 ,/ , *6 63 * * 5;
T$ta! 0; +<0 ; 00 0@1 1 1 00<
Tab!e 47 Re!ative Fre6%e"c* $( Patie"t'I"itiate Speech Acts
: Phase Speech Act T$ta!
1ist E)am Treat $ta Ans 9ea Dir
*nternal 3* A+ / 6 +? / / +8
4ynaec. / +A 2 , +, / / 1<
Paed. *> >3 / 3 +> / / 1<
O9L ? +3 3 *> >3 / / 1;
Orthop. , >? + 36 A? / / 18
T$ta! 11 ;8 + 1@ <@ @ @ 1@@
Tab!es 85 ;5 <5 1@7 Res%!ts $( the F'test
; Participa"t
1ynaec. /aed. "23 "rthop.
Internal 3,A,E-/AZ 3,?/E-/?Z *,/,E-/?Z 3,?3E-/AZ
1ynaec. /,A3 /,,* /,++
/aed. /,>* /,A
"23 /,,
; Speech Act
1ynaec. /aed. "23 "rthop.
80
Internal ,,A/E-/+Z 2,,/E-*/Z *,A/E-*AZ 6,6/E-*6Z
1ynaec. /,,3 3,2/E-/2Z /,/6Z
/aed. 3,,/E-/3Z /,*>
"23 /,6
; Phase
1ynaec. /aed. "23 "rthop.
Internal /,*3 3,A/E-/6Z 6,>/E-/,Z +,3/E-/6Z
1ynaec. 3,2/E-/3Z >,,/E-/2Z /,/?Z
/aed. /,+3 /,??
"23 /,,,
; Particip
Phase *,*/E-3,
4.0.+ Fi"i"&s
&.peech act theory offers a means to break the flow of talk into discrete
parts' (#odd *+>24 *?/-. %n the first sample, ?33 following speech acts (besides
questions- have been e8cerpted4 3*? (2,[- statements, 232 (,3[- answers, 3/
(2[- reactives, and ?2 (*/[- directives (see #ables *, 3, and Figure *-. 3>3
(6,[- of these speech acts are initiated by doctors, 26/ (,,[- are initiated by
patients. ?, (*/[- are used during the history-taking phase, 2+/ (?2[- during the
phase of e8amination, and *?A (3A[- during the treatment section (#ables *, 3,
and Figure 3-.
#he analysis, both quantitative and qualitative, has revealed a number of
interesting points % would like to comment on. Firstly, the most numerous speech
81
acts (besides questions- are answers. $s has already been discussed in section
?.3.3, ?6+ (+/[- turns out of A3, are manifested solely by questions or answers
in the first sample. Moreover, all doctor-initiated questions are answered by the
patient, and all patient-initiated questions are answered by the doctor. How such
fact influences the phenomenon of asymmetry and its changes has been stressed
as well.
More importantly, the qualitative investigation has also revealed the
sequential organisation of the speech acts under consideration. $s .acks,
.chegloff, and Gefferson (*+A6- assume, there is a t#$'part str%ct%re in
conversation between equal participants in "$"'i"stit%ti$"a! setti"&s
(e.g. question-answer, greeting-reply-. #he interaction in institutional settings,
however, is organised in a different manner. $ccording to the 1irmingham
discourse analysis group, it is a three'part e2cha"&e (initiation-response-
feedback- that is characteristic of the i"stit%ti$"a! ta!). &#he difference seems to
be a consequence of the asymmetry between participants, which produces a third
part to the conversation' (#odd *+>24 *?6-.
Mriginally, the three-part e8change was proposed for the educational
setting (;oulthard *+AA-, only later for the medical setting (;oulthard I 1raCil
*++3-. 5uring the classroom interaction, the third part is initiated by a teacher as
an evaluation of a students= work. %n the medical encounter, it is a reactive, which
is initiated by the doctor in order to maintain control of the medical encounter.
*>
)hat is important, is the three-part structure of interaction, with the reactive at
the end, and the way in which it enters doctor-patient talk in all the medical
branches (E8amples 2?, 2A, and 2>-.
E2amp!e 04
54 $o you haven+t e)perienced this symptom #efore-
74 0o not that * can remem#er Doctor.
,7 I see.
(%nternal medicine-
E2amp!e 08
54 1o" did you feed your children- 6reast or #ottle-
82
74 * #reast-fed all of them #ut only managed for a#out the first three months and
after that "e #egan to top them up "ith #ottle mil!.
,7 "4.
(Mbstetrics and !ynaecology-
E2amp!e 0;
54 Does it hurt-
74 0o.
54 Does it run-
74 0o * 3ust can+t hear.
,7 2ight. (Mto-rhino-laryngology-
$ccording to #odd, there are two reasons the doctor uses the reactive.
&First, to end the interactional segment and the topic, and second, to bring
control of the interaction back to the doctor, allowing the doctor to end that
frame and to initiate a new one' (*+>24 *?,-. $s is obvious from E8ample 2+, by
using the reactive That seems O@, the doctor acknowledges the patient=s reply,
ends the topic and the particular part of the interview, and continues with another
question. #he question introduces a new topic, is answered by the patient, and
finally acknowledged by the doctor=s reactive 4ood, which fulfils the same
function as the previous one.
E2amp!e 0<
54 .hat does the stool loo! li!e- *s it yello" or green- Does it smell strong-
M4 .ell it+s very pale #ut it doesn+t smell much.
,7 That seems "4. Can you tell me a#out Aames+s immunisation-
M4 2es he+s had his triple Doctor.
,7 1ood. 1o" are things generally- Any an)iety a#out Aames-
(7aediatrics-
$s is evident from #ables * and 3, most speech acts occur during the phase
of e8amination (2+/0 ?2[-. 1y comparing the length, the amount of talk, and the
structure of turns between the phases of the medical encounter, it appears to me
that the e8planation could be summarised as follows4 #he e8amination is the
longest part of the interview (
3
9
2
of total time-. #he doctor does not only question
the patient and receive his9her responses in return, as it is common during the
83
history-taking phase, but he also conducts physical e8amination and considers the
patient=s condition (E8ample 6/-.
*+
E2amp!e 1@
74 Everyday "hen * "a!e up my mouth+s dry and * can+t tal!. * have to have a fe"
drin!s or something to get my mouth "or!ing. As the day goes on my voice tires
as "ell and * get hoarse.
,7 I(d like to look down your voice box with this mirror. "pen your mouth wide.
That(s lovely. /ut your tongue out. 3et me hold it with this swab. I(ve warmed
this mirror slightly on the Bunsen burner. It(s not hot, you can see that.
Breathe through your mouth. !it up straight. 3ean very slightly forward ,
lovely. 3et me put this to the back of your mouth. 4eep your tongue down, that(s
super, and say 5hay6 , ou(ve got laryngitis. our vocal cords, your voice box,
they(re all sore. Do you smoke%
74 2es.
Furthermore, the doctor provides m%!tip!e speech acts per turn during the
phase of e8amination (E8ample 6*-. #his feature is not characteristic of the
history-taking phase, where both the doctor and the patient utter only one, two, or
three speech acts per turn (E8ample 63-. #he treatment phase, on the contrary,
also consists of multiple speech acts provided by doctors. However, this phase of
the medical interview is much shorter than the e8amination, and there are almost
no questions and answers, i.e. the most numerous speech acts, initiated
(E8ample 62-.
3/
E2amp!e 11
54 .ell "hat *+m going to do is *+m going to listen to your #reathing. $o could
you ta!e a deep #reath for me- 9ight. That+s fine. 2ou can 3ust #reathe normally
no". 0o" *+m going to listen to your heart. Aust lie do"n. *+ll 3ust have a loo! at
your tummy. 0o" "hat "e also need to do is have a little loo! at your pee so
could you put a little #it in this pot here.
(E8amination-
E2amp!e 1+
84
,7 &s far as you know, are there any illnesses that run in your family%
74 0one that * !no" of Doctor.
,7 )othing like diabetes, high blood pressure, or heart disease, stroke, cancer,
mental illness or anything like that%
74 Oh * see5 My father had a heart condition and * have t"o aunts "ho have
dia#etes.
,7 &nd is your father still alive%
74 0o he isn+t.
,7 $ow old was your father when he died%
74 1e "as BC.
,7 *hat did he die of%
74 1e had a heart attac!.
(History-taking-
E2amp!e 10
54 *+ll also get you to spea! to one of the contact tracers "ho "ill give you some
information a#out se)ually transmitted infections and ho" you can prevent them.
6efore you leave the clinic could you also please give me a specimen of urine 7
(#reatment-
4.0.+.1 ,$ct$r'I"itiate Speech Acts
$s #ables 2 and 6 show, doctors initiate 3>2 speech acts
(besides questions- in the first sample. *>2 (?6[- of them belong to the category
of statements, *+ (A[- to the category of answers, *+ (A[- to the category
of reactives, and ?3 (33[- to the category of directives (see #ables 2, 6, and
Figure 2-. 3A (*/[- of the speech acts occur during the history-taking phase, +A
(26[- during the phase of e8amination, and *,+ (,?[- during the treatment
section (see #ables 2, 6, and Figure 6-.
85
%n general, doctors initiate the speech acts from all categories selected and
in every part of the medical encounter. More interestingly, most speech acts are
provided during the treatment section and from the category of statements. $s the
correlation between the phase and the participant of the interview proves
(rY -/.6?-, there is a connection between these two variables. Moreover, the
result of the F-test for the comparison of the participant and the phase with
regard to the category of speech acts is *.*/E-3,, which also indicates that it is
worth considering the significance of the category of speech acts, for their
distribution.
$s has already been shown in section ?.3.3.*, the treatment section is
reserved for doctors to e8plain the process of treatment and therapy to their
patients. @aturally, this task can be successfully manifested particularly by
initiating statements (E8ample 66-.
E2amp!e 11
54 1ere you can see a fracture through the third #one "hich is called the
metacarpal. 2ou can see that the #one is #ent and in order for you to #e a#le to
use your hand normally * thin! "e ought to give you an anaesthetic to put you to
sleep in order to straighten the #one. .e should #e a#le to hold it in the straight
position "ith a plaster #ut it is possi#le "e might need to put "ires in the #one to
hold it in place.
$side from statements, another numerous category initiated by doctors are
directives. Mut of si8ty-three directives in the first sample, there were si8ty-two
provided by doctors. $s #odd (*+>24 *?+- suggests, directives provide the doctor
86
with control of the floor as much as the reactives do. %n my corpus, directives
usually take place during the e8amination and treatment sections. More
interestingly, they are provided in the form of direct speech acts during the phase
of e8amination (E8ample 6,-, and in the form of indirect speech acts during the
treatment section (E8ample 6?-.
E2amp!e 15
54 *+m going to e)amine your mouth. "pen your mouth wide for me. 3et me put
these tongue blades under your lips to look from side to side. !tick your tongue
out. 3ift it up to the roof of your mouth , down again , to your right , to
your left.
E2amp!e 14
54 6efore you leave the clinic could you please give me a specimen of urine so
that * can test it for any signs of infection- I will also need to take a blood
sample from you "hich "ill #e tested for syphilis "hich is a routine #lood test "e
do on every#ody that attends the clinic. Than! you.
%n addition to what has been said, out of 3>2 doctor-initiated speech acts
**+ (63[- are provided by oto-rhino-laryngologists. $s #ables 2 and 6 show and
as the results of the F-test for the comparison of MDJ and other medical branches
with regard to the category of speech acts proves (*.A/E-*A0 3.2/E-/20 3.,/E-
/3-, there is a significant distinction between MDJ and other medical branches
under discussion. #he factors underlying this point of divergence are the large
number of directives provided by the oto-rhino-laryngologists and the conte8t of
their medical branch which forces them to use many directives so frequently.
$s shown in ;hapter A, where the use of medical terminology is discussed,
MDJ professionals use tools and medical instruments for e8amining the patient,
more than in any other discipline. #hey must conduct a ph*sica! e2ami"ati$" of
subtle parts of a body, and the e8amination, of course, is not always pleasant for
the patient. !enerally speaking, the shorter the process of the e8amination, the
better it is for the patient. #hus, short directives (E8ample 6A- are preferred to
longer questions, which are characteristic of verba! e2ami"ati$". #he patient,
whose throat is very often checked, would not be able to answer anyway.
87
E2amp!e 18
5D !it up straight. 3ean very slightly forward. *+d li!e to loo! deep into your
throat "ith this mirror. *+ve "armed it "ith a #urner. 2ou can see it+s not hot. *
can touch it and it doesn+t hurt. "pen your mouth wide. !tick your tongue out.
*+m going to put a s"a# round it and hold it. Breathe steadily through your
mouth. *+m passing this mirror to the #ac! of your mouth and now say 5ee6.
4.0.+.+ Patie"t'I"itiate Speech Acts
$s displayed by #ables , and ?, out of 22+ patient-initiated speech acts
(besides questions-, 22 (*/[- belong to the category of statements, 2/6 (+/[- to
the category of answers, * (/[- to the category of reactives, and * (/[- to the
category of directives (see #ables ,, ?, and Figure ,-. 2> (**[- appear during the
history-taking, 3+2 (>A[- during the e8amination, and only > (3[- during the
treatment (see #ables ,, ?, and Figure ?-.
%n general, aside from questions, patients initiate only two types of speech
acts4 statements and answers, particularly during the first two parts of the medical
encounter. .ince the e8planation for this fact is easily deduced from what has
been said about the speech acts provided by doctors, it not necessary to comment
on the issue (see section ?.2.3.*-. )hat is of greater interest, however, are the
figures obtained for patient-initiated reactives and directives.
$s displayed by #able ,, only one reactive and one directive are provided
by one patient in the first sample. #hey take place during the history-taking phase
(D- and at the beginning of the phase of e8amination (5-, and are provided in the
88
surgery of an orthopaedist. .ince such a low number limits any reliable
interpretation, let me introduce the following situation (E8ample 6>- and consider
the process of the interview.
E2amp!e 1;
M4 Doctor *+ve noticed that my daughter+s spine has #ecome croo!ed.
54 .hen did you first notice this Mrs 6lac!-
M4 *t "as during the summer "hen my daughter "as "earing a T-shirt. * noticed
that the right side of her #ac! appeared very prominent.
54 And since you first sa" that has there #een any change in the shape of your
daughter+s #ac!-
M4 0o not really although it may have #ecome slightly more curved over the last
fe" months.
54 1o"+s Mary+s health-
M4 $he+s usually a very fit girl. $he has suffered from asthma in the past #ut
doesn+t ta!e any medicine regularly.
54 *s there anyone else in your family "ho suffered from curvature of the spine-
M4 2es my #rother that+s Mary+s uncle "as ,uite severely disa#led #y curvature
of the spine "hen he "as in his teens.
54 * see so you+re o#viously concerned that the same thing may happen to your
daughter.
M4 2es Doctor that(s right.
54 .hat *+d li!e to do no" is to e)amine Mary if that+s all right "ith you.
M4 2es please go ahead.
%n E8ample 6>, an orthopaedist is visited by Mrs 1lack and her daughter
Mary. %t is the first meeting between the doctor and the family. #he mother is
worried about her daughter=s health as she thinks that Mary suffers from
curvature of the spine. #he doctor initiates the talk by asking Mrs 1lack
questions about Mary=s past medical history, and whether or not anyone in the
family is disabled. )hen he finds out that Mary=s uncle had a similar problem as
a teenager, he utters a reactive * see, and continues with a structure, which is
rather more of a commentary on the situation than a real question ( so you+re
o#viously concerned that the same thing may happen to your daughter-.
@evertheless, Mrs 1lack provides an answer and even proceeds with a reactive.
#hen, the doctor approaches Mary=s e8amination, which is followed by the
89
permission-seeking if that+s all right "ith you. #his use of modality can indicate
the doctor=s sensitivity to Fthe delicacy of consulting with a small child=.
3*
#he
permission is, of course, given by Mrs 1lack0 surprisingly, it is provided in the
form of a directive please go ahead.
$s #odd (*+>24 *?,- maintains4
#he patient=s conversation also displays reactives0 the patient=s
reactives, however, differ from those of the doctor in that they
occur in single speech act turns. #he patient does not usually,
in her turn, utter a reactive and continue. Dather, she utters the
reactive as both the initiation and the end of her turn and in
response to the doctor=s utterance.
7atient-initiated directives, on the other hand, are very unusual for doctor-
patient communication. From what has been observed % would suggest that it is
the personality of Mrs 1lack that influences the flow of interaction.
33
$ highly
verbal, assertive, and educated woman, a caring mother. %t has been proved (e.g.
Doter and Hall *++3- that better-educated patients have more to say and are more
assertive. However, as has been stressed, in this particular case we cannot
generalise.
4.0.0 C$mparis$" $( Samp!es
Jet me compare my findings, based on the first sample, with the findings
based on the second sample. $s the focus of the present chapter is the function of
speech acts in doctor-patient communication, it will be interesting to see how
many parallels or differences e8ist not only from the standpoint of the
quantitative analysis, but also how much divergence or agreement e8ists from the
point of view of the qualitative analysis.
Tab!e 117 Res%!ts Cabs$!%te a" re!ativeD $( the 1
st
Samp!e
Particip Phase Speech Act T$ta!
D P 1ist E)am Treat $ta Ans 9ea Dir
A#s. 3>2 22+ ?, 2+/ *?A 3*? 232 3/ ?2 4++
: 6, ,, */ ?2 3A 2, ,3 2 */ 1@@
90
Tab!e 1+7 Res%!ts Cabs$!%te a" re!ativeD $( the +
"
Samp!e
Particip Phase Speech Act T$ta!
D P 1ist E)am Treat $ta Ans 9ea Dir
A#s. 3>2 2>6 ?+ 2+2 3/, 3>? 23/ 3/ 6* 448
: 63 ,> */ ,+ 2* 62 6> 2 ? 1@@
%t can be seen in #able *3 that the quantitative results of both samples are
very similar. Mut of ??A speech acts e8cerpted from the second corpus, there are
3>2 (63[- initiated by doctors and 2>6 (,>[- initiated by patients. 3>? (62[- of
them are statements, 23/ (6>[- are answers, 3/ (2[- are reactives, and 6* (?[-
are directives. ?+ (*/[- speech acts occur during the history-taking, 2+2 (,+[-
during the phase of e8amination, and 3/, (2*[- during the treatment.
More precisely, the computation of chi-square proves that as regards the
number of doctor-initiated and patient-initiated speech acts, both samples are the
same (chi-squareY3.?A?-. $s regards the distribution of speech acts within the
interview, both samples are also the same (chi-squareY6./*6-. Mn the contrary, as
regards the number of speech acts within the particular categories, there is a
slight divergence between the samples (chi-squareY*6.63>-. @evertheless, the
basic pattern of the distribution is preserved.
32
#he qualitative interpretation supports the quantitative findings. %n both
samples, we can observe a three-part e8change (E8ample 6+- that serves the same
purpose, i.e. to keep control of the interview in doctor=s hands. %n both samples,
most speech acts occur during the phase of e8amination because it is the longest
part of the interview with multiple speech acts per turn (E8ample ,/-.
E2amp!e 1<
54 Did you not realise that your appointment had come up-
74 2es #ut then something else came up at the same time and so * couldn+t really
come to the Clinic so * "as7
,7 &ll right.
E2amp!e 5@
54 *+ll loo! at your eyes no". Loo! at my finger. @eep your head still and follo" it
"ith your eyes. Open your mouth. Can you feel this pin-
91
Furthermore, in both samples, the most numerous speech acts provided in
the treatment section are statements (E8ample ,*-. 5irectives are also quite
common and they take the form of direct speech acts during the e8amination
(E8ample ,3- and the form of indirect speech acts during the phase of treatment
(E8ample ,2-. $s has been discussed in section ?.2.3.*, doctors provide
directives in the form of direct speech acts when it is necessary to conduct
a physical e8amination. 5irectives in the form of indirect speech acts function as
a polite way of e8plaining the process of treatment and9or therapy.
E2amp!e 51
54 .ell there are changes and improvements in treatment all the time. .e "ill
ta!e a specimen of your #lood and put you on the computer for a !idney
transplant. .hen a suita#le !idney comes "e "ill do a !idney transplant
operation. This "ill ma!e life a lot easier and there are ne" drugs no" to prevent
the #ody re3ecting the ne" !idney. $o there are several "ays of helping you. .e+ll
3ust have to see ho" you get on.
E2amp!e 5+
54 Put your hands a#ove your head. 4ood. 0o" #ehind your #ac!. $"ing your
legs onto the couch. .here does it hurt- Aust rela). 6end the legs. Can you feel
me touching them- Do #oth sides feel the same- 0o" lie on your tummy and *+ll
loo! at your #ac!. 9oll over. *+m 3ust going to pummel you #ac! a #it. Tell me if it
hurts.
E2amp!e 50
54 .ell the pain is not nearly as #ad as it "as "hen you "ere seen in ;e#ruary
and * #elieve that the pill therefore has a good chance of "or!ing if ta!en
continuously. * would therefore suggest that * see you again in three months+
time #ut of course * would be very happy to see you earlier if your pain is not
settling or indeed gets "orse and then "e "ill arrange for a repeat laparoscopy.
#he fact considered for E8ample ,2 supports the idea that patient-centred
strategies become more frequent and, consequently, influence changes in the
manifestation of power and asymmetry between the parties.
92
4.1 S%mmar*
#o sum up the principal research results, let me now present the following
chart, which stresses the most important aspects of the function of speech acts
with regard to symmetry and9or asymmetry of the medical encounter. For a more
detailed e8amination of the findings see sections ?.3.3 and ?.2.3.
S*mmetr* As*mmetr*
*. 5octors tend to offer interpretations *. 2,6 (+,[- questions are initiated
of their decisions. by doctors0 only 3/ (,[- questions
are initiated by patients.
3. $ll questions asked by patients 3. 5octors use all question types0 no E9M
are answered by their doctors. questions are posed by patients.
2. 5octors use directives in the form 2. @o patient-initiated questions are posed
of indirect speech acts during during the history-taking phase.
the treatment section.
6. 5octors provide statements during 6. #here is a three-part structure
the treatment section. in the medical encounter.
,. 5octors provide multiple speech acts
per turn0 patients usually provide
single speech acts per turn.
?. 5octors initiate reactives frequently0
patients do not initiate reactives.
A. 5octors often use directives0
patients do not use directives.
)hat has been said about the roles and functions of speech acts might
suggest that the asymmetrical relationship between doctors and patients has been
preserved. However, there is a tendency to &reduce hierarchies and renegotiate
roles' (!wynn 3//34 ?+-. $s has been stressed elsewhere (e.g. #odd *+>2, .huy
*+>2-, more empirical research is needed. Mnly then we will be able to
Fenlighten theory= and to suggest new strategies for improved doctor-patient
communication.
93
4.5 N$tes
* For the definitions of direct and indirect speech act, or any other
sociolinguistic and pragmatic terms used throughout the thesis, see section
!lossary of Jinguistic #erms.
3 .ee, for e8ample, 5rew and Heritage (*++3-.
2 #odd=s classification of speech acts is based on 5= $ndrade=s 7reliminary
.peech $ct ;ategory .ystem4 $. $tatements (e8positives, representatives,
assertions- reports 9 quotes 9 instantiations 9 claims 9 stimulations 9
inferences0 1. Directives (requests, orders, e8ercitives- suggest 9 request 9
order 9 request ob:ect 9 agree as to truth 9 e8pression of approval 9
sympathy 9 support 9 commitment 9 direct action 9 direct 9 indirect0 ;.
Euestions 9 wh-form 9 yes9no form 9 tag form 9 intonation-only form 9
information-only versus other uses 9 5. 9eactives (various kinds of
agreement or disagreement with what has previously been stated- agree as
to truth versus disagree as to truth 9 give attention 9 accede (agree to
commit, or actually do- versus refuse0 E. E)pressives 9 give approval
versus disapproval (sympathy, regret, e8asperation, etc.- direct versus
indirect (accusation, disagreement, etc.-0 F. Commissives 9 promise, offer,
vow, etc.
6 For details about the function of different types of questions in general,
see Doter and Hall (*++34 >2-.
, #sui (*++34 */3-*/+- claims that elicitations are targeted towards the
following functions4 information, confirmation, agreement, commitment,
repetition, clarification.
? %n my thesis, % interpret the results of the F-test in order to make the
quantitative analysis more reliable. Mn the other hand, the F-test is
understood as a supplementary device, which has no priority over the
qualitative analysis, and is taken into consideration only when the sample
discussed is large enough, or when the results of the F-test are so
significant that they could provide new insights into the sub:ect under
scrutiny.
A % use the asterisk to indicate when the results are of certain significance.
94
> For details about the topics of discourse, see, for instance, .huy (*+>2-.
+ #he use of medical terminology in medical encounters will be researched
in ;hapter A (&Bse of Medical #erminology in 5-7 ;ommunication'-.
*/ Here % would see the influence of various #< series and soap operas (e.g.
Chicago 1ope, Emergency-, which sometimes present surgeons as some
supernatural creatures.
** ;f. Doter and Hall (*++3-.
*3 #his information is acquired in )est (*+>24 A?-.
*2 .ee, for e8ample, )est (*+>24 ?A-.
*6 7oliteness and its language manifestation in doctor-patient communication
will be discussed in ;hapter >.
*, #his information is required in )est (*+>24 ++-.
*? #he differences between the two samples and the reasons to analyse both
of them are e8plained in ;hapter , in the section &;orpus 5escription'.
*A $s regards the question types, in both samples the largest number of
questions belong to L9@ questions, then to open questions, and finally to
E9M questions. $s regards the phases, in both samples the largest number
of questions take place during the phase of e8amination, then during the
history-taking, and finally during the phase of treatment.
*> ;f. Mishler (*+>64 ?*- and his structural unit of doctor-patient discourse4
a. 7hysician Xuestion 9 b. 7atient Desponse 9 c. 7hysician $ssessment 9 d.
(pause- 9 e. @e8t Xuestion.
*+ ;f. the division of the medical consultation proposed by 1yrne and Jong
(*+A?-.
3/ For details, see ?.3 &Dole of Xuestions in 5-7 ;ommunication'.
3* ;f. !wynn (3//34 >3-.
33 ;f. Doter and Hall (*++3-0 especially the chapter &#he %nfluence of 7atient
;haracteristics on ;ommunication between the 5octor and the 7atient'.
32 $s regards the number of speech acts, in both samples the largest number
of acts belong to the category of answers, then to the category of
statements, then to the category of directives, and the least numerous
category are reactives
95
Chapter Seve"
3SE OF ME,ICAL TERMINOLO-= IN ,'P COMM3NICATION
!ood communication between doctor and patient is vital in order to make an
accurate diagnosis, to satisfy a patient and make him feel less an8ious and to
ensure that he follows the advice given. @o medical terms should be used
that the patient cannot understand.
Goy 7arkinson
8.1 I"tr$%cti$"
$ccording to various linguists (e.g. MEllerov I Hoffmannov 3///4 */-,
research in the field of doctor-patient interaction forms a very important part of
many approaches interested in the interpretation of spoken discourse. %n
particular, conversation analysts (e.g. Heath *++3, ten Have *++,- have been
attempting to reveal the functioning of medical encounters, and therefore they
have challenged most levels of its analysis. Bnfortunately, one aspect of the
communication between doctors and patients, namely the %se $( meica!
termi"$!$&*, has so far received little attention. #he aim of this chapter is to
stress the importance of medical terminology, and discuss its significance for the
distribution of asymmetry.
1efore this chapter of the dissertation had been worked out, some of the
most recent collections of studies touching the topic of doctor-patient
communication (Fisher I #odd *+>2, 7endleton I Hasler *+>2, Daffel-Engel
*+>+- were consulted. .urprisingly, only one out of 6A contributions (.huy *+>2-
deals with medical terminology, and there are :ust a few general findings
scattered throughout a couple of monographs on medical encounters (Doter I
Hall *++3, !wyn 3//3-.
;onsequently, there are almost no sources with which my own findings
could be compared0 the only e8ception being A Manual of English for the
Overseas Doctor (7arkinson 3//6- and two ;Cech sources, Aa! vedeme dialog
s institucemi U%nteraction in %nstitutional ;onte8tV (MEllerov I Hoffmannov-
and ?st%lenF modely !omuni!ace ve GvolenFm typu !omuni!a&nH ud%losti8dialog
lF!aI / pacient UEstablished Models of ;ommunication in the .elected #ype of
;ommunicative $ct9doctor K patientV (7etrovov *++A-.
*
96
8.+ A"a!*sis
#he very first problem that needs to be solved before starting the actual
analysis is to discuss criteria determining the definition of medical terminology.
%n other words, to answer the question4 .?hat is5 i" (act5 a meica! termE/ %t is
not as easy to discern such terms as one might think. %t does not mean there are
no definitions provided. However, all definitions % have been able to collect so
far are too broad, and they do not define precisely which words can be regarded
as medical terms and which cannot.
%t could be stated that the best method to reach a satisfactory conclusion is
to consult a medical dictionary, e.g. Dictionary of Medicine (;ollin *++?-, and all
words included must obviously belong to the terminology of the medical field.
@evertheless, % would argue whether such dictionary entries as, for instance,
hea or !e& can be given the status of a term4
#ermTn :e le8iklnT :ednotka slouPTcT odborn\mu vy:ad]ovnT
s p]esn^m, Cpravidla po:mov^m v^Cnamem, ve sv\m oboru
:ednoCna_n, ustlen a normaliCovan, beC vedle:`Tch
p]TCnaka citov^ch. (7etrovov *++A4 ?*-
U#he term is a le8ical unit serving the language of profession,
with precise, usually notional content, in its scientific branch
unambiguous, stabilised and standardised, without additional
indications and emotional connotations0 translated by M. b.V
Moreover, it should also be noted that the ma:ority of &real' terms are based in
!reek or Jatin (E8amples * and 3-.
3
E2amp!e 1
,4 H .e+re going to perform a test puncture of the antrum using a Tilley-
Licht"itG Trocar and cannula ,
E2amp!e +
,4 7 .e have to suc! out your tracheostomy #efore "e ta!e the old tu#e out in
case you have a lot of mucus 7
97
$nother way to approach the delimitation of medical terms could be the
investigation of the most common categories of words used by doctors and
nurses. $ccording to MEllerov (3///4 AA-, the number of the most frequent
groups of e8pressions appearing in medical encounters is not very large. .he
distinguishes iseases a" their s*mpt$ms5 meth$s $( e2ami"ati$"5 s%r&ica!
i"terve"ti$"s5 meica! specia!ities and h$spita! epartme"ts. .ome, on the
other hand, distinguish only four categories4 *- 5iseases I ;onditions,
3- 7rocedures I #ests, 2- .ymptoms I .igns, 6- Medications.
2
However, even
such delimitation is not without further complications. For e8ample, a symptom
is defined as &any s%bjective evidence of disease',
6
which is in sharp contrast
with the definition of terms as presented above (p. +A-.
$lthough my ability to present a new definition of a medical term is
certainly limited, in the present chapter % have attempted to e8clude e8pressions
which suffer from the above mentioned sub:ectivity, ambiguity, and other
problematic features. $s a result, % have decided to work with the following
group of medical terms4 *- ,isease F I!!"esses (E8ample 2-, 3- Meicati$"s
(E8ample 6-, 2- Meica! t$$!s (E8ample ,-, and 6- Pr$ce%res F Meth$s
(E8ample ?-.
E2amp!e 0
,4 7 2ou+ve got laryngitis 7
E2amp!e 1
,4 7 &spirin sometimes affects the stomach. * thin! you should ta!e /aracetamol
instead. *t doesn+t cause stomach pro#lems.
E2amp!e 5
,4 7 0o" *+m going to have a loo! "ith the magnifying otoscope and if "e need
to later "e can use the operating microscope to see your eardrum in more detail.
E2amp!e 4
,4 7 *f you do have pro#lems "e can al"ays help #y giving you $2T (hormone
replacement therapy- 7
98
$s the ma:ority of the terms are based on Jatin or !reek, it is absolutely
without doubt that such word stock reduction helps to diminish the flow of non-
medical terminology into my samples. %n this way **? medical terms have been
e8cerpted. 5etails about their further classification and results of the F-test are
presented below.
Tab!e 17 Abs$!%te Fre6%e"c* $( Terms i" ,'P I"tervie#s
A#s. Particip Phase Cate&$r* T$ta!
D P 1ist E)am Treat *JD Med Tools Meth
*nternal ** A *3 ? / *3 , / * 1;
4ynaec. 23 ? / 3A ** *, */ , > 0;
Paed. + + 3 *, * , 2 3 > 1;
O9L 3, * * ** *6 A * + + +4
Orthop. ** , 3 A A , 3 3 A 14
T$ta! ;; +; 18 44 00 11 +1 1; 00 114
Tab!e +7 Re!ative Fre6%e"c* $( Terms i" ,'P I"tervie#s
: Particip Phase Cate&$r* T$ta!
D P 1ist E)am Treat *JD Med Tools Meth
*nternal ?* 2+ ?A 22 / ?A 3> / , 14
4ynaec. >6 *? / A* 3+ 6/ 3? *2 3* 00
Paed. ,/ ,/ ** >2 ? 3> *A ** 66 14
O9L +? 6 6 63 ,6 3A 2 2, 2, ++
Orthop. ?+ 2* *3 66 66 2* *2 *2 62 10
T$ta! 84 +1 15 58 +; 0; 1; 14 +; 1@@
Tab!e 07 Abs$!%te Fre6%e"c* $( ,$ct$r'I"itiate Terms
A#s. Phase Cate&$r* T$ta!
1ist E)am Treat *JD Med Tools Meth
*nternal + 3 / > 3 / * 11
4ynaec. / 3* ** *, > 2 ? 0+
Paed. * A * 2 * * 6 <
O9L * */ *6 ? * + + +5
Orthop. * 6 ? 2 * 3 , 11
T$ta! 1+ 11 0+ 05 10 15 +5 ;;
99
Tab!e 17 Re!ative Fre6%e"c* $( ,$ct$r'I"itiate Terms
: Phase Cate&$r* T$ta!
1ist E)am Treat *JD Med Tools Meth
*nternal */ 3 / + 3 / * 1+
4ynaec. / 36 *2 *A + 6 A 08
Paed. * > * 2 * * , 1@
O9L * ** *? A * */ */ +;
Orthop. * , A 6 * 3 ? 10
T$ta! 10 5@ 08 1@ 11 18 +< 1@@
Tab!e 57 Abs$!%te Fre6%e"c* $( Patie"t'I"itiate Terms
A#s. Phase Cate&$r* T$ta!
1ist E)am Treat *JD Med Tools Meth
*nternal 2 6 / 6 2 / / 8
4ynaec. / ? / / 3 3 3 4
Paed. * > / 3 3 * 6 <
O9L / * / * / / / 1
Orthop. * 2 * 3 * / 3 5
T$ta! 5 ++ 1 < ; 0 ; +;
Tab!e 47 Re!ative Fre6%e"c* $( Patie"t'I"itiate Meica! Terms
: Phase Cate&$r* T$ta!
1ist E)am Treat *JD Med Tools Meth
*nternal */ *6 / *6 */ / / +1
4ynaec. / 3* / / A A A +1
Paed. 6 3+ / A > 6 *6 00
O9L / 6 / 6 / / / 1
Orthop. 6 */ 6 A 6 / A 1;
T$ta! 1; 8; 1 0+ +< 11 +; 1@@
Tab!es 85 ;5 <5 1@7 Res%!ts $( the F'test
; Particip
-*"aec. Pae. ORL Orth$p.
Internal /,*3 /,+3 2,*,E-/,Z /,>?
1ynaec. /,/+ *,6/E-/2Z /,3/
/aed. *,++E-/,Z /,A+
"23 +,A>E-/,Z
; Phase
-*"aec. Pae. ORL Orth$p.
100
I"ter"a! /,A? /,,2 /,66 /,*6
-*"aec. /,?> /,*> /,/6Z
Pae. /,*, /,/6Z
ORL /,2+
; Cate&$r*
-*"aec. Pae. ORL Orth$p.
I"ter"a! /,/>Z /,/6Z /,/AZ /,/2Z
-*"aec. /,,6 /,>, /,6A
Pae. /,?> /,+3
ORL /,?/
; Participa"t
E2am Treat
Hist /,+> 3,//E-/?Z
E2am 2,//E-/>Z
8.0 Fi"i"&s
$ccording to .huy4 &From a linguist=s perspective, vocabulary is the most
trivial aspect of language studiesc %n physician-patient communication, it is the
most obviously repairable problem, provided it is noticed and understood' (*+>24
*+/-. However, in some cases, especially when the medical terminology is
concerned, it could be very difficult for patients to understand what their doctors
mean by using certain words (E8ample A-. Moreover, even doctors themselves
frequently face the same problems as &the patient may also have a medical,
social, or regional vocabulary that is at odds with that of physician' (.huy *+>24
*+/-, as you may see in E8ample >.
E2amp!e 8
74 Doctor you recommended that * sa" a physiotherapist for my tennis el#o"
"hen * last visited you. $he mentioned a treatment called iontophoresis. .hat
does it involve-
54 .ell Mr ;oster this involves putting some cream on the s!in over the el#o"
and then using a special electrical device to encourage it to penetrate the s!in.
E2amp!e ;
101
54 .hat seems to #e the pro#lem at the moment-
74 .ell *+ve #een feeling so poorly recently.
54 * see. ;eeling poorly. *hat do you mean by that%
74 *+ve #een getting very short of #reath.
1ased on these assumptions, it can be stated that the relationship between
the doctor and the patient is strictly asymmetrical. However, a more careful
investigation of different elements of the medical encounter seems to provide
little support for such a definite conclusion. #he situation in the field of medicine
is, in my opinion, much more complicated. Henceforth, through a comparative
analysis of 5-7 dialogues in different medical branches, % shall demonstrate the
constant shifts in &hierarchies' in the e8ample of medical terminology, and offer
a more lucid account of its usage. $s mentioned earlier, similar insights into the
use of medical terms are still missing.
Dobert ). .huy (*+>24 *+/- points out that both patients and doctors
believe that using inappropriate vocabulary, i.e. medical terminology, has a
negative effect, and they tend to avoid it. %n Goy 7arkinson=s view, &no medical
terms should be used that the patient cannot understand' (3//64 +?-.
@evertheless, the statistics % have attempted to elaborate show that the reality is
different. %n general, both doctors and patients use medical terminology quite
frequently, in all the medical branches under discussion (E8amples +, */, and **-,
throughout all the parts of the medical encounter, and from all the word
categories selected (see E8amples 2, 6, ,, and ?-. Furthermore, patients usually
understand the medical terms initiated by doctors and, in most cases, are even
able to use them correctly.
E2amp!e <
54 .hen you had your first child do you remem#er "hat !ind of anaesthetics you
had for delivery-
74 * managed at first for a little "hile using gas and air #ut after that it really
#ecame too painful and * had to have an epidural.
54 Did you start la#our #y yourself or did they have to give you some help-
74 0o it #egan #y itself although * remem#er some of the other "omen in the
"ard having to get started off.
54 Do you remem#er ho" long the la#our "ent on for-
102
74 *t "as ,uite long. *t "as at least KL hours.
54 And the delivery itselfM "as it 7aesarean a forceps or "as it normal-
74 .ell in the end they had to use forceps to help get the #a#y out #ecause he
"as #eginning to get a #it tired as "ell.
(Mbstetrics and !ynaecology-
E2amp!e 1@
54 .hat *+d li!e to do no" Mrs $mith is 3ust have a loo! at Aames and chec!
things out li!e his heart and his chest. .hat *+m doing no" is *+m having a loo!
at his refle)es to ma!e sure that they are in places * "ould e)pect them to #e. 0o"
*+m going to have a gentle loo! in his mouth "ith this "ooden spatula. 0o"
loo!ing in his mouth * can see that he has a little #it thrush so *+ll give you
something called )ystatin for that to help it go a"ay. Can you tell me Mrs
$mith "hether you have any concerns a#out Aames-
M4 .ell yes Doctor *+m a little #it concerned a#out his cord #ecause * "ould
have e)pected it to have come off #y no".
(7aediatrics-
E2amp!e 11
54 .hat ta#lets are you ta!ing at present-
74 *+m ta!ing ibuprofen.
54 1ave you had any pro#lems "ith them-
74 * sometimes get indigestion and heart#urn.
54 1ave you had any treatments in the past-
74 * tried 1old in'ection #efore #ut it "as stopped after * developed itching and a
rash.
54 1o" does your arthritis affect your life-
74 * find it difficult sometimes to dress and "ashing can #e a pro#lem. *t is
sometimes difficult to com# my hair and * find house"or! difficult at times.
(Mrthopaedics-
Mut of **? medical terms, there are >> (A?[- doctor-initiated and 3>
(36[- patient-initiated in the first sample (see #ables *, 3-. 66 (2>[- terms
belong to the category of illnesses and diseases, 3* (*>[- to the category of
medication, *> (*?[- to the category of medical tools, and 22 (3>[- to the
category of medical procedures (see #ables *, 3, and Figure *-. *A (*,[- terms
103
appear during the history-taking phase, ?? (,A[- during the e8amination phase,
and 22 (3>[- during the treatment phase (see #ables *, 3, and Figure 3-.
#he data suggests that .huy=s and Goy 7arkinson=s standpoint about &the
simple language used by doctors and the avoidance of medical terminology'
(3//64 **/- cannot be taken for granted. %n the following % shall consider why
such a disparity in our findings e8ists.
%n my view, the most likely e8planation for the distinction in our opinions
rests with the approaches we have adopted when considering the phenomenon of
s$cia! rev$!%ti$"
,
and its impact on the language of medicine. $ccording to
.huy=s and 7arkinson=s understanding, what has changed are the attit%es $(
$ct$rs t$#ars their patie"ts. #hey believe that society has e8perienced a
certain balancing in the asymmetry between doctors and patients, especially as
regards the vocabulary used. #hey maintain that doctors prefer simple language,
tend to avoid medical terminology, and behave as partners.
7ersonally, % would also stress the changes in the attit%es $( patie"ts
t$#ars their $ct$rs. %n my view, patients, thanks to media and other forms of
modern technology, have greater access to the field of medicine than ever before,
and are generally better educated than previous generations. $s a result, they are
more likely to understand particular terms and their doctors may feel freer to use
them.
8.0.1 ,$ct$r'I"itiate Meica! Terms
104
7etrovov (*++A4 A3- maintains that &it is quite typical to use medical
terminology in doctor-patient interviews'. $s has been mentioned above, medical
terms used by doctors are more numerous than those used by patients. Mut of >>
medical terms, 2, (6/[- terms can be classified as illnesses and diseases, *2
(*6[- as medications, *, (*A[- as medical tools, and 3, (3+[- terms as medical
procedures (see #ables 2, 6, and Figure 2-. *3 (*2[- take place during the
history-taking phase, 66 (,/[- during the phase of e8amination, and 23 (2A[-
during the treatment phase (see #ables 2, 6, and Figure 6-.
#hese figures, together with the figures presented in #ables 2 and 6,
indicate that there are at least two important points which should be discussed.
#heir significance is stressed by some results of the F-test and correlation
between particular variables.
Firstly, it needs to be stressed that most medical terms in my corpus are
implemented by doctors specialised in Mbstetrics and !ynaecology. %n this case,
it is not too difficult to find an e8planation. )omen visit these specialists quite
regularly, and pregnancy for them is one of the most important events in their
lives. #hey spend a lot of time talking about their &problems' and &:oys' with
partners and parents. #hey e8change information with other women. Media offer
a notable amount of information, as well. .imply said, ladies know a significant
amount about this medical branch, and gynaecologists know this as well
(E8ample *3-. #hat is why they use medical terms quite frequently without the
need for an associated e8planation.
E2amp!e 1+
105
54 0o" have had a smear done "ithin the last N years-
74 * had one done a#out O years ago Doctor.
54 Do you remem#er the results of it-
74 2es they said it "as clear.
54 Do you !no" ho" often you ought to #e coming for a smear test%
74 * thin! it+s every K or N years.
54 2es that+s right7
Mf greater interest are the figures obtained from the branch of Mto-rhino-
laryngology. Medical terms used within this medical speciality are also very
numerous (E8ample *2-. #his time, however, we cannot e8plain the situation by
the frequency of visits and its importance for patients. #he e8planation is to be
sought somewhere else. #he correlation between the category of terms and
medical branches is /.22, i.e. there is quite a significant correspondence between
these two attributes of the consultation. Moreover, the result of the F-test for the
comparison of MDJ and %nternal Medicine with regard to the category of medical
terms is /./2, which also means it is worth investigating the significance of the
category of terms for their distribution.
E2amp!e 10
54 1ave you ta!en any medicine-
74 2es *+ve had some 8ibramycin and some nose drops.
54 Any #enefit-
74 *+m not really sure.
54 $it up in this chair. *+ll turn on the light to loo! up your nose. *+m holding
your nostril open "ith this speculum. 0o" *+m loo!ing up "ith my light. Are you
tender here on your chee! and around your eye-
%nternal Medicine has been mentioned for there is no term initiated in the
category of tools. Mn the contrary, ten words for tools and instruments are
utilised by specialists in Ear-@ose-#hroat, more than in any other discipline.
#hose who have visited an oto-rhino-laryngologist know that the medical
professionals in this branch use different kinds of tools and instruments quite
often. 1ecause some of their interventions are complicated, MDJ practitioners
106
tend to e8plain the process of e8amination or treatment and, at the same time, the
use of instruments (E8ample *6-.
E2amp!e 11
54 2ou+ve got some "ea! #lood vessels here. They are very prominent in "hat "e
call PLittle+s areaQ. * thin! that+s "here you+re #leeding from. *+d li!e to
cauterise those. 7 0o" *+m going to spray this area "ith some anaesthetic. Open
your mouth and #reathe through your mouth "hile * do it. *t doesn+t taste very
good. 0o" "ait a couple of moments. 1as the taste gone- 4ood. Let me see your
nose again. *+m putting this speculum in. *+m going to touch this area "ith this
stic!. .e can cauterise it. Ahh you+re #leeding slightly no" from that "ea! point.
*+ll hold this stic! on it for a minute. 4ood it+s stopped. 0o" there are a fe"
other areas. *+ll do the same. 7
Here % would see the e8planation to the above mentioned frequency of
medical terms within the branch of Mto-rhino-laryngology. ;orrespondingly, it
should be stressed that this strategy (doctors e8plaining the process of the
e8amination and treatment, and the use of medical instruments- is important for
balancing the asymmetry between the doctor and the patient.
?
8.0.+ Patie"t'I"itiate Meica! Terms
#he distribution of medical terms used by patients in my corpus is as
follows4 there are + (23[- medical terms belonging to the category of illnesses
and diseases, > (3+[- of them belong to the category of medication, 2 (**[- to
the category of medical tools, and > (3>[- to the category of medical procedures
(see #ables ,, ?, and Figure ,-. , (*>[- of them appear during the history-taking
phase, 33 (A>[- take place during the phase of e8amination, and only * (6[-
medical term appears during the phase of treatment (see #ables ,, ?, and
Figure ?-.
107
#he most noticeable fact concerning these figures is the absence of
medical terms used by patients during the treatment phase. )e see there is only
one term initiated during the phase of treatment (see E8ample A- $s the F-test
proves (FY3.//E-/?0 FY2.//E-/>-, the distinction between the treatment section
and the other parts of the medical encounter from the standpoint of participants is
very significant, and thus worth studying. %n my opinion, the distinction is
closely connected with the function of the treatment phase. %t is used by doctors
to e8plain the process of treatment or therapy, and by patient to ask some
additional questions about their diagnosis and the associated cure (see section
?.3.3.* &5octor-%nitiated Xuestions'-.
$ closer e8amination of doctor-patient interviews reveals that it is the
doctor who uses a particular term initially, usually when asking questions.
7atients only use these terms in their responses (E8ample *, and *?-. .ince there
e8ist almost no questions asked by doctors during the treatment phase,
A
we can
hardly e8pect any medical terms to be used on the part of patients.
E2amp!e 15
54 And "ere there any pro#lems after"ards- Did you need a D97 (dilatation and
curettage- or anything-
74 2es * had a ,uic! D97 after"ards #ut there "eren+t any further pro#lems.
(Mbstetrics and !ynaecology-
E2amp!e 14
54 As far that you !no" are there any illnesses that run in your family-
74 0one that * !no" of Doctor.
108
54 0othing li!e diabetes high #lood pressure or heart disease stro!e cancer
mental illness or anything li!e that-
74 Oh * see5 My father had a heart condition and * have t"o aunts "ho have
diabetes.
(%nternal medicine-
Moreover, the treatment section is the last phase of the medical interview
and where everything, including options, risks, and benefits of the medical
treatment, should be e8plained and clarified (E8ample *A-. %t is no surprise that
patients, unlike doctors (see A.2.*-, prefer to avoid medical terms, in order to
assure that there is no misunderstanding. #his would support the idea that
conventional, i.e. asymmetrical, roles of doctors and patients have been preserved
so far.
E2amp!e 18
54 Damien * have put the plaster on to !eep your #one in the right position. *t+s
very important that you do not get the plaster "et #ecause then it "ill #ecome
soft and the #one may move. * "ould also li!e you to come #ac! to hospital
straight a"ay of your fingertips feel tingly or num# or if your fingers go pale or
#lue. This "ould suggest that the plaster is too tight and "e "ould need to split it
to relieve the pressure. *n order to avoid s"elling "ithin the plaster * recommend
that you !eep your hand elevated so that the s"elling can drain a"ay. 2ou+ll need
to #e in the plaster for si) "ee!s altogether #ut "e+ll need some <-rays done
#efore then to ma!e sure the #ones haven+t moved.
#he figures obtained from each medical branch are interesting as well.
7atients
>
use the most medical terms when visiting a paediatrician (E8ample *>-.
Mn the contrary, there was only one term initiated during a consultation with an
oto-rhino-laryngologist (E8ample *+-.
E2amp!e 1;
54 1o" "as the #a#y at #irth- Did he have any pro#lems- 1o" "as he in the
first fe" days of life- Did the #a#y stay "ith you or did he need to go to special
care or to the nursery for any reason-
74 2es he "as ta!en to the special care unit #ecause he "as very small and he
"as getting cold and needed to #e given oxygen.
109
54 .as the #a#y premature / pre-term appropriate for dates or overdue-
74 1e "as three "ee!s early.
54 .hat did he "eigh-
74 Only O l#.
54 .as he 'aundiced / "hen he "as #orn-
74 2es he had photo therapy for 'aundice.
E2amp!e 1<
54 .as it a normal #irth-
74 0o he "as #orn ten "ee!s early and "ent to a special care #a#y unit. 1e had
meningitis then. 6ut loo!ed as if he "as normal.
%n my view, these results are not surprising, since parents, who usually
accompany their children to the doctor=s, are well informed about the most
common terms used throughout the visit0 they either remember the times of their
own childhood, or they (especially mothers- acquired the knowledge when
talking to other parents. Mn the contrary, MDJ practitioners are not visited so
often, and therefore their patients are less familiar with this medical branch.
8.1 C$mparis$" $( Samp!es
%n this part of the chapter % attempt to bring into view even more evidence
that my findings based on the sample taken from the first corpus are truly reliable
so as to confidently draw ob:ective conclusions. First, let me discuss quantitative
results based on the sample taken from the second corpus. #hen % would like to
consider and compare the qualitative aspects of doctor-initiated and patient-
initiated medical terminology in both samples under scrutiny.
Tab!e 117 Res%!ts Cabs$!%te a" re!ativeD $( the 1
st
Samp!e
Particip Phase Terms T$ta!
D P 1ist E)am Treat *JD Med Tools Meth
A#s. >> 3> *A ?? 22 66 3* *> 22 114
: ?? 26 *, ,A 3> 2> *> *? 3> 1@@
110
Tab!e 1+7 Res%!ts Cabs$!%te a" re!ativeD $( the +
"
Samp!e
Particip Phase Terms T$ta!
D P 1ist E)am Treat *JD Med Tools Meth
A#s. +2 2A *3 ,6 ?6 6> *+ *3 ,* 10@
: A3 3> + 63 6+ 2A *, + 2+ 1@@
$s can be seen, the results of both samples are almost the same.
;oncerning the second sample, out of A3, turns % have e8cerpted *2/ medical
terms. +2 (A3[- terms are doctor-initiated, 2A (3>[- initiated by patients. 6>
(2A[- terms belong to the category of illnesses and diseases, *+ (*,[- are
medications, *3 (+[- belong to the category of tools, and ,* (2+[- are
procedures. *3 (+[- medical terms are posed during the history-taking phase, ,6
(63[- during the e8amination, and ?6 (6+[- during the phase of treatment.
Furthermore, the computation of chi-square proves that as regards the total
number of medical terms (chi-squareY/.+,+-, both samples are the same. #he
very same conclusion concerns the number of medical terms posed by the
participants (chi-squareY*.2>6-, and the number of terms within the particular
categories (chi-squareY,.22*-.
Mn the contrary, as regards the number of terms provided during the
particular phases of the medical encounter, there is a certain divergence between
the two samples (chi-squareY**.+?+-. #he number of medical terms initiated
during the treatment phase is much higher (almost ,/[- in the second sample
than in the first sample. However, this divergence could be easily e8plained by
the differences in my corpora.
#he second corpus, unlike the first one, contains a larger number of
interviews in the surgery of an oncologist. .uch interviews are specific as the
treatment phase is much longer than usual. #he oncologist must inform the
patient about all the details of the treatment, let him9her know about possible
side-effects, dangers, and risks, and, of course, motivate the patient to fight the
disease.
+
%t is not possible without using specific terminology, which is, as
a result, much more numerous in the treatment phase than in any other part of the
encounter (E8ample 3/-.
111
E2amp!e +@
74 H 2ou mentioned radiotherapy #efore. Do * still need that-
54 2es you "ill need radiotherapy. That "ill reduce the ris! of any recurrence in
the #reast #ut radiotherapy has very fe" side-effects. *t is the drug therapy that is
pro#a#ly important to consider at this stage as * mentioned to you #efore
#ecause the lymph nodes have some tumour in them. *t is possi#le although #y no
means certain that there may #e tumour cells else"here in the #ody.
@4 Do you mean she "ill have radiotherapy as "ell as chemotherapy-
54 2es. .e usually give chemotherapy for a#out si) months and then give a
course of radiotherapy after it is finished. The chemotherapy is given once a
month and in most cases tends to ma!e you feel sic! and un"ell for a#out three
days so that means that you "ill feel sic! and un"ell for a#out three or four days
a month. The side-effects vary considera#ly from one person to another.
74 .ill * need any other treatment Doctor-
54 *t may #e "orth considering giving you tamoxifen as "ell as the
chemotherapy. 7
74 Am * going to die-
54 0o.
74 .ell *+m going to fight this.
54 That+s the #est "ay. 2ou seem a strong person.
74 Oh yes *+ve al"ays #een fit and * have so much to live for.
54 4ood "ell *+ll see you ne)t "ee! and * "ill introduce you to the Oncology
team. 4ood luc!.
E8cept for the fact that in the second sample, unlike in the first one,
doctors provide a large number of medical terms during the treatment section,
there are only parallels between the two samples. Jet me now consider at least
some of them. %n both samples, the doctor and the patient freely take the
advantage of using medical terms (E8ample 3*-. Mostly it is the doctor who uses
particular terms initially, the patient only uses these terms when responding
(E8ample 33-. #he doctor also tends to e8plain what the process of e8amination
and treatment is about, what some medical terms mean, and how he9she is going
to use a particular medical tool or instrument (E8ample 32-. #he patient mostly
understands and uses medical terminology correctly (E8ample 36-.
*/

112
E2amp!e +1
54 1ave you had any operations-
74 0o. Only appendix.
54 .hen did you last have your #ac! :-rayed-
74 Long ago.
54 Are you ta!ing any ta#lets-
74 * ta!e t"enty-si) units of insulin for my diabetes. * have ;antec for my ulcer
ta#lets for my hay fever and also t"o glibenclamide for my diabetes.
54 .ho loo!s after your diabetes-
E2amp!e ++
54 7 2es sometimes the #acteria that cause a sore throat can ma!e your
psoriasis flare up.
74 *s this rash all over me the same as the psoriasis that * get on my el#o"s-
54 2es it is a form of psoriasis. Does any#ody else in your family have psoriasis-
74 My father has psoriasis and his father has psoriasis. My dad+s psoriasis is #ad
7
E2amp!e +0
54 Mmm. .ell it loo!s as though the ne)t step "ill #e to get you into hospital to
start further treatment. * thin! you are going to need peritoneal dialysis
treatment. 7 *t means putting a tu#e into the a#domen and then "ashing fluid in
and out to !eep the to)ic su#stances in the #lood do"n.
E2amp!e +1
74 $ince * "as diagnosed as having endometriosis * have #een doing a lot of
reading and * am really "orried that * have got the pain again. Also * "ould li!e
to have some #a#ies in the future and * thin! this may #e difficult "ith
endometriosis. * "onder if it "ill ever go a"ay #ecause the pain is really getting
me do"n.
1oth the quantitative and the qualitative findings suggest that medical
terminology is deeply rooted in the medical encounter, and the tendency to use
it is increasing.
**
Moreover, according to !wyn (3//34 A-4 &Medical terms are
scattered throughout our conversations, and a much wider knowledge of
terminology is discernible in everyday discourse than e8isted a generation ago.'
113
#hus, the avoidance of medical terminology in doctor-patient communication, as
suggested by .huy (*+>2- and 7arkinson (3//6-, is not the best way to bridge the
gap between the doctor and the patient. %n my opinion, the patient should be
understood as a responsible adult who is competent enough to find necessary
information, especially about those medical branches he9she has not been in
contact so far.
*3

8.5 S%mmar*
#o follow the form of the previous chapters, let me summarise this section
with a chart including the most significant findings in relation to symmetry
and9or asymmetry of the medical interview. #he research results are presented in
more detail in section A.2.
S*mmetr* As*mmetr*
*. 5octors tend to e8plain the process *. >> (A?[- terms are doctor-initiated0
of e8amination and the use of medical 3> (36[- terms are patient-initiated.
terms, especially tools and instruments.
3. 7atients mostly understand and use 3. 5octors initiate the use of terms0 patients
medical terminology correctly. do not initiate the use of terms, they
only respond to doctor-initiated questions.
2. 5octors use terms from all the categories0
patients do not use medical terms from
the category of tools very often.
6. 5octors pose medical terms throughout
the interview0 only one patient-initiated
term is posed during the treatment phase.
#he findings presented in this chapter are only preliminary, and will
require subsequent analyses. % have not discussed some significant results of the
F-test and some important correlation (e.g. between the medical specialities and
phases of the medical encounter, /. 2+-0 their e8planation is either &transparent
and close to the surface', or my sample is not large enough to struggle for their
interpretation. Mn the other hand, as pointed out above, this article is one of few
114
te8ts attempting to bring new insights into the use of medical terminology in
doctor-patient interviews. #hus my work could be perceived as a first step.
8.4 N$tes
* % do not attempt to compare ;Cech and English versions of doctor-patient
interaction. However, such a comparison could be very interesting and
needed. %n my opinion, it should become the perspective of further
research.
3 ;f. !wynn (3//34 *36- and his notes on medical metaphors4 &Hthe more
closely we e8amine the etymology of medical terms, the more likely we
are to find a metaphor behind every dictionary definition. #hus, Fcancer= is
itself a metaphor of the creeping motion of the crab. Malaria, from the
%talian mala aria (bad air-0 measles, from the middle English mesel ($
leper-0 mumps, from si8teenth century English mump (to grimace- are
further e8amples.'
2 $vailable online4Qwww.medicine.net.com S, cited +. 6. 3//6.
6 $vailable online4Qwww.medterms.com S, cited +. 6. 3//6.
, &%n general, the newly emerging form of society is termed the ris! society.
#he risk society can be defined as advanced liberalism in )estern
countries. #he state withdraws from its responsibility for individuals, thus
forcing risks upon individuals who develop a variety of strategies to avoid
these risks or to deal with them' (7arusnTkov *+++4 *6+-. For details see
;hapter Mne (&%mportance of 5octor-7atient ;ommunication Desearch'-.
? ;f. Humphreys (3//34 26-.
A For details see ?.3 (&Dole of Xuestions in 5-7 ;ommunication'-.
> %n this case, patients Y parents. $s it has been shown elsewhere (MEllerov
I Hoffmannov 3///, #annen I )allat *+>2-, the paediatrician uses
different linguistic registers when talking to the parent, and when talking
to the child. ;onsidering medical terminology, we may e8pect that parents
are the audience to be addressed.
+ ;f. Humphreys (3//34 62-4 &Jeydon et al (3///- found the amount of
information sought by cancer patients varied between patients and at
115
different stages in their illness. #he need to maintain hope was found to be
an important element influencing the amount of information sought.'
*/ %nterestingly, some researches have proved that those patients whose
knowledge of medical terminology is considerable &may orient to such
knowledge as belonging to an authoritative professional by, for e8ample,
the tentative or uncertain use of medical terminology' (5rew and Heritage
*++34 ,/-.
** For details about other reasons some doctors tend to use medical
terminology so often, see Doter I Hall (*++34 +,-.
*3 ;f. 7arusnTkov (*+++4 *,/-4 &%n medicine, the risk society manifests itself
above all in the ideology of healthism. Healthism involves a total
medicaliCation of society, where health issues become part of people=s
everyday life. #his corresponds to the general ethos of the risk society4
since it is we, individuals, and not the state who are responsible for our
health, we also must acquire some basic medical knowledge, we must lead
healthy lives and avoid health haCards.'
116
Chapter Ei&ht
MANIFESTATION OF POLITENESS IN ,'P COMM3NICATION
7oliteness is a system of interpersonal relations designed to facilitate
interaction by minimiCing the potential for conflict and confrontation
inherent in all human interchange. )e like to think of conversation as
conflict-free, with speakers normally being able to satisfy one another=s
needs and interests. 1ut, in fact, we enter every conversation with some
personal desideratum in mind.
Dobin Jakoff
;.1 I"tr$%cti$"
#he purpose of ;hapter > is three-fold. First of all, % attempt to analyse
some means of manifesting p$!ite"ess in doctor-patient interaction in order to
either confirm or contradict the findings of previous research. .econd, my aim is
to compare the productivity of negatively polite linguistic strategies that occur in
i"stit%ti$"a! setti"&s (e.g. medical encounter- with those that are characteristic
of authentic communication in "$"'i"stit%ti$"a! setti"&s. #hirdly, the present
chapter offers a more detailed description of some aspects of doctor-patient
communication that have so far been only outlined (e.g. as*mmetr* vs.
p$!ite"ess-.
%n this section % have drawn upon the following sources4 *- #he theory of
politeness as advocated by 1rown and Jevinson (*+>A- becomes my main source
of information about negative politeness strategies. 3- My interpretation of
politeness devices that occur during doctor-patient interaction draws, for
instance, on 7aget (*+>2-, Mishler (*+>6-, HenCl (*+>+-, and !wyn (3//3-.
2- #he material from which % would like to make the comparison of the
institutional and non-institutional discourse is taken from )ilamov (3//,-. $s
she argues, her conclusions, however valid only for fictional dialogue, could also
be relevant for authentic communication. Moreover, e8amples taken from her
corpora give evidence that most dialogues she has worked with are of non-
institutional character.
*
117
;.+ A"a!*sis
$ccording to 7aget (*+>24 ,+-, &H politeness forms are frequently deleted
from UmedicalV discourse. #hey are almost entirely absent from the speaking
practices of the physician in these encounters.' $s she maintains, a typical
e8ample of this impoliteness is the doctor=s failure to answer questions provided
by the patient. 7aget also criticises doctors for not being able to acknowledge
responses of the patient, and for insufficient clarification of their inquiries.
3
$s has been proven in the previous sections, the corpora % have analysed
differ considerably. $ll patient-initiated questions are answered by doctors, and
doctors usually spend a huge amount of time clarifying and interpreting their
diagnoses and the following treatment (see ;hapter ? &Function of .peech $cts'-.
Moreover, doctor-initiated medical terminology, understood by some researchers
as an instance of impoliteness, is usually provided with an e8planation so that
there is no misapprehension on the part of the patient (see ;hapter A &Bse of
Medical #erminology'-.
Furthermore, there are many other politeness strategies initiated by doctors
in my corpora. 5octors, generally, do not interrupt patients= talk (E8ample *-,
listen attentively to patients= worries, and even introduce questions by referring
to patients= own words (E8ample 3-. #hey are reassuring and supportive
(E8ample 2-, and at the end of the consultation they make sure that nothing has
been left une8plained during the interview (E8ample 6-. 5rawing on Mishler
(*+>6-, doctors, surprisingly, avoid so called Gv$ice $( meici"eH and seek to
communicate what he calls Gthe v$ice $( the !i(e#$r!H.
2
#hey follow his model
of Fhumaneness=, and thus balance asymmetrical relations between doctors and
patients during medical interviews.
E2amp!e 1
54 *s this a ne" thing-
P7 <y abdomen is always a little bit sore in the first couple of days, but over the
last few weeks, I(ve been getting really sore. I(ve been getting this terribly
crampy feeling in my tummy and some back ache as well. It(s been coming on
before bleeding begins and it(s been so bad that I(ve had to have some days off
118
from work over the last few months. I(ve also got another problem. I get so up-
tight 'ust before my periods. I feel as though I could murder everyone.
54 That sounds typical of PMT / pre-menstrual tension.
E2amp!e +
54 Do you thin! he+s having any pro#lem "ith cho!ing-
M4 .ell he seems to #e e)periencing ,uite a lot of trou#le getting his air and
getting his breath.
54 is it the first time that Aames has found it difficult to get his breath%
E2amp!e 0
54 That+s very good. 2ou+re certainly doing your part. Our part is to get the
treatment started as soon as possi#le. *+ll arrange your appointment at the
radiotherapy clinic. .ould you li!e me to spea! to your "ife-
E2amp!e 1
54 .arts can #e treated #y freeGing them "ith li,uid nitrogen #ut * thin! the #est
"ay to treat your "arts "ould #e to put some podophylum paint on them. 2ou "ill
#e re,uired to "ash the paint off after si) hours #ecause if you leave it on for
longer this may cause some discomfort. *=ll as! you to go and spea! to one of our
advisers "ho+ll give you information on genital "arts and ho" you have
ac,uired the. 2ou+ll need to return to the clinic in t"o "ee!+s time for further
treatment and #y that time the results of the tests * have done "ill also #e #ac!.
.ould you li!e to as! me any ,uestions #efore * as! you to see the health adviser-
%t is obvious that 7aget=s opinion about politeness forms, being almost
entirely absent from the doctors contributions to the encounter, cannot be taken
for granted. %n what follows, % bring quantitative and qualitative evidence that
politeness devices occur quite frequently in doctor-patient communication, both
on the part of the doctor and the patient, within all the medical branches under
scrutiny, and during all the parts of the medical interview.
.ince the quantitative analysis presupposes a limited number of strategies
that could be investigated, % have decided to research only those linguistic
devices that are characteristic of "e&ative p$!ite"ess. #he reason for my decision
is that negative-politeness behaviour, as % believe, is more likely to take part in
institutional settings, of which doctor-patient communication is a representative
119
e8ample, than strategies characteristic of p$sitive p$!ite"ess.
6
Moreover, such
a choice allows me to compare my findings with those investigated by )ilamov
(3//,-.
$s the analysis of her data has shown, &there are four basic linguistic
strategies that occur in negatively polite discourse, namely *- GIH:G=$%H
av$ia"ce ($void-0 3- ista"ci"& strate&* (5ist-0 2- m$a! verb ch$ice
strate&* (Modal-0 and 6- st*!istic ch$ice' ()ilamov 3//64 6/-.
,
#o satisfy the
needs of the comparison, % have included, in accordance with her research, only
the first three strategies to my quantitative analysis. #he stylistic choice has not
been mapped because it would be quite difficult to organise its quantification.
More importantly, the comparison is also drawn based upon the level of the
qualitative interpretation.
Tab!e 17 Abs$!%te Fre6%e"c* $( P$!ite"ess Strate&ies i" ,'P I"tervie#s
A#s. Particip Phase Strate&* T$ta!
D P 1ist E)am Treat Avoid Dist Modal
*nternal 3? ** ** 3? / 3A * + 08
4ynaec. 26 6 3 33 *6 *? / 33 0;
Paed. 2/ , *, , *, */ / 3, 05
O9L 2> 3 , + 3? 2* / + 1@
Orthop. 32 6 > + */ *, / *3 +8
T$ta! 151 +4 11 81 45 << 1 88 188
Tab!e +7 Re!ative Fre6%e"c* $( P$!ite"ess Strate&ies i" ,'P I"tervie#s
: Particip Phase Strate&* T$ta!
D P 1ist E)am Treat Avoid Dist Modal
*nternal A/ 2/ 2/ A/ / A2 2 36 +1
4ynaec. >+ ** , ,> 2A 63 / ,> +1
Paed. >? *6 62 *6 62 3+ / A* +@
O9L +, , *3 32 ?, AA / 32 +0
Orthop. >, *, 2/ 22 2A ,? / 66 15
T$ta! ;5 15 +0 1@ 08 54 1 10 1@@
Tab!e 07 Abs$!%te Fre6%e"c* $( ,$ct$r'I"itiate P$!ite"ess Strate&ies
120
A#s. Phase Strate&* T$ta!
1ist E)am Treat Avoid Dist Modal
*nternal + *A / *> / > +4
4ynaec. * *+ *6 *6 / 3/ 01
Paed. *, 2 *3 + / 3* 0@
O9L 6 > 3? 2* / A 0;
Orthop. A > > *3 / ** +0
T$ta! 04 55 4@ ;1 @ 48 151
Tab!e 17 Re!ative Fre6%e"c* $( ,$ct$r'I"itiate P$!ite"ess Strate&ies
: Phase Strate&* T$ta!
1ist E)am Treat Avoid Dist Modal
*nternal 2, ?, / ?+ / 2* 18
4ynaec. 2 ,? 6* 6* / ,+ +0
Paed. ,/ */ 6/ 2/ / A/ +@
O9L ** 3* ?> >3 / *> +5
Orthop. 2/ 2, 2, ,3 / 6> 15
T$ta! +1 04 1@ 54 @ 11 1@@
Tab!e 57 Abs$!%te Fre6%e"c* $( Patie"t'I"itiate P$!ite"ess Strate&ies
A#s. Phase Strate&* T$ta!
1ist E)am Treat Avoid Dist Modal
*nternal 3 + / + * * 11
4ynaec. * 2 / 3 / 3 1
Paed. / 3 2 * / 6 5
O9L * * / / / 3 +
Orthop. * * 3 2 / * 1
T$ta! 5 14 5 15 1 1@ +4
Tab!e 47 Re!ative Fre6%e"c* $( Patie"t'I"itiate P$!ite"ess Strate&ies
: Phase Strate&* T$ta!
1ist E)am Treat Avoid Dist Modal
*nternal *> >3 / >3 + + 10
4ynaec. 3, A, / ,/ / ,/ 15
Paed. / 6/ ?/ 3/ / >/ 1<
O9L ,/ ,/ / / / *// ;
Orthop. 3, 3, ,/ A, / 3, 15
T$ta! 1< 4+ 1< 5; 1 0; 1@@
Tab!es 85 ;5 <5 1@7 Res%!ts $( the F'test
121
; Particip
1ynaec. /aed. "23 "rthop.
Internal /,/3Z /,*3 *,3,E-/,Z /,*+
1ynaec. /,62 6,//E-/*Z /,2+
/aed. 6,?2E-/2Z /,+/
"23 ,,/AE-/2Z
; Phase
1ynaec. /aed. "23 "rthop.
Internal /,3/ ,,A?E-/,Z +,AAE-/2Z *,2>E-/2Z
1ynaec. 6,/6E-/2Z /,*> /,/6Z
/aed. /,*/ /,,*
"23 /,6/
; Strate&*
1ynaec. /aed. "23 "rthop.
Internal /,6/ /,A? /,>? /,2+
1ynaec. /,?* /,2/ /,+2
/aed. /,?3 /,,>
"23 /,2/
; Strate&*
E2am Treat
Hist$r* /,+2 /,+,
E2am /,+>
;.0 Fi"i"&s
#he procedure described in the preceding paragraphs yielded the following
results4 from A3, turns % have managed to e8cerpt *AA negatively polite devices.
*,* (>,[- are initiated by doctors and 3? (*,[- are initiated by patients (see
#ables *, 3-. $ closer e8amination of #ables * and 3 reveals that ++ (,?[-
devices belong to the category of F%=9=Lou= avoidance strategy, * (*[- to the
distancing strategy, and AA (62[- to the modal verb choice strategy (see also
Figure *-. 6* (32[- politeness devices originate during the history-taking phase,
A* (6/[- during the phase of e8amination, and ?, (2A[- during the phase of
treatment (see #ables *, 3, and Figure 3-.
122
.huy (*+>2- advocates that doctor-patient communication is in many
aspects similar to everyday conversation0 it is structured and organised. $t the
same time, he stresses the fact that medical encounters differ from everyday
conversations0 especially as regards balanced participation of the interaction.
;orrespondingly, having compared my findings based on the analysis of medical
interviews with the results of the research based on the analysis of normal
conversation, there are both the similarities and differences. First of all, let me
e8amine the points of similarity, the points of divergence will be analysed later
(pp. *3?-*3>-.
#he frequency of occurrence of structural le8ico-grammatical devices
presented by )ilamov (3//,4 A+- is as follows4 the total number of negatively
polite devices in her corpus is >?, 2* (2?./[- politeness devices belong to
F%=9FLou= avoidance strategy, *A (*+.>[- of them to the strategy of distancing,
and 2> (66.3[- to the modal verb choice strategy, which becomes the most
numerous category.
%n addition, )ilamov also distinguishes sets of subcategories for
particular linguistic strategies. #hese are the process of "$mi"a!iIati$" (E8ample
,-, using GITH as a s%bject (E8ample ?-, GTHEREATO JEH c$"str%cti$"
(E8ample A-, G?EH as a pers$"a! pr$"$%" strate&* (E8ample >-, and using
impers$"a! or i"e(i"ite s%bjects:$bjects (E8ample +- for F%=9FLou= avoidance
strategy. E8amples of these subcategories e8cerpted from the material that has
been researched in the presented thesis are supplemented below.
E2amp!e 5
54 *s this your first pregnancy- (i.e. $re you pregnant for the first timed-
123
E2amp!e 4
54 And the delivery itselfM was it Caesarean a forceps or was it normal-
(i.e. 5id you have ;aesarean or did you have a normal deliveryd-
E2amp!e 8
54 2es that+s right although if there are any a#normalities on any of the smear
tests you must come #ac! more regularly than that. (i.e. although if you have any
abnormalities-
E2amp!e ;
54 O@. That+s good. *e 3ust need to do a little internal e)amination no". (i.e.
% :ust need to e8amine you-
E2amp!e <
54 Do any problems run in the family- (i.e. 5o you have any problems in your
familyd-
#he distancing strategy is divided into two substrategies, namely the
ista"ci"& verb and the ista"ci"& em$"strative. $s for the modal verb choice
strategy, it is subdivided into modals e8pressing $b!i&ati$" or pr$hibiti$"
(E8ample */-, modals asking for permissi$" (E8ample **-, modals e8pressing
v$!iti$" (E8ample *3-, abi!it* (E8ample *2-, te"tative p$ssibi!it* (E8ample *6-,
and h*p$thetica! %sa&e (E8ample *,-. $s )ilamov (3//,4 ,?- points out, &the
classification here draws on Jeech=s (*+A,- functional typology of modal verbs,
which provided the theoretical background for a further study of modal verbs in
negatively polite discourse'. E8amples of these subcategories selected from my
corpus are again offered below.
E2amp!e 1@
54 * would advice you not to ta!e any alcohol "hile you are on these anti#iotics.
(i.e. % want you not to take any alcohol-
E2amp!e 11
M4 7ould I ask you Doctor "hat your advice "ould #e if * "ere to #reast-feed
my #a#y-
124
E2amp!e 1+
54 1ello Mrs $mith. *ould you li!e to undress Aames-
E2amp!e 10
54 * can(t give you any guarantee that they "ill not return.
E2amp!e 11
74 *+m afraid * might have asthma.
E2amp!e 15
74 * feel tightness in my chest so * thought it would #e "ise to come in and see
you.
@otably, in both samples F%=9FLou= avoidance (,?[, 2?[- and the modal
verb choice strategy (62[, 66[- are the most frequent negatively polite
strategies. Furthermore, as can be seen from my e8amples, all subcategories of
particular strategies are represented in the samples under discussion.
%t should also be pointed out that these linguistic strategies perform similar
functions within the discourse. $s regards modals, &they enable the speaker to go
on record, but with redress, which is achieved with minimum linguistic effort'
()ilamov 3//,4 AA-. $s for F%=9FLou= avoidance, its function is to evade direct
reference both to the speaker and the hearer, and thus contribute to a higher
degree of negative politeness.
?
7roceeding now to the points of divergence, it is worth mentioning that
there is only one linguistic device from the distancing strategy in my sample
(E8ample *?-. Mn the contrary, there are seventeen devices in the sample
presented by )ilamov (3//,-. %n my opinion, a possible e8planation for this
divergence could be sought in the way the distancing strategy functions. $s she
maintains, &this device allows the speaker to ista"ce himself i" time (i.e.
distancing from Fnow=- and hence distancing from an F#$' (3//,4 ,6-. However,
as regards medical interviews, this function has no beneficial effect on the
process of doctor-patient communication.
%ntuitively, both the doctor and the patient tend to avoid the use of
distancing devices, because it could clash with the main purpose of medical
125
interviews, that being, responsible diagnosis and treatment. %t is crucially
important for the doctor to know #he" e8actly his patient=s health problems
started and for h$# !$"& they have lasted. $s a result, they carefully observe the
most suitable use of tenses (E8ample *A-, and for being polite they prefer other
devices, for instance above mentioned F%=9FLou= avoidance strategy. Maybe that is
the reason this strategy is more frequent in my sample than in the sample it is
compared with.
E2amp!e 14
74 * thought it "ould #e "ise to come in and see you.
E2amp!e 18
54 .hat seems to #e the pro#lem at the moment-
74 .ell I(ve been feeling so poorly recently.
54 * see. ;eeling poorly. .hat do you mean #y that-
74 I(ve been getting very short of #reath.
54 1m7$ow long has this been going on-
74 =or about >? months * thin!.
54 And were there any other symptoms before then or did it start +uite suddenly-
74 * hadn(t noticed anything before then.
#he last e8amples reveal that negative politeness devices provided in
institutional settings, particularly in the surgeries of doctors, are very frequent,
even more frequent than in non-institutional conversation. Mn the contrary,
concerning the number of particular types of linguistic strategies, non-
institutional talk is more diverse, and takes advantage of using all the structural
le8ico-grammatical devices under scrutiny.
!enerally speaking, these results support the idea that the institutional talk
is more structured, predictable, and organised around a limited number of topics
that must be pursued.
A
%n everyday conversation, on the other hand, speakers are
allowed to be more spontaneous, unpredictable and creative, yet polite.
>

$t this moment, before approaching the e8amination of doctor-initiated
and patient-initiated negatively polite strategies in various medical branches, let
me consider the mutual relationship between the phenomena of politeness and
126
asymmetry, which is of crucial importance when interpreting the topic of my
dissertation, namely the process of change in doctor-patient interaction.
Mne might simplify that when communicating, the degree of politeness is
in indirect proportion to the degree of asymmetry. %n other words, the more polite
doctors are the less asymmetrical their relationship towards patients is. However,
as has been stressed elsewhere (#homas *++,-, politeness is Fconte8t-sensitive=,
and &the social roles of the participants in the communicative event are directly
relevant in the e8pression of politeness' (Brbanov 3//24 *>-.
Jet me now consider the following e8ample. %n e8ample *>, the doctor
initiates a question by asking the patient about the way she fed her children. #he
patient replies, and the doctor acknowledges her response with a reactive O@.
That+s good. $lthough he is polite, we cannot say that this e8pression of
politeness makes their relationship more symmetrical. $s has been already shown
in ?.2.3, the reactive enables the doctor to end the topic and to initiate a new one
(.e 3ust need to do a little internal e)amination no". -. %t allows to &swerve the
talk back into the doctor=s turn, and maintain control of the conversation, thereby
manifesting medical institutional power' (#odd *+>24 *??-.
E2amp!e 1;
54 1o" did you feed your children- 6reast or #ottle-
74 * #reast-fed all of them #ut only managed for a#out the first three months and
after that "e #egan to top them up "ith #ottle mil!.
54 O!. That+s good. .e 3ust need to do a little internal e)amination no".
;.0.1 ,$ct$r'I"itiate P$!ite"ess Strate&ies
$s has been proven in the research provided by other linguists (e.g. .huy,
*+A?0 Jabov and Fanshel, *+AA-, the amount and distribution of speech during
doctor-patient communication is rather asymmetrical. $ccording to 1yrne and
Jong (*+A?-, on the average the medical interview lasts eight minutes. Most of
the time is e8ploited by doctors for the purpose of information-gathering,
e8amination, and treatment. 7atients are usually more passive and the period of
127
time they spend talking is, compared to the doctor=s, very short. ;onsequently, it
is the doctor whose initiation of politeness strategies is more frequent.
Mut of the total number of negatively polite devices e8cerpted from ;orpus
% (*AA-, *,* (>,[- are doctor-initiated (see #ables 2, 6-. >6 (,?[- politeness
devices belong to the category of F%=9FLou= avoidance strategy, / (/[- to the
category of distancing strategy, and ?A (66[- to the category of modal verb
choice strategy (see #ables 2, 6, and Figure 2-. 2? (36[- take place during the
history-taking, ,, (2?[- during the phase of e8amination, and ?/ (6/[- during
the treatment phase (see #ables 2, 6, and Figure 6-.
$ more detailed e8amination of #ables 2, 6, A, >, +, and */ reveals several
interesting points. $s can be seen, the largest number of politeness devices occur
during the treatment section, and is provided both from the category of F%=9FLou=
avoidance strategy and the modal verb choice strategy. $s has been shown in the
previous chapters (e.g. ;hapter ?-, the treatment phase is in many aspects
specific0 the e8amination of a patient is over, and the doctor already knows the
diagnosis. @ow the doctor=s task is to inform the patient about his9her health
problems and future treatment. %n many cases, especially when a surgical
intervention is required, a more polite way of informing the patient suits the
situation (E8ample *+-.
E2amp!e 1<
,7 ou(ve got a deviated nasal septum. This part of your nose is cartilage, and
instead of being straight it(s twisted and the twist is blocking you on the left
side. I(m pleased to say we can fix it for you. *e can put it right with an
128
operation to straighten up your nose, as there are no medicines or tablets really
that will help.
74 *s it a #ig operation-
,7 N$5 "$t t$$ bi&. ItHs 6%ite c$mm$". I( *$% a&ree5 #eH!! bri"& *$% i"t$
h$spita! the a* be($re the $perati$". =$% ca" %s%a!!* &$ h$me the a* a(ter
*$%r $perati$"5 $r p$ssib!* the sec$" a* a(ter that. ?e $ it %"er a
&e"era! a"aesthetic. ItHs $"e thr$%&h *$%r "$stri!s5 thereHs "$ c%ts $" *$%
(ace.
74 0o #lac! eyes-
,7 )ot for this operation. *hen you wake up from anaesthetic, you(ll probably
have a bandage up both nostrils overnight so, you see, you(ll have to breath
through your mouth that night. *ould you like the operation%
$s regards the modal verb choice, it is not difficult to e8plain why this
category of negatively polite strategies is so numerous4
English modals represent e8tremely fle8ible devices which not
only have a grammatical function (i.e. as helping words-, but
which also carry a Fsemantic= meaning that Fcolours= the
propositional content of the message. ()ilamov 3//,4 AA-
%n this respect, modal verbs function as important negatively polite devices in
both the institutional and non-institutional settings.
Mf a greater interest is the function of F%=9FLou= avoidance strategy and its
subcategories (see above-. Especially the use of the i"c!%sive G#eH in doctor-
patient communication is worth discussing.
+
5octors, unlike patients, often
substitute the address pronoun you by the first person plural pronoun "e
(E8ample 3/-. $ccording to HenCl4 &#he preference of "e in addressing patients
is common across the whole medical profession, and shifts in pronominal use
mark the speech of medical personnel of all levels and specialiCations' (*+>+4
>>-. #he results of the F-test calculated for the five medical branches under
discussion (see #able +- give this opinion statistical support.
*/

E2amp!e +@
54 @eep #reathing through your mouth 3ust let the "ater run out of your nose.
.ell done it+s coming #ac! clear no". .e can stop. (i.e. Lou can stop-
129
#he qualitative interpretation of the function of the inclusive Fwe= reveals
that doctors tend to employ this device because &it avoids e8plicit reference to
either the speaker himself or to the addressee' ()ilamov 3//,4 6A-.
@evertheless, it also reflects asymmetry in the social status of the interlocutors. %t
is the doctor who e8ercises the power by making decisions for the patient (HenCl
*+>+-.
**
#he employment of the inclusive Fwe= provided by the patient would be,
on the contrary, considered rather impolite.
1esides the inclusive Fwe=, doctors also make use of the so called
e2c!%sive G#eH (E8ample 3*- or its pronominal modification G%sH (E8ample 33-.
%n this case, however, the pronoun "e performs a different function. %t fulfils the
need for se!('pr$tecti$" and se!('e(e"ce. $lthough it is not likely that patients
would carry out face-threatening acts (see >.2.3 -, doctors still tend to protect
themselves by withdrawing from the responsibility for potentially unsuccessful
outcomes of their treatment.
E2amp!e +1
DD .ell the "a) loo!s ,uite soft so we(ll syringe it. Ri.e. * "ill syringe it.>
E2amp!e ++
54 This "a) is too hard for us to get out no". (i.e. #his wa8 is too hard for me.-
$s regards the manifestation of doctor-initiated politeness, there are two
more discourse strategies worth considering, namely the .prese"tati$"a!/ and
.pers%asi$"a! strate&ies/. 1oth strategies are described as Fnegotiating
mechanisms= that provide information, and suggest or specify how the
information should be understood (Fisher *+>2-.
#he presentational strategies are described as .s$(t se!!s/. #o clarify their
function, Fisher (*+>24 *62- mentions the following4
For e8ample, a practitioner would say, F)e usually treat this by
freeCing.= #his presentation provides the patient with
information about treatment option while suggesting that it is
the &usual' or &normal' way to treat her condition.
130
#he persuasional strategies, on the other hand, are labelled as .harer se!!s/.
Fisher offers the following e8ample to e8plain their use4
For e8ample, a practitioner might say, F)hat you should do if
you don=t want any more children is have a hysterectomy. @o
more uterus, no more cancer, no more babies, no more birth
control, and no more periods.= #his presentation provides the
patient with information about what treatment she should have
while specifying why she should have it. (Fisher *+>24 *62-
%n terms of negative politeness, it seems to me that that the presentational
strategy is !ess imp$si"&5 and hence m$re p$!ite than the persuasional strategy.
%n terms of asymmetry, the &soft sell', unlike the &harder sell', &places the
patient in a position where they could, if they wished, question not only the
treatment, but the thinking behind it. #herefore, this strategy is significant in
balancing the asymmetry between doctors and patients' (Humphreys 3//34 26-.
%n connection with my sample, the presentational strategy is the more
frequent. Moreover, it is embedded in all the medical disciplines under
consideration (see E8amples 32, 36, 3,-.
E2amp!e +0
DD * can feel a little lump underneath my fingers and "hat that indicates to me is
that he+s got some overgro"th of the muscle at the e)it of the stomach and that it
#loc!ing the material li!e his mil! draining from his stomach so * thin! that it+s
li!ely that "hat "e need to do is a small operation to cut through the muscle and
rela) it.
(7aediatrics-
E2amp!e +1
54 .e have got the results of your #iopsy and *+m afraid "e "ill need to give you
more treatment for your voice.
(Ear-nose-throat-
E2amp!e +5
54 .arts can #e treated #y freeGing them "ith li,uid nitrogen #ut * thin! the #est
"ay to treat your "arts "ould #e to put some podophyllum paint on them.
(Mbstetrics and !ynaecology-
131
;.0.+ Patie"t'I"itiate P$!ite"ess Strate&ies
$s mentioned above, patients infrequently carry out potentially face-
threatening acts. $ccording to Fisher, they &rarely say aloud that they do not trust
their medical practitioners or that they suspect them of trying to manipulate the
situation' (*+>24 *2A-. ;orrespondingly,
$insworth-<aughn presents only two e8amples from her data,
one in which a woman covertly questions her physicians
competence, the other in which a male patient makes blatant
se8ual references to both his (female- physician and (off
screen, as it were- to female nursing stuff. (!wynn 3//34 A>-
$ccordingly, we may characterise the patient=s behaviour as very polite. %t
is influenced, of course, by the social role he9she plays in doctor-patient
interaction. Bnlike the doctor, who is supposed to provide a health service, the
patient is Fone who waits, suffers, and is treated= (!wynn 3//3-.
*3
%t is no
surprise that his9her relationship with the doctor is very polite, more accurately,
of negatively polite character.
$lthough the space9time for the employment of patient-initiated politeness
strategies is limited (see >.2.*-, % have managed to e8cerpt 3? negatively polite
devices in the first sample. *, (,>[- negatively polite devices are of the F%=9FLou=
avoidance strategy, * (6[- of the distancing strategy, and */ (2>[- of the modal
verb choice strategy (see #ables ,, ?, and Figure ,-. , (*+[- of them occur
during the history-taking phase, *? (?3[- during the e8amination phase, and
again , (*+[- during the treatment section (see #ables ,, ?, and Figure ?-.
132
%n accordance with what has already been discussed (e.g. in ;hapter ?
&Function of .peech $cts in 5-7 ;ommunication'-, the largest number of
politeness devices is provided by patients during the phase of e8amination
(E8ample 3?-. #his part of the medical encounter is the longest, and it is not
reserved only for merely answering doctor-initiated questions as the information-
gathering part (history-taking- or for doctors= e8planation and clarification of
therapeutic procedures as the phase of treatment.
E2amp!e +4
M4 .hat "ould you advise Doctor a#out dressing him at night time for sleep
#ecause *+ve heard different vie"s on this.
.ince the use of negatively polite strategies has already been considered,
let me complete this subchapter with one more interesting point. $s shown by
#ables , and ?, most patient-initiated politeness devices occur in the surgery of
the doctor specialised in internal medicine (**0 62[-. $lthough the number of
negatively polite devices provided by patients is quite low, we may speculate that
the e8planation is to be sought mainly in the fact that doctors of this
specialisation are not visited too often0 certainly less than, for instance,
paediatricians (in case of children- or gynaecologists (in case of women-. $s a
result, patients are not so confident, and manifest more respect and polite
behaviour towards internists (E8ample 3A-.
E2amp!e +8
74 * feel tightness in my chest so * thought it "ould #e "ise to come in and see
you.
;.1 C$mparis$" $( Samp!es
Following the organisation of previous chapters, let me now consider both
the quantitative and qualitative findings based on the analysis of the sample
e8cerpted from ;orpus %%. % would also like to compare these findings with the
results calculated and interpreted for the first sample. Hopefully, my data will
support the view that although the doctor-patient relationship is rather an
133
asymmetrical one, there are a large number of politeness strategies employed in
medical interviews, especially on the part of the doctor.
Tab!e 117 Res%!ts Cabs$!%te a" re!ativeD $( the 1
st
Samp!e
Particip Phase Strate&* T$ta!
D P 1ist E)am Treat Avoid Dist Modal
A#s. *,* 3? 6* A* ?, ++ * AA 188
: >, *, 32 6/ 2A ,? * 62 1@@
Tab!e 1+7 Res%!ts Cabs$!%te a" re!ativeD $( the +
"
Samp!e
Particip Phase Strate&* T$ta!
D P 1ist E)am Treat Avoid Dist Modal
A#s. *,3 3+ *? 6* *36 >2 ? +3 1;1
: >6 *? + 32 ?> 6? 2 ,* 1@@
$s shown by #able *3, the frequency occurrence of the doctor-initiated
and the patient-initiated negatively polite strategies is very similar to that
calculated for the first sample. From A3, turns, *>* negatively polite devices
have been e8cerpted. *,3 (>6[- of them are provided by doctors, 3+ (*?[- by
patients. >2 (6?[- devices belong to F%=9FLou' avoidance strategy, ? (2[- to the
distancing strategy, and +3 (,*[- to the modal verb choice strategy. *? (+[-
occur during the history-taking, 6* (32[- to the section of e8amination, and *36
(?>[- during the treatment section.
More accurately, the computation of chi-square proves that concerning the
total number of negatively polite strategies provided by participants, both
samples are the same (chi-squareY/.*/2-. $s regards the number of doctor-
initiated and patient-initiated devices, both samples are again the same (chi-
squareY/.*?A-. $s concerns the number of strategies within the particular
categories, there is also agreement (chi-squareY?.2/+-.
Mn the contrary, as regards the number of strategies provided during the
particular phases of the medical interview, there is certain divergence between
the samples. #he number of strategies provided during the treatment section is
much higher in the second sample (*360 ?>[- than in the first one (?,, 2A[-.
#hat is why % would like to discuss this discrepancy now.
134
$s has been pointed out in section A.6, ;orpus %%, unlike ;orpus %,
contains a larger number of interviews in the surgery of an oncologist. %t has also
been mentioned that this type of interviews is specific as its treatment phase is
much longer than usual. #he oncologist must inform her patient about all details
related to the treatment, inform her of potential side-effects, dangers, and risks,
and, of course, motivate the patient to fight the disease. However, it is
particularly the possibility of the death of a patient that influences the degree of
doctor=s polite behaviour (E8ample 3>-.
E2amp!e +;
54 *t may #e "orth considering giving you tamo)ifen as "ell as the chemotherapy.
At the moment "e are not sure "hether this additional treatment is of any #enefit
so "e are as!ing patients "hether they "ish to go into a trial so that "e can find
out "hether tamo)ifen or other hormone drugs should #e added to chemotherapy.
2ou do not need to ma!e a decision a#out this at the moment #ut * "ill as! the
Oncologist to discuss this "hen you see her.
Mtherwise, both samples are similar also from the qualitative point of
view. 5octors and patients use negatively polite devices especially from F%=9FLou=
avoidance strategy (E8ample 3+- and modal verb choice strategy (E8ample 2/- in
order to avoid an $vert re(ere"ce, to lower the degree of imp$siti$", to e8press
respect and initiate se!('pr$tecti$". Moreover, doctors prefer presentational
strategies (E8ample 2*- to persuasional ones, and patients provide the largest
number of negatively polite devices during the section of e8amination (E8ample
23-.
E2amp!e +<
54 There+s no illness in the family is there- 0o T6-
E2amp!e 0@
54 4ood morning Mr Malin *+m Dr $mith. .ould you li!e to ta!e a seat here and
your "ife can have this one.
135
E2amp!e 01
54 .ell although "e could give you medication for the palpitations it isn+t really
necessary as they are not in the least #it dangerous. They+re a nuisance #ut they
may disappear of their o"n record.
E2amp!e 0+
74 * "onder if it could #e #lood.
;.5 S%mmar*
$s % have attempted to advocate above, there is no correspondence, direct
or indirect, between politeness and asymmetry. ;orrespondingly with this view,
the following summary presents only those aspects of the phenomenon of
politeness that are significant in shifting the asymmetry between doctors and
their patients. For further details see >.2.
S*mmetr* As*mmetr*
*. 5octors seek to communicate *. 7atients very rarely carry out
the Fvoice of the lifeworld=. face-threatening acts.
3. 5octors prefer presentational strategies 3. 5octors often use the inclusive Fwe=0
to persuasional strategies. patients never use the inclusive Fwe=.
2. #here are *,* (>,[- doctor-initiated
negatively polite devices.
6. Most of doctor-initiated negatively polite
devices occur during the treatment phase.
,. 5octors also use the e8clusive Fwe=.
%n this chapter % have managed to discuss only a few elements of what we
call politeness and its strategies0 many others have been left untouched and
une8plained. % have not considered, for instance, the function of thanking,
apologising, and honorifics. #he manifestation of all the aspects of positive
136
politeness has been left aside. However, the main purpose of this section, i.e. the
analysis of medical interviews from the viewpoint of how doctors and patients
manifest negative politeness, has been fulfilled.
;.4 N$tes
* % am well aware of the fact that this source ( On E)pressing 0egative
Politeness in English ;ictional Discourse- is not suitable for the
comparison % have decided to elaborate on0 its results being primarily
based on fictional dialogues, not on authentic conversation. However,
)ilamov (3//,4 *,6- claims that &the fictional dialogue here has typical
features which are identical with those in authentic communication', and
% do believe that such a comparison may reveal some useful information
about communication in institutional settings, especially in a doctor=s
surgery.
3 .ee also !wynn (3//34 ??-.
2 &#he concept of Fvoices= is introduced to specify relationships between
talk and speakers= underlying frameworks of meaning. #wo are
distinguished, the Fvoice of medicine= and the Fvoice of the lifeworld=,
representing, respectively, the technical-scientific assumptions of medicine
and the natural attitude of everyday life' (Mishler *+>64 *6-. For details,
see also ;hapter 3 (&History of 5octor-7atient ;ommunication Desearch'-.
6 $ccording to 1rown and Jevinson4 &@egative politeness is the heart of
respect behaviour, :ust as positive politeness is the kernel of Ffamiliar= and
F:oking= behaviour' (*+>A4 *3+-. $pparently, the relationship between
doctors and patients, their roles, and status presuppose that it is the
negative politeness that functions in doctor-patient communication.
, $side from these linguistic strategies, labelled by )ilamov as structural
le8ico-grammatical devices, there are also many pragmatic markers in
negatively polite discourse of doctors and patients (e.g. hedges-.
@evertheless, % have not included these signals of politeness into my
analysis as it would be quite difficult to work out their quantification.
137
? %n my view, it is not necessary to be more specific as )ilamov (3//,- has
already described all the functions of negatively polite devices in detail.
Moreover, greater elaboration of that type lies beyond the scope of my
thesis.
A ;f., for instance, Fisher (*+>24 *6*-.
> #he aim of this chapter was to discuss some aspects of negative politeness
in doctor-patient communication. @evertheless, it would be interesting to
investigate whether positively polite strategies occur in medical
encounters, too. $gain, a comparison with everyday conversation could be
a convenient methodological approach. % leave it as a future focus of
investigation in the field of professional and non-professional dialogues.
+ For more details on the function of the inclusive Fwe= in various languages,
see 1rown and Jevinson (*+>A-.
*/ Moreover, similar data have been recorded in the speech of vets (NatC
*+>*-.
** More interestingly, this phenomenon has also been observed in the speech
of lawyers, teachers, nurse, and some other professions that e8ercise the
power of making decisions for the addressee (HenCl *+>+-.
*3 For details on social roles of doctors and patients, see, for instance, Doter
and Hall (*++3-.
138
Chapter Ni"e
CONCL3SION
5iscourse between doctor and patient is an open system, always adding and
changing its nature, but, nevertheless, tied to how each successive move in
the system can be made to appear as part of the environment of
understanding in which it is created and placed.
Dobillard, )hite and MaretCki
%n this dissertation % have attempted to describe the process of
communication between doctors and patients, and to deliver both the quantitative
and qualitative evidence that would either support or challenge the frequently
quoted opinion that the traditional asymmetry and power distribution in doctor-
patient relationship has been altered.
My findings, based on a comparison of five medical branches, has
confirmed the hypothesis that the social revolution, particularly greater access to
information on the part of the patient and the more patient-centred approach on
the part of the medical doctor, is gradually redefining the conventional roles of
the participants within the medical encounter.
%n general, doctors avoid what Mishler (*+>6- labels the Fconflict of
voices=, and follow his desired models of Fhumaneness=. #hey are reassuring and
supportive, do not interrupt patients= talk, and make sure that nothing has been
left une8plained during the medical interview. 7atients, on the other hand, thanks
to a highly developed media and other forms of modern technology, are much
better educated than previous generations.
However, having studied doctor-patient communication in close detail, as
regards the level of speech acts (;hapter ?-, meica! termi"$!$&* (;hapter A-,
and p$!ite"ess (;hapter >-, % would like to stress that the above mentioned claims
should not be oversimplified, since there are constant shifts and changes in the
positions and hierarchies of the interlocutors.
$s regards the meth$s $( as)i"& in doctor-patient communication, the
most notable fact in relation to asymmetry is the ispr$p$rti$" of doctor-
initiated and patient-initiated questions. #he research has revealed that questions
provided by doctors are much more numerous than those posed by patients.
139
Moreover, doctors freely use all question types, and with the e8ception of the
treatment phase they pose questions throughout the medical interview0 unlike
patients, who avoid what is called either9or questions, and are not supposed to
ask during the history-taking phase, even if they want to. Mn the other hand, all
questions patients raise are answered by their doctors.
$s far as $ther speech acts are concerned, doctors initiate multiple speech
acts per turn, and from all categories selected0 numerous categories are, for
e8ample, directives and reactives. .ignificantly, directives provided by doctors
during the phase of e8amination are in the form of direct speech acts, directives
initiated by doctors during the treatment section are, however, frequently in the
form of indirect speech acts. %n addition, doctors tend to offer interpretations of
future treatment and therapy to their patients. #his task is successfully completed
by initiating statements, aside from questions and answers, the most numerous
speech act category. 7atients, contrary to doctors, usually provide only single
speech acts, and the initiation of directives and reactives is avoided.
%nterestingly, both doctors and patients provide meica! terms frequently.
However, a closer e8amination of doctor-patient interviews has shown that it is
the doctor who uses a particular term initially, usually when asking questions0
patients only use these terms in their responses. 5octors provide medical terms
from all categories and during every part of the consultation. 7atients, on the
contrary, do not use medical terms from the category of tools very often, and
there are almost no patient-initiated terms provided during the treatment section.
%mportantly, doctors present the e8planation of medical terms, especially the
terms of tools and instruments.
$s concerns the phenomenon of politeness in doctor-patient interaction, it
is primarily the "e&ative p$!ite"ess that has been analysed. #he largest number
of negatively polite devices provided by doctors occur during the treatment
section, and is provided from the category of F%=9FLou= avoidance strategy and the
modal verb choice strategy. Bnlike patients, doctors often substitute the address
pronoun Fyou= by the first person plural pronoun Fwe=, especially the inclusive
Fwe=. 5octors also make use of the e8clusive Fwe= or its pronominal modification
Fus=, and prefer presentational strategies to persuasional ones. Mn the contrary,
140
patients never initiate the use of the inclusive Fwe=. %t is also worth noting that
they very rarely carry out face-threatening acts.
#he present thesis has also attempted to investigate how the dialogic
conte8t in the interaction of particular medical disciplines, namely I"ter"a!
Meici"e, Obstetrics a" -*"aec$!$&*, Paeiatrics, Ot$'rhi"$'!ar*"&$!$&*,
and Orth$paeics, influence the character and process of doctor-patient
communication. )hether the fact that some medical specialists are visited more
often than other practitioners may have an impact, for instance, on the role of
questions or the use of medical terminology. )hether it is relevant for the
function of speech acts or the manifestation of politeness, the process of
e8amination is rather verbal within some medical branches, and both verbal and
physical within other disciplines.
#he comparative analysis, supplemented with the computation of the F-
test, has proven the following4 as regards the most important aspect of medical
interviews, i.e. questioning practices of doctors and patients, the conte8t of the
particular speciality is, surprisingly, not so important. #he way doctors pose their
questions is identical in all the medical branches under discussion. #he most
significant element that should be taken into consideration when solving the
problem of the distribution of patientKinitiated questions is the !eve! $( patie"tHs
a"2iet* about his health problems and their treatment.
$s regards the function of other speech acts, the results for the comparison
of MDJ and other medical branches prove that there is a significant distinction
between MDJ and the remaining disciplines. #he factors underlying this point of
divergence are the large number of directives provided by oto-rhino-
laryngologists and the conte8t of the medical branch which forces them to use so
many directives. #he data show that MDJ professionals use a lot of tools and
medical instruments for e8amining the patient. #hey must conduct a physical
e8amination of subtle parts of a body, and the e8amination is not always pleasant
for the patient. %n other words, the shorter the process of the e8amination is, the
better it is for the patient. $s a result, short directives are preferred to longer
speech acts, characteristic of verbal e8amination.
;orrespondingly, $t$'rhi"$'!ar*"&$!$&ists provide more medical terms
than other specialists, with the e8ception of gynaecologists and obstetricians.
141
From what has been observed, MDJ practitioners frequently use different types of
tools and instruments. 1ecause some of their interventions are complicated, they
tend to e8plain the process of e8amination or treatment, and, at the same time,
the function of instruments they work with. $s concerns &*"aec$!$&ists and
$bstetricia"s, the large number of terms can be e8plained by the regularity of
visits and the importance of pregnancy for women.
$s far as the manifestation of politeness is concerned, the most frequent
negatively polite strategies provided by doctors are F%=9FLou= avoidance and the
modal verb choice. 1oth strategies are equally distributed across the whole
medical profession. Mn the contrary, most patient-initiated politeness devices
occur in the surgery of doctor specialised in I"ter"a! Meici"e. $lthough the
number of negatively polite devices provided by patients is quite low, we may
speculate that the e8planation is to be sought mainly in the fact that doctors of
this specialisation are not visited too often. ;onsequently, patients are not so
confident, and they manifest more respect and polite behaviour towards
internists.
$s has become evident from the information revealed in the thesis, doctor-
patient talk is in many aspects similar to other institutional talks (e.g. in
educational settings-. %t shares the three'part e2cha"&e str%ct%re, it is more-or-
less predictable, and organised around a limited number of topics that must be
pursued. Bnlike normal conversations, doctor-patient communication is not so
spontaneous, creative, and diverse. 5espite that, it is also in many aspects similar
to everyday conversation, especially as regards the frequent use of negatively
polite le8ico-grammatical devices.
%n view of these facts, let me offer the following summary. Medical
interviews have been e8periencing profound changes in recent years. #he social
revolution, the ideology of healthism in particular, has left its imprints on the
language of medicine, and thus influenced doctor-patient communication. #he
balance of power has been altered in favour of the patient, who is nowadays more
involved in the medical encounter, especially in the decision-making process. #he
doctor-patient relationship, however, should not be understood as a
symmetrical one. %t is still unbalanced, particularly in terms of questioning
strategies and the overall organisation of the medical encounter.
142
$s a final concluding point, it is necessary to admit that my dissertation is
but a modest contribution to the issues of doctor-patient communication and its
process of change. #here are other aspects worth considering that have not been
discussed, for e8ample non-verbal or intercultural communication of doctors and
patients. However, all these issues lie beyond the scope of the work and beyond
the limits of my qualification.
143
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CIech S%mmar*
148
;Tlem p]edkldan\ diserta_nT prce :e konverCa_nT anal^Ca prabOhu
komunikace meCi l\ka]em a pacientem na p]elomu tisTciletT, a to na anglick\m
:aCykov\m materilu. $utor usilu:e o detailnT kvantitativnT a kvalitativnT popis
l\ka]sk^ch interview. .naPT se tak bug potvrdit, _i vyvrtit _asto citovan^
p]edpoklad, Pe tradi_nO asymetrick^ vCtah meCi l\ka]em a :eho klientelou pro`el
v poslednTch letech v^raCn^mi CmOnami.
$nal^Ca v^Ckumu :e CamO]ena na sociolingvistick\ a pragmatick\ aspekty
Cvolen\ho typu institucionlnTho dialogu a vychCT C tCv. komunika_nT
komparatistiky pOti raCn^ch l\ka]sk^ch obora4 internT medicTny, porodnictvT a
gynekologie, pediatrie, otorinolaryngologie a ortopedie. #ento metodologick^
p]Tstup :e autorem vnTmn :ako velmi produktivnT, a sledovnT komunika_nTch
odli`nostT meCi :ednotliv^mi specialiCacemi medicTny se tak stv v^choCTm
bodem :eho CkoumnT.
Materilovou Ckladnu vytv]T dva soubory te8ta, pavodnO p]episy
autentick^ch nahrvek roChovora meCi l\ka]i a :e:ich pacienty ve <elk\ 1ritnii a
.po:en^ch sttech americk^ch. ekladnTm Cdro:em :e korpus vydan^ pod nCvem
English for Doctors (ed. Mria !y"rffy 3//*-. .oubor druh^, kter^ slouPT :ako
vCorek ovO]ovacT, :e sou_stT publikace Manual of English for the Overseas
Doctor a :eho autorkou :e Goy 7arkinson (3//6-.
$utor se CamO]u:e na t]i CsadnT okruhy probl\ma, kter\ vnTm :ako
ne:v^raCnO:`T ukaCatele CmOn. .etknT a roChovor l\ka]e s pacientem Ckoum na
hrovni :ednotliv^ch mluvnTch akta. 5le analyCu:e le8iklnT obsaCenT dialogu,
Ce:m\na uPTvnT l\ka]sk\ terminologie, a tak\ se Ca:Tm o princip Cdvo]ilosti a
Cpasoby :eho uplatnOnT v komunikaci. <edle:`Tm produktem v^Ckumu :e CTsknT
obecn^ch informacT o celkov\ v^stavbO a organiCaci profesnTho dialogu, p]TpadnO
o realiCaci nOkter^ch strategiT :eho h_astnTka.
<^sledky v^Ckumu potvrCu:T uvedenou hypot\Cu a prokaCu:T, Pe
probTha:TcT socilnT revoluce p]ispTv k postupn\mu p]edefinovnT tradi_nO
chpan^ch rolT v rmci komunikace il\ka] - pacientj. Ge to dno :ak vOt`Tm
p]Tstupem k informacTm na stranO pacienta, tak na klienta CamO]enO:`Tm
Cpasobem vedenT konCultace Ce strany l\ka]e. evOry :e v`ak t]eba chpat :ako
p]edbOPn\ a otev]en\ detailnO:`Tmu up]esnOnT. Gako podstatn\ pokra_ovnT
149
v^Ckumu se vnTm studium neverblnTch aspekta dialogu a Ce:m\na interkulturnT
srovnnT roChovora v l\ka]sk\ ordinaci :ako celku.
-erma" S%mmar*
150
5as eiel der vorliegenden 5issertationsarbeit ist die $nalyse des <erlaufs
der Nommunikation Cwischen dem $rCt und dem 7atienten in der
Gahrtausendwende und Cwar auf englischem .prachenmaterial. 5er $utor bemEht
sich hier um eine quantitative und qualitative 1eschreibung der krCtlichen
%nterviews. $uf diese $rt versucht er das oft Citierte <orurteil entweder Cu
bestktigen oder Cu widerlegen, dass die traditionell asymmetrische 1eCiehung
Cwischen dem $rCt und seiner Nlientel in den letCten Gahren bedeutsame
<erknderungen durchgemacht hat.
5ie $nalyse der Forschung ist auf soCiolinguistische und pragmatische
$spekte des erwkhnten #yps vom institutionellen 5ialog gerichtet und sie geht
aus der sog. Nommunikativen Nomparatistik fEnf verschiedener mediCinischen
1ereichen aus4 innere MediCin, !eburtshilfe und !ynkkologie, 7kdiatrie, H@M-
MediCin und Mrthopkdie. 5ieser methodologische <organg wurde von dem $utor
als sehr produktiv wahrgenommen. 5ie 1eobachtung kommunikativer
Bnterschiede Cwischen einCelnen mediCinischen .peCialgebieten wird so Cum
$usgangspunkt seiner Forschung.
5ie Materialiengrundlage bilden Cwei !ruppen von #e8ten, die
ursprEnglichen $bschriften der Mriginalaufnahmen von !esprkchen Cwischen
lrCten und ihren 7atienten in !rombritannien und in den <ereinigten .taaten von
$merika. $ls grundlegende Xuelle dient ein Norpus, ausgegeben unter dem #itel
nEnglish for 5octors& (ed. Mria !yoerffy 3//*-. 5er Cweite #eil, der als
<ergleichsprobe dient, ist ein #eil der 7ublikation nManual of English for the
Mverseas 5octor& deren $utorin Goy 7arkinson (3//6- ist.
5er $utor lenkt seine $ufmerksamkeit auf drei wichtige 7roblemgebiete,
die in seinen $ugen die wichtigsten eeiger der <erknderungen sind. 5ie #reffen
und !esprkche von lrCten und ihren 7atienten untersucht er auf den einCelnen
.prechaktebenen. )eiter analysiert er die le8ikalische 1esetCung der 5ialoge,
v.a. den !ebrauch der mediCinischen #erminologie, und er interessiert sich auch
fEr den 7rinCip der H"flichkeit und seine !eltendmachung in der
Nommunikation. $ls @ebenprodukt der Forschung gibt es hier den !ewinn
allgemeiner %nformationen Eber den !esamtaufbau und Mrganisation des
151
Fachdialogs, beCiehungsweise Eber die Dealisation mancher .trategien seiner
#eilnehmer.
5ie Ergebnisse der Forschung bestktigen die aufgefEhrte Hypothese und
beweisen, dass die durchlaufende .oCialrevolution daCu beitrkgt, dass die
traditionell verstandenen Dollen im Dahmen der Nommunikation n$rCt-7atient&
langsam anders definiert werden. 5as ist einerseits dadurch gegeben, dass die
7atienten einen gr"meren eugriff Cu %nformationen haben, und anderseits dadurch,
dass auch von der .eite des $rCtes die NonsultationsfEhrung mehr auf den
7atienten gerichtet ist.
5ie Ergebnisse sind aber vorlkufig, und von daher weiteren 7rkCisierungen
offen Cu verstehen. $ls wesentliche FortsetCung der Forschung wird das .tudium
nonverbaler $spekte der 5ialoge gesehen, hauptskchlich ein interkultureller
<ergleich der !esprkche in der $rCtpra8is als !esamtheit.

152