Running head: A SMALL DISCOURSE COMMUNITY IN A LARGE DISCOURSE

A Small Discourse Community in a Large Discourse Community: Physicians of

Emergency Medicine
Chiharu Takashi
University of California Davis

A SMALL DISCOURSE COMMUNITY IN A LARGE DISCOURSE

A Small Discourse Community in a Large Discourse Community: Physicians of

Emergency Medicine
A group of physicians is one of discourse communities in medical field.
According to the characteristics, which Swales (1990) points out on page 470-471 in
The Concept of Discourse Community from his book Genre Analysis: English in
Academic and Research Settings, to determine if a community is a discourse community,
a group of physicians fulfills them to be a discourse community of medicine. However, I
claim that many smaller discourse communities based on physicians specialties exist in
the large discourse community. If so, there should be some special characteristics
belonging only to one while sharing same features among them. This research is
conducted to discover how one small discourse community can be different from other
small ones even though they are in a same large discourse community. Specifically, I
approach to the differences of physicians of emergency medicine from physicians of
other specialties.
History of Emergency Medicine
Medicine has been developed since ancient times and so as different specialties in
medicine. However, emergency medicine (EM) has only 50 years of history since it is
considered as a specialty. According to Suter (2012), medical knowledge and technology
have advanced in specialties to give better outcomes for most medical and surgical
problems (Early Formation of Emergency Department, para. 2). This was not true for

A SMALL DISCOURSE COMMUNITY IN A LARGE DISCOURSE

EM before it became as a real specialty. The fact of an unexpected visiting of a patient

who needed a specialty emergency care made it difficult for physicians out of the
specialty to provide best treatments at the time. With the need to develop EM as a
specialty, the American College of Emergency Physicians (ACEP) was established in
1968. After the recognition of EM as a specialty by the American Medical Association
(AMA), EM had progressed to become a distinct specialty (Suter, 2012).
Defining a Discourse Community of Emergency Medicine
Before looking at the special characteristics of emergency medicine, I would like
to briefly illustrate EM as one discourse community despite the fact of that EM is
relatively new to other specialties. It can be seen by carefully examining a community of
emergency physicians. There are many slightly different definitions of a discourse
community because of its vague concept, but I would like to use the idea of Swales
(1990) here as I did above. According to his six characteristics, emergency physicians
form a discourse community of EM. First, emergency physicians have a broadly agreed
set of common public goals (A Conceptualization of Discourse Community, 1). Their
purpose of practicing EM is to save peoples lives, which is also true for all physicians.
Second, they share mechanisms of intercommunication among its members (A
Conceptualization of Discourse Community, 2). Some of the mechanisms are same for all
physicians. Mainly physicians talk directly to other physicians. For emergency
physicians, they communicate by not only direct talking but also explaining a situation
using radio
A SMALL DISCOURSE COMMUNITY IN A LARGE DISCOURSE

contact in a helicopter. Third, they have participatory mechanisms primarily to provide

information and feedback (A Conceptualization of Discourse Community, 3), which
means that there exists an organization for a discourse community to exchange
information among the members. There are associations of physicians in the United
States, but each specialty has its own associations. Specifically, the associations of EM
are American Academy of Emergency Medicine (AAEM), American College of
Emergency Physicians (ACEP), etc. If a physician is a member of AAEM, for example,
he or she is able to view news of emergency medicine from the world, journals, blogs,
etc. Forth, they have one or more genres in the communicative furtherance of its aims
(A Conceptualization of Discourse Community, 4). EM has its own topics of the specialty
to focus on, its own form to practice, and its special function to perform. In fact, EM
basically covers topics of all specialties, but it can be considered as a new specialty
because no specialty covers that broad topics. Fifth, they use some specific lexis (A
Conceptualization of Discourse Community, 5) when communicating each other. All
physicians learn and acquire to use technical medical terms, but as medicine develops and
each specialty needs to define new terms for efficient communication among its
physicians, certain terminology or abbreviations can evolve only within the community.
In fact, the government releases General Acronyms for EMS [Emergency Medicine
Service] Communications. It lists acronyms used often in emergency medicine. Also,
not all medical terms is used often by all physicians. Internal physicians, for example, use
the terms used in surgery less or not at all whereas surgeons often use them. Emergency
physicians use variety of terms of many disciplines because of their work with various A

A SMALL DISCOURSE COMMUNITY IN A LARGE DISCOURSE

types of patients. Last, they have suitable degree[s] of relevant content and [are]
discoursal expertise[s] (A Conceptualization of Discourse Community, 6). All
physicians need to have undergraduate degrees to enter medical schools, earn Doctor of
Medicine degrees, and pass standardized national licensure exams. However,
depending on their specialties to proceed, internship and residency programs are different
and can be from 3 to 7 years (How to Become a Physician or Surgeon, 2015). Within a
residency of a specialty, physicians become experts in the field. Therefore, physicians on
EM residency enter the field along with acquiring terms, skills, and techniques of the
specialty. From these characteristics I gave above, there are some shared in all small
discourse communities of the discourse community of physicians and some applied to
only EM. After all, it is able to see that EM is a distinct discourse community from
discourse communities of other specialties while sharing same characteristics with them
and making the large discourse community of physicians as a whole.
Characteristics of Emergency Medicine
If emergency medicine is a small discourse community in the large discourse
community of physicians as I concluded above, what makes it different from other
specialties. I mentioned some of the differences when defining a discourse community
above. Now, I would like to examine more specifically by incorporating the voices of
professionals of EM. Since the difficulty could exist to interview physicians, I instead use
the interview done by Betty Hua, Kristen Meler and Sarp Aksel, who were the second
year medical students in Albert Einstein College of Medicine. The interviewees were
Thomas Perera, an associate professor of clinical medicine in Albert Einstein College of

A SMALL DISCOURSE COMMUNITY IN A LARGE DISCOURSE

Medicine and also residency director of emergency medicine at Jacobi Medical Center
and Montefiore Medical Center, and Mary Hannon, a fourth-year resident of emergency
medicine at the medical centers. In addition to the interview, the online sources were also
used in the research.
In the interview, when he was asked to define emergency medicine, Perera
described it as the front door of the hospital because emergency physicians are
mandatory to appropriately treat anyone for any reason (Albert Einstein College of
Medicine. Inside the Doctors Studio: Emergency Medicine. 2012). Therefore, they
cannot expect what kinds of patients to come. Both of interviewees agreed with that
emergency physicians start with knowing zero background of patients and confront with
problems from blank. Hannon added that they are required to have high skills in order to
manage a life or death situation of someone who you never met in a short time (Albert
Einstein College of Medicine. Inside the Doctors Studio: Emergency Medicine. 2012).
This side of EM is also seen in Overtons article. As an advisor of applicants to
emergency medicine programs, Overton states emergency physicians must be
comfortable making important decisions, sometimes with an incomplete database in life
or death situations (n.d., Cons: Decision-Orientation). They cannot gather data and
information and establish knowledge for a certain case before they need to make an
immediate decision. This is the reason why Hannon thinks she needs real skills to be an
emergency physician.

Because of having variety of patients, they need to have knowledge across

specialties to make best diagnosis. In the research Perception of Emergency Medicine
A SMALL DISCOURSE COMMUNITY IN A LARGE DISCOURSE

by Consultants and Specialist Registrars from Other Hospital Specialties by Reid S.,
Stephenson D. and Bowden L. (2009), the result of questionnaires from physicians of
other specialties in a district general hospital in Northern England indicates that other
specialties may rely on emergency practitioners to train juniors in acute care by that the
physicians see training of junior doctors from all specialties [are] important (The
Purpose of EM, para. 3). Perera claims that, as specialties knowing all the fields, good
emergency physicians have a continual desire to learn due to the nature of that
emergency medicine touches on so many fields (Albert Einstein College of Medicine.
Inside the Doctors Studio: Emergency Medicine. 2012). As other fields develop, they
should be aware of the advancements of all the fields. Even though it is difficult to timely
know everything, emergency physicians need the passion and attitude to actively learn
and progress. Perera added that they also should [have] a very high work ethic. There
is always more patients to be seen, therefore by his words, they need to be motivated to
get up and see the next one, two, three patients and organize as much as possible to hand
tasks to next emergency physicians in shifts. That implies that as Hannon said, if a major
trauma comes in right before his or her shift ends, an emergency physician cannot leave
without taking care of a patient (Albert Einstein College of Medicine. Inside the Doctors
Studio: Emergency Medicine. 2012). Therefore, even though emergency physicians have
shifts and typical schedules to some extent, no one can expect what comes and it makes
their works atypical (Albert Einstein College of Medicine. Inside the Doctors Studio:

Emergency Medicine. 2012). However, the shift style means that their minds can be away
from patients when they are off from their works. Hannon compared to other specialties
A SMALL DISCOURSE COMMUNITY IN A LARGE DISCOURSE

and found EM is nice because when you [a physician] leave work you dont take
anything with you such as a pager or phone calls from a hospital (Albert Einstein
College of Medicine. Inside the Doctors Studio: Emergency Medicine. 2012).
Contradictory, the shift style also means that emergency physicians need to be there and
take care patients whenever their shifts are. Because as Perera said, emergency
department have to be staffed at all times (Albert Einstein College of Medicine. Inside
the Doctors Studio: Emergency Medicine. 2012), there are times when emergency
physicians have to work their share of midnights, weekends, holidays, and other times
when the rest of the world is home, with their families and friends or asleep (Overton,
n.d., Cons: Lifestyle). Using an example of having a shift and sons baseball game at the
same time, Perera described that, as an emergency physician, a physician cannot leave
during the shift no matter how important things are (Albert Einstein College of
Medicine. Inside the Doctors Studio: Emergency Medicine. 2012). Also, outside of work
hours, emergency physicians take recovery time from night shifts (Perera, 2012, para. 7).
They cannot avoid these situations as people playing major roles to save patients coming
to EM. All of the characteristics I identified above are specific to EM but not to other
specialties. Studying all different specialties, emergency physicians have broad
knowledge of medicine in order to diagnose all kinds of patients and are active about
learning new developments of other specialties. In addition, they separate their work
when they are off from shifts but work hard during their works in order to accept more

patients. As a whole, all of what I mentioned above characterizes EM as a distinct

discourse community from other specialties discourse communities.
A SMALL DISCOURSE COMMUNITY IN A LARGE DISCOURSE

Conclusions
Having different characteristics can lead each discourse community to have
different environment and therefore different atmosphere. Therefore, the characteristics
of emergency medicine make a special atmosphere in the discourse community of
emergency department. Physicians in the community or emergency physicians are
motivated and passionate about taking care of as many patients as they can during their
shifts. They also stand up to accept patients even it is a weekend, holiday, or night time.
In addition to their work times, they spend times to learn advancements in all specialties
so that they can quickly correspond to any problem of a patient to come. As a team, they
corporate to diagnose as many patients as possible. These elements differentiate the
community of EM to have energetic atmosphere resulting from being active about saving
more patients and learning new developments. Also, emergency physicians connect to not
only within emergency department but also outside of their department, which is one of
the defining features of the emergency physician according to the College of Emergency
Medicine (as cited in Reid, Stephenson and Bowden, 2009, para.1). In Pereras words,
emergency physicians take up patients from downstairs to upstairs of hospitals (Albert
Einstein College of Medicine. Inside the Doctors Studio: Emergency Medicine. 2012).
They reach out to other fields in terms of both knowledge and connections. As a result,
EM functions dynamically in hospitals.

In this research, I specifically focused on physicians in emergency medicine

seeing it as a small discourse community in the large discourse community of physicians.

A SMALL DISCOURSE COMMUNITY IN A LARGE DISCOURSE

However, there are many discourse communities which take same similar forms as the
discourse community of physicians. Each smaller discourse community composing the
large discourse communities have different feature from other smaller ones. The
differences make small discourse communities distinct from each other while
contributing that its own roles to the large discourse communities.

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References
Albert Einstein College of Medicine (2012, March 29). Inside the Doctors Studio:
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Overton, David T. (n.d.). Advice for Emergency Medicine Applicants. Homer Stryker
M.D. School of Medicine.
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How to Become a Physician or Surgeon. (2015). Occupational Outlook Handbook.
Retrieved from United States Department of Labor
http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm#tab-4
Perera, T. (2012, March). The Joy and Stress of Being an Emergency Physician. [Web
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Medicine Journal, 26.10, 706-710.

http://emj.bmj.com/content/26/10/706.long#T2
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