The dynamic consultation : a discourse analytical study of doctor-patient communication / Marisa Cordella.

Format:

Book

Author/Creator:

Cordella, Marisa.

Series:

Pragmatics & beyond ; new ser. 128.

Pragmatics & beyond The dynamic consultation

Language:

English

Subjects (All):

Discourse analysis.

Physician and patient.

Physical Description:

1 online resource (270 p.)

Edition:

1st ed.

Place of Publication:

Philadelphia : John Benjamins Pub., c2004.

Language Note:

English

Summary:

This book introduces a unique model of medical discourse that identifies the forms of talk - voices - that doctors and patients use during the consultation, and studies the dynamic interaction as it unfolds particularly in follow-up visits. Natural recordings, semi-structured interviews, questionnaires and ethnographic observations provide the data for the research, which was carried out in an Outpatient Clinic in Santiago, Chile. Using an interactional sociolinguistic approach, analysis of the data identifies doctor-patient communication as a micro-performance of broader socio-cultural realities, in which social status, power, knowledge and personal beliefs and values all find expression in the consultative setting. Importantly, while both doctor and patient voices are shown to contribute to an essentially asymmetrical exchange, the study also identifies the holistic and empathic Fellow Human voice, which places doctors and patients on a more equal footing. In connection with this voice, the Spanish concept of simpatía is also discussed.While the model in this study was developed within a specific socio-cultural framework, it is hoped that it will be adapted and modified more widely and contribute to a better understanding between doctors and their patients.

Contents:

The Dynamic Consultation

Editorial page

Title page

LCC page

Dedication page

Table of contents

Preface

Note

References

Acknowledgments

1. Introduction

2. Discourse, society and doctor-patient communication

2.1. A multi-disciplinary approach: Interactional socio-linguistics

2.1.1. Footing

2.2. Power, society and discourse

2.2.1. Discourse, power and simpatía

2.3. Everyday and institutional talk

2.4. Micro and macro realities of a socio-cultural group

2.5. Bio-medical and socio-relational approaches to doctor-patient communication

2.6. Doctor-patient communication: The medical and linguistic perspectives

2.6.1. Medical approaches to doctor-patient communication

2.6.2. Linguistic approaches: The doctor's perspective

2.6.3. Linguistic approaches: The patient's perspective

2.7. Sociological factors and doctor-patient communication

2.8. Conclusion

3. Doctor-patient communication

3.1. Discourse analysis: Interactional socio-linguistics and ethnographic approaches

3.2. Research design

3.3. Research questions

3.4. The Chilean health care system

3.5. The research site: The PUC Outpatient Clinic

3.5.1. The consultation room at PUC

3.6. Permissions

3.7. Stage I: Observation

3.8. Stage II: Questionnaire

3.9. Stage III: Semi-structured interview

3.10. Stage IV: Tape-recording of the medical consultation

3.11. The participants

3.11.1. The researcher

3.11.2. The doctors

3.11.3. The patients

3.12. Data analysis

3.13. The volume of data

3.14. Voices in doctor-patient communication

3.14.1. Analysis of doctors' voices

3.14.2. Analysis of patients' voices

3.14.3. Limitations to the number of voices

3.15. Ethical issues

Notes

4. The Doctor voice

4.1. Seeking information

4.2. Assessment and review.

4.3. Alignment to authority

4.4. Summary

4.5. Conclusion

5. The Educator voice

5.1. Communicating medical facts

5.1.1. Information regarding available test results

5.1.2. Information regarding proposed tests

5.1.3. Information regarding the functioning of the human body

5.2. Responding to patient discomfort

5.3. Summary

5.4. Communicating medical treatment and management

5.4.1. Spanish markers of inevitability

5.4.2. Spanish markers of conditional inevitability

5.4.3. The impersonal pronoun

5.4.4. Persuasive education

5.5. Summary

5.6. Statistical findings

5.7. Absence of the Educator voice

5.8. Conclusion

6. The Fellow Human voice

6.1. Facilitating the telling of patients' stories

6.2. Assisting the telling of patients' stories

6.2.1. Utterance extension

6.2.2. Predictable utterance completion

6.2.3. Helpful utterance completion

6.3. Creating empathy with the patient

6.3.1. Agreement discourse markers

6.3.2. Emotional reciprocity

6.4. Showing special attentiveness to patients' stories

6.4.1. Mirroring

6.4.2. Clarifying a previous utterance

6.5. Asking questions unrelated to the patient's health

6.6. Statistical findings

6.7. Conclusion

7. Patients' voices

7.1. Introduction

7.2. The voice of Health-related storytelling

7.3. The voice of Competence

7.3.1. The Complier

7.3.2. The Apologizer

7.3.3. The Challenger

7.4. The voice of Social Communicator

7.5. The voice of Initiator

7.6. Statistical findings

7.7. Results of Stage III: Semi-structured interview

7.8. Conclusion

8. Patterns of footing

9. The Dynamic Consultation

9.1. Doctors' and patients' talk: Animator, author, principal

9.1.1. Doctor voice and Educator voice

9.1.2. Fellow Human voice.

9.1.3. The voices of patients' stories

9.2. Asymmetry, power and the use of voices

9.2.1. Asymmetry in the institution

9.2.2. Asymmetrical questioning

9.2.3. Asymmetrical disapproval

9.2.4. Asymmetrical knowledge

9.3. Knowledge, power and simpatía

9.4. Affiliative discourse and simpatía

9.5. One consultation, two participants: An interactional work

9.6. Competence in the medical setting

9.7. A dynamic model of doctor-patient communication

10. Concluding remarks

Bibliography

Appendices

Appendix 1

Aproximate total word count of doctors and patients

Appendix 2a (English version)

PATIENT QUESTIONNAIRE

Appendix 2b (Spanish version)

CUESTIONARIO PARA EL PACIENTE

Appendix 3a (English version)

DOCTOR QUESTIONNAIRE

Appendix 3b (Spanish version)

CUESTIONARIO PARA EL MEDICO

Appendix 4

Symbols used in discourse transcriptions

Appendix 5a (English version)

EXPLANATORY STATEMENT FOR PATIENT AND DOCTOR

Appendix 5b (Spanish version)

DECLARACIÓN ACLARATORIA PARA PACIENTE Y MEDICO

Appendix 6a (English version)

CONSENT FORM

Appendix 6b (Spanish version)

CONSENTIMIENTO

Index.

Notes:

Bibliographic Level Mode of Issuance: Monograph

Includes bibliographical references (p. 221-234) and index.

ISBN:

9786612160264

9781282160262

1282160265

9789027295187

9027295182

OCLC:

70773225