Cover not available
Article published In:
Australian Review of Applied Linguistics
Vol. 27:2 (2004) ► pp.92–109

You know doctor, i need to tell you something

A discourse-analytical study of patients’ voices in the medical consultation

| Monash University

Most studies in the area of doctor-patient communication focus on the talk that doctors perform during the consultation, leaving under-researched the discourse developed by patients.1 This article deconstructs and identifies the functions and forms of the voices (i.e. specific forms of talk) that Chilean patients employ in their interactions with general practitioners. Patients use four different voices in the interaction: Health-related Storytelling, Competence, Social Communicator and Initiator. Health-related Storytelling and Competence are the voices most frequently used by both female and male patients and constitute the object of analysis and interpretation for this study. The use of these voices reflects the patients’ role in the Western medical institutions, knowledge about health issues, social identity and aspiration to better understand health problems. I conclude that medical communicative practices that favour the development of patients’ discourse can improve patients’ knowledge of medical issues which in turn may have a positive impact on patients’ health.

Published online: 1 January 2004
DOI logo
https://doi.org/10.1075/aral.27.2.07cor
References
Ainsworth-Vaughn, N.
(1998) Claiming power in doctor-patient talk. Oxford: Oxford University Press.Google Scholar
Barton, E. L.
(2000) The interactional practice of referrals and accounts in medical discourse: expertise and compliance. Discourse Studies, 21, 259–281. DOI logoGoogle Scholar
Beach, W.
(2001) Introduction: diagnosing “Lay diagnosis”. Text, 211, 13–18. DOI logoGoogle Scholar
Bensing, J.
(1991) Doctor-patient communication and the quality of care. Social Science and Medicine, 32 (11), 1301–1310. DOI logoGoogle Scholar
Blanchard, C., Labrecque, M. & Ruckdeschel, J.
(1988) Information decision-making preferences of hospitalized adult cancer patients. Social Science Medicine, 27 (11), 1139–1145. DOI logoGoogle Scholar
Brown, P. & Levinson, S.
(1987) Politeness. Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Burgoon, M., Birk, T. & Hall, J.
(1991) Compliance and satisfaction with physician-patient communication. An expectancy theory interpretation of gender differences. Human Communication Research, 181, 177–208. DOI logoGoogle Scholar
Charon, R., Greene, M.G. & Adelman, R.D.
(1994) Multidimensional interaction analysis. A collaborative approach to the study of medical discourse. Social Science and Medicine, 391, 955–965. DOI logoGoogle Scholar
Cohen-Cole, S. A.
(1991) The medical interview: the three-function approach. St Louis, Baltimore: Mosby Year Book.Google Scholar
Cordella, M.
(1990) Apologizing in Chilean Spanish and Australian English: a cross-cultural perspective. Australian Review of Applied Linguistics, Series S, 71, 66–92. DOI logoGoogle Scholar
(1991) Spanish speakers apologizing in English: a cross-cultural pragmatics study. Australian Review of Applied Linguistics, 141, 115–138. DOI logoGoogle Scholar
(1992) Travels, cultures and speech acts: a pragmatics study in apology. The Ken Garrad Working Papers in Hispanic Studies 2. Clayton, Vic: Monash University.Google Scholar
(1999) Medical discourse in a Hispanic environment: power and simpatia under investigation. Australian Review of Applied Linguistics, 22 (2), 35–50. DOI logoGoogle Scholar
(2001) The dynamic consultation: a discourse-analytical study of doctor-patient communication in Chilean Spanish. Unpublished doctoral dissertation, Monash University, Australia.Google Scholar
Cordella M.
(2002) La interacción médico-paciente en escrutinio: Un estudio de sociolingüistica interaccional. Onomázein. Revista de Lingüística, Filología y Traducción del Instituto de Letras de la Pontificia Universidad Católica de Chile, 71, 117–144.Google Scholar
Cordella, M.
(2003) En el corazón del debate: el análisis del discurso en la representatión de las voces médicas. Oralia. Análsis del discurso oral, 61, 147–168.Google Scholar
in press a). ‘No, no I haven’t been taking it doctor’: compliance, face threatening acts and politeness in medical consultations. In M. Placencia & C. Garcia Eds Linguistic politeness in the Spanish-speaking world Mahwah, N.J. Lawrence Erlbaum Associates
Coulthard, M. & Ashby, M.
(1975) Talking with the doctor 1. Journal of Communication, 251, 140–145. DOI logoGoogle Scholar
Daly, M. & Hulka, B.
(1975) Talking with the doctor 2. Journal of Communication, 25 (30), 148–152. DOI logoGoogle Scholar
Davis, K.
(1988) Power under the microscope. Dordrecht: Foris.Google Scholar
Donovan, J. L. & Blake, D.R.
(1992) Patient noncompliance-deviance or reasoned decision-making. Social Science and Medicine, 34 (5), 507–513. DOI logoGoogle Scholar
Du Bois, J.
(1991) Transcription design principles for spoken discourse research. Pragmatics, 11, 71–106. DOI logoGoogle Scholar
Fairclough, N.
(1992) Discourse and social change. Cambridge: Polity Press. Google Scholar
Fisher, S.
(1991) A discourse of the social: medical talk/ power talk/ oppositional talk? Discourse and Society, 21, 157–182. DOI logoGoogle Scholar
(1995) Nursing wounds: nurse practitioners, doctors, women patients and the negotiation of meaning. New Brunswick, N.J.: Rutgers University Press.Google Scholar
Fisher, S. & Todd, A.D.
(1986) Friendly persuasion: negotiating decisions to use oral contraceptives. In S. Fisher & A.D. Todd (Eds.) Discourse and institutional authority: medicine, education, and law (pp. 3–25). Norwood, N.J.: Ablex.Google Scholar
Gerber, K.
(1986) Compliance in the chronically ill: an introduction to the problem”. In K. Gerber & A. Nehemkis (Eds.) Compliance: the dilemma of the chronically ill (pp. 13–23). New York: Springer.Google Scholar
Goffman, E.
(1967) Interactional ritual essays on face-to-face behavior. New York: Pantheon Books.Google Scholar
(1971) Relations in public. Micro-studies of the public order. New York: Harper and Row.Google Scholar
Goffinan, E.
(1974) Frame analysis. New York: Harper and Row.Google Scholar
Goffman, E.
(1981) Forms of talk. Philadelphia: University of Pennsylvania Press.Google Scholar
Gruninger, U.J.
(1995) Patient education: an example of one-to-one communication. Journal of Human Hypertension, 11, 15–25.Google Scholar
Gumperz, J.
(Ed.) (1982) Language and social identity. Cambridge: Cambridge University Press.Google Scholar
Hadlow, J. & Pitts, M.
(1991) The understanding of common health terms by doctors, nurses and patients. Social Science and Medicine, 321, 193–196. DOI logoGoogle Scholar
Heath, C.
(1992) The delivery and reception of diagnosis in the general-practice consultation. In P. Drew & J. Heritage (Eds.) Talk at work: studies in interactional sociolinguistics, 81, 235–267. Cambridge: Cambridge University Press.Google Scholar
Irish, J. T. & Hall, J.A.
(1995) Interruptive patterns in medical visits: the effects of role, status and gender. Social Science and Medicine, 41 (6), 873–881. DOI logoGoogle Scholar
Jefferson, G.
(1984) On the organization of laughter in talk about trouble. In J. M. Atkinson & J. Heritage (Eds.) Structure and social action (pp. 346–369). Cambridge: Cambridge University Press.Google Scholar
Korsch, B. M., Gozzi, E.K. & Francis, V.
(1968) Gaps in doctor-patient communication: doctor-patient interaction and patient satisfaction. Pediatrics, 421, 855–871.Google Scholar
Kreps, G. L.
(1988) Relational communication in health care. Southern Communication Journal, 531, 344–359. DOI logoGoogle Scholar
Labov, W. & Fanshel, D.
(1977) Therapeutic discourse:psychotherapy as conversation, New York: Academic Press.Google Scholar
Lacoste, M.
(1981) The old woman and the doctor: a contribution to the analysis of unequal linguistic exchange. Journal of Pragmatics, 51, 169–180. DOI logoGoogle Scholar
Lieberman, J. A.
(1996) Compliance issues in primary care. Journal of Clinical Psychiatry, 571, 76–85.Google Scholar
Mishler, E. G.
(1984) The discourse of medicine. Dialectics in medical interviews. Norwood, N.J.: Ablex.Google Scholar
Neighbour, R.
(1987) The inner consultation. Newbury: Petroc Press.Google Scholar
Ong, L. M. L., De Haes, J. C. J. M., Hoos, A.M. & Lammes, F.B.
(1995) Doctor-patient communication: a review of the literature. Social Science and Medicine, 40 (7), 903–918. DOI logoGoogle Scholar
Pauwels, A.
(1995) Cross-cultural communication in the health sciences: communicating with migrant patients. South Melbourne: Macmillan Education.Google Scholar
Robinson, W.P., Shepherd, A. & Heywood, J.
(1998) Truth, equivocation/ concealment, and lies in job applications and doctor-patient communication. Journal of Language and Social Psychology, 17 (2), 149–164. DOI logoGoogle Scholar
Roter, D., Hall, J. & Katz, N.
(1987) Relations between physicians’ behaviors and analogue patients’ satisfaction, recall and impressions. Medical Care, 25 (5), 437–451. DOI logoGoogle Scholar
Roter, D.
(2000) The enduring and evolving nature of the patient-physician relationship. Patient Education and Counseling, 391, 5–15. DOI logoGoogle Scholar
Royster, L.
(1990) Doctor-patient communication: an exploration of language use during the informed consent. Unpublished doctoral dissertation, University of Pennsylvania.Google Scholar
Shaikh, A., Knobloch, L.M. & Stiles, W.B.
(2001) The use of a verbal response mode coding system in determining patient and physician roles in medical interviews. Health Communication, 131, 49–60. DOI logoGoogle Scholar
Stivers, T. & Heritage, J.
(2001) Breaking the sequential mold: answering ‘more than the question’ during comprehensive history taking. Text: An Interdisciplinary Journal for Discourse Research, 211, 151–185. DOI logoGoogle Scholar
Street, R.L. & Millay, B.
(2001) Analyzing patient participation in medical encounters. Health Communication, 131, 61–73. DOI logoGoogle Scholar
Sundquist, J.
(1995) Ethnicity, social class and health. A population-based study on the influence of social factors on self-reported illness in 223 Latin American refugees, 333 Finnish and 126 South European labour migrants and 841 Swedish controls. Social Science and Medicine, 40 (6), 777–787. DOI logoGoogle Scholar
Thompson, T.
(1998) Patient/health professional communication. In L. Jackson & B.K. Duffy (Eds.) Health communication research: a guide to developments and directions (pp. 37–56). Westport, C.T: Greenwood.Google Scholar
(2001) Introduction. Health Communication, 131, 1–4. DOI logoGoogle Scholar
Thorne, S. E., Nyhlin, K. T. & Paterson, B. L.
(2000) Attitudes toward patient expertise in chronic illness. International Journal of Nursing Studies, 371, 303–311. DOI logoGoogle Scholar
Trosborg, A.
(1987) Apology strategies in natives/non-natives. Journal of Pragmatics, 111, 147–167. DOI logoGoogle Scholar
van Dijk, T. A.
(1982) Episodes as units of discourse analysis. In D. Tannen (Ed.) Analysing discourse: text and talk (pp. 177–195). Washington: Georgetown University Press.Google Scholar
(1987) Communicating racism: ethnic prejudice in thought and talk. Newbury Park, Calif: Sage.Google Scholar
von Friederichs-Fitzwater, M.M. & Gilgun, J.
(2001) Relational control in physician-patient encounters. Health Communication, 131, 75–87. DOI logoGoogle Scholar
Walker, K. L., Arnold, C.L., Miller-Day, M. & Webb, L.M.
(2002) Investigating the physician-patient relationship: examining emerging themes. Health Communication, 141, 45–68. DOI logoGoogle Scholar
West, C.
(1984) Routine complications: troubles with talk between doctors and patients. Bloomington: Indiana University Press.Google Scholar
(1990) Not just ‘doctors’ orders’: directives-response sequences inpatients’ visits to women and men physicians. Discourse and Society, 11, 85–112. DOI logoGoogle Scholar
Williams, S., Weinman, J. & Dale, J.
(1998) Doctor-patient communication and patient satisfaction: a review. Family Practice, 15 (5), 480–492. DOI logoGoogle Scholar
Wodak, R.
(Ed.) (1989) Language, power and ideology: studies in political discourse. Amsterdam: John Benjamins. DOI logoGoogle Scholar
(1996) Disorders of discourse. London: Longman.Google Scholar
Young, A. & Flower, L.
(2002) Patients as partners, patients as problem-solvers. Health Communication, 141, 69–97. DOI logoGoogle Scholar
Cited by

Cited by 5 other publications

Clyne, Michael, Marisa Cordella, Doris Schüpbach & Brigid Maher
2013. Connecting younger second-language learners and older bilinguals: interconnectedness and social inclusion. International Journal of Multilingualism 10:4 ► pp. 375 ff. DOI logo
Cordella, Marisa
2011. Chapter Nine Overcoming Language and Cultural Differences in Medical Encounters: The Use of a Language and Culture Training Course (LACT) in Educating IMGs in Australia. In English Language and the Medical Profession: Instructing and Assessing the Communication Skills of International Physicians [Innovation and Leadership in English Language Teaching, 5], ► pp. 175 ff. DOI logo
Cordella, Marisa & Simon Musgrave
2010. Oral communication skills of international medical graduates: Assessing empathy in discourse. Communication and Medicine 6:2 ► pp. 129 ff. DOI logo
Ordonez, Jessica, Sonia Margarit, Katy Downs & Beverly M. Yashar
2013. Peering into a Chilean Black Box: Parental Storytelling in Pediatric Genetic Counseling. Journal of Genetic Counseling 22:6 ► pp. 805 ff. DOI logo
[no author supplied]
2011. References. In English Language and the Medical Profession: Instructing and Assessing the Communication Skills of International Physicians [Innovation and Leadership in English Language Teaching, 5], ► pp. 291 ff. DOI logo

This list is based on CrossRef data as of 23 april 2024. Please note that it may not be complete. Sources presented here have been supplied by the respective publishers. Any errors therein should be reported to them.