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Part of
A Pragmatic Agenda for Healthcare: Fostering inclusion and active participation through shared understanding
Edited by Sarah Bigi and Maria Grazia Rossi
[Pragmatics & Beyond New Series 338] 2023
► pp. 330–358

Chapter 14
The pragmatics of diagnostic uncertainty

A closer look at hedges and shared understanding in diagnostic statements

| The Australian National University
| Royal Victorian Eye and Ear Hospital

Diagnosis is a complex communicative and clinical task. This interdisciplinary study explores diagnostic statements, specifically uncertainty, combining perspectives from medicine and linguistics. We infer divergent understanding of uncertainty expressions between patients and clinicians, linking them to diagnostic errors and shared decision making.

We analysed 16 role-play scenarios, applying discourse analysis to identify diagnostic statements and analyse them for shared understanding and expressions of uncertainty.

Results showed that in interactions linked to diagnostic error, clinicians heavily relied on evidence and expressed uncertainty indirectly through hesitations, false starts, and lengthy introductory phrases. This suggests clinicians use evidence and phrases as ‘shields’ to signal their lack of commitment to the diagnosis. If these shields aren’t recognised as such, shared understanding may be at risk.

Keywords: expression of uncertainty, epistemic modality, interpersonal pragmatics, hedges, diagnosis
Article outline
  • 1.Introduction
  • 2.Methods
    • 2.1Data collection and participants
  • 3.Analysis and analytical frameworks
  • 4.Findings
    • 4.1Diagnosis and diagnostic statements
    • 4.2Trust: Approachability features
    • 4.3Shared understanding
      • 4.3.1(Un)explained medical terminology
      • 4.3.2Self-repairs
    • 4.4Hedges and expressions of uncertainty
      • 4.4.1Explicit expressions of uncertainty
      • 4.4.2Hedges: Implicit expressions of uncertainty
  • 5.Discussion
    • 5.1Explicit expression of uncertainty or certainty?
    • 5.2Implicit expressions of uncertainty and explicated evidence as shields against diagnostic uncertainty
    • 5.3Hedges as markers of relational work or diagnostic uncertainty?
  • 6.Concluding remarks
  • References
  • Appendix
Published online: 17 November 2023
DOI logo
https://doi.org/10.1075/pbns.338.14dah
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