Exploring Health Communication

Language in Action

Kevin Harvey, Nelya Koteyko

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781136218118
• Edition: 1
• Topic: Education
• Subtopic: Education General

Routledge Introductions to Applied Linguistics is a series of introductory level textbooks covering the core topics in Applied Linguistics, primarily designed for those beginning postgraduate studies, or taking an introductory MA course as well as advanced undergraduates. Titles in the series are also ideal for language professionals returning to academic study.

The books take an innovative 'practice to theory' approach, with a 'back-to-front' structure. This leads the reader from real-world problems and issues, through a discussion of intervention and how to engage with these concerns, before finally relating these practical issues to theoretical foundations. Additional features include tasks with commentaries, a glossary of key terms, and an annotated further reading section.

Exploring Health Communication brings together many of the various linguistic strands in health communication, while maintaining an interdisciplinary focus on method and theory.

It critically explores and discusses a number of underlying themes that constitute the broad field of health communication including spoken, written and electronic health communication. The rise of the internet has led to an explosion of interactive online health resources which have profoundly affected the way in which healthcare is delivered, and with this, have brought about changes in the relationship between provider and patient. This textbook uses examples of real life health language data throughout, in order to fully explore the topics covered.

Exploring Health Communication is essential reading for postgraduate and upper undergraduate students of applied linguistics and health communication.

Part I

Spoken health communication

1 The practitioner–patient relationship

Doctor–patient encounters

Introduction: spoken discourse in clinical settings

A significant amount of medical practice takes place through verbal interchange. Indeed it is no exaggeration to claim that, over the last three millennia, healthcare has principally been conducted through some kind of face-to-face encounter between patient and health expert (Brown et al., 2006: 81). Yet it is only relatively recently – with the advent of sophisticated tape and video recording (technical advancements that allow researchers to capture naturally occurring spontaneous talk with exceptional degrees of precision) that the patient-provider exchange has been studied in any significant linguistic detail. With the availability of detailed transcripts that faithfully account for not only the content of conversation, but also the precise way in which such content is articulated (including details such as pitch, speed, pauses, false starts, repetitions, overlaps and interruptions), researchers have brought to bear a range of broadly discourse-based approaches on the medical consultation, resulting in a proliferation of studies that have contributed to our understanding of the patientprovider exchange.

In tandem with the aforesaid technological advances, the twentieth century has witnessed what has commonly been described as a ‘linguistic turn’, that is, a concern for ‘the modalities of language use’ that has preoccupied disciplines from sociology and anthropology through to literature and philosophy (Silverman, 1987: 19). The linguistic turn has led to researchers focussing on observable communication in a range of everyday and institutional settings. In particular, the medical setting has become an important research site for investigation, with micro-analytic attention to the discourse of the clinic offering a more precise study of the ‘human social world’ (Brown et al., 2006: 81) than that afforded by other forms of sociological analysis. Although the clinical setting encompasses a range of communicative practices that involve a variety of medical and nonmedical personnel, applied linguistic research has favoured doctor–patient interaction, and it is this specific encounter between professional and patient that we explore extensively this chapter.

Putting the doctor–patient encounter in context: themes and issues

Research into doctor–patient interaction to date has been extensive and still continues to grow apace, hence it is impossible to do justice to all the rich variety of work in the area. Nonetheless, there are several broadly applied linguistic research themes that have dictated enquiry into the doctor–patient encounter, chief among them typological/ structural concerns, that is, attempts to identify and explicate recurring sequences of talk that make up the consultation process, and issues relating to the enactment of authority and control in the consultation. Since arguably the most outstanding characteristic of the doctor– patient encounter is, at least from an interactional perspective, ‘the unequal nature of the power relationship’ (Gwyn, 2002: 63), we shall devote most of this chapter to exploring the connection between authority and the linguistic resources on which participants draw to enact and negotiate power relations during the consultation.

Among the wide range of practitioner–patient exchanges that routinely take place in clinical settings, the doctor–patient relation has been described as the most interpersonally complex (Ong et al., 1995: 903). Part of this complexity lies in the multi-purpose function of the consultation. For example, three distinct yet connected purposes of doctor–patient communication can be readily identified, namely building a good inter-personal relationship, exchanging information and making decisions about treatment (Ong et al., 1995: 903-4). Moreover, these discursive activities take place in an institutional context where the participants are situated in unequal positions, with patients ‘investing their trust and faith’ (Lupton, 2003: 114) in the clinical proficiency of the doctor. Thus, as Gwyn (2002: 62) observes, asymmetries between doctor and patient can be seen to arise, to some extent, as a consequence of the format of the consultation itself (an issue to which we will return later in this chapter).

As ten Have (1991: 138) observes, medical interviews are tightly organised interactional events, and the doctor–patient consultation is no exception. Given the relatively unvarying format of the exchange, researchers have been able to identify a number of recurring phases of action that take place within it. Two influential typologies are those proposed by Byrne and Long (1976) and ten Have (1989). Byrne and Long, who were among the first researchers to systematically interrogate the structure of the consultation, describe six characteristic sequences of action:

• I Greeting and relating to the patient
• II Ascertaining the reasons for the patient’s attendance
• III Conducting a verbal or physical examination or both
• IV Considering the patient’s condition
• V Outlining further treatment
• VI Terminating the consultation.

(Byrne and Long, 1976: 132)

From the doctor’s perspective, the value of this structural template is that it forms a model sequence, a logical order, deviation from which, in some instances, can potentially to lead to problems for the participants. For example, the sequence I-II-III-V-III-I-VI is identified by Byrne and Long as being particularly indicative of a problematic encounter. This can be seen in the following extract in which the patient, a labourer who has a long history of back troubles, is returning to his GP following a hospital referral. At the start of the sequence, the doctor has already greeted the patient (Phase I) but still has, as the exchanges demonstrate, to fully discover the reasons for his attendance.

1	D:	(Phase III) What is your job?
2	P:	Well, I’m on a quarry job, carting clay, as a slagger – it’s a very rough job – that’s the trouble… well I’ve been seriously thinking about getting a lighter job if I could and I’m travelling to Denton but it would be out on the moors type of thing.
3	D:	(V) Oh, well that’s no good to you…and this business of turning your head round most of the time, you see you’re putting a strain on your neck.
4	P:	I have to move back into the yards.
5	D:	Oh that’s no good to you. It’s enough trouble if you’ve got your neck normal. It would be better if you could find a job – this is a fairly new job, isn’t it? Were you on long distance before that?
6	P:	Well, I was on middle distance actually, it wasn’t as strenuous.
7	D:	It might be better to look for something lighter. (III) How old are you now?
8	P:	Fifty-three.
9	D:	(V) It’s not the time of life to start looking for another job, is it?

(Byrne and Long, 1976: 134)

Throughout these exchanges, the doctor shifts between the activities of conducting a verbal examination of the patient (Phase III) and outlining further treatment for his problems (V), missing out Phase IV (considering the patient’s condition). According to Byrne and Long, the doctor’s leaping back and forth between these two phases betrays the ‘mess’ in which he finds himself. Although already possessing much information about the patient’s prior clinical treatment and personal biography, the doctor continues to elicit this same information from the patient, details of which he should of course be readily aware. The doctor’s reverting to Phase III of the consultation is, Byrne and Long suggest, a means of ‘keeping control over of what he is doing’ (1976: 135), imposing order on the seemingly erratic development of the interaction.

Byrne and Long’s six phases of the consultation serve as what they call ‘a checklist’ with which doctors might ‘facilitate their self-learning’ (1976: 132). As Brown et al. observe, this typology (and others similar to it) is thus pedagogically motivated, designed to equip medical students with frameworks ‘within which to learn and diligently reproduce the lists, typologies and forms of knowledge that would gain them the best marks’ (2006: 86). This emphasises the fact that a number of structural typologies (Byrne and Long’s included) are designed from the perspective of, and intended for, the medical practitioner. This inevitably downplays the role of the patient in the consultation: consultations are two-way exchanges in which patients, to varying degrees, jointly verbally negotiate clinical outcomes with their doctor. A more sensitive structural typology of the consultation – or at least one that emphasises negotiated speech activities between the participants – is that outlined by ten Have (1989), who describes what he calls the ‘Ideal Sequence’. Consultations that feature the Ideal Sequence are resolved into six phases of action which unfold in a predictable order:

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Table of contents

• Front Cover
• Exploring Health Communication
• Routledge Introductions to Applied Linguistics
• Title
• Copyright
• Dedication
• Contents
• Acknowledgments
• Permissions
• Series editors’ introduction
• Introduction
• Part I Spoken health communication
• Part II Written health communication
• Part III Computer-mediated health communication
• Commentary on selected tasks
• Appendix
• Glossary
• Further reading
• References
• Index