34.687, Review: Applied Linguistics, Sociolinguistics: Kondo (2022)

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LINGUIST List: Vol-34-687. Mon Feb 27 2023. ISSN: 1069 - 4875.

Subject: 34.687, Review: Applied Linguistics, Sociolinguistics: Kondo (2022)

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Date: Mon, 27 Feb 2023 16:44:35
From: Yufei Ren [ryffei at 163.com]
Subject: Patient-centred Communication

 
Discuss this message:
http://linguistlist.org/pubs/reviews/get-review.cfm?subid=36842097


Book announced at http://linguistlist.org/issues/33/33-2516.html

AUTHOR: Kayo  Kondo
TITLE: Patient-centred Communication
SUBTITLE: Discourse of In-home Medical Consultations for Older Adults
SERIES TITLE: Language at Work
PUBLISHER: Multilingual Matters
YEAR: 2022

REVIEWER: Yufei Ren, Tsinghua University

SUMMARY

  Chapter 1 (Introduction to Patient-centred Communication) is a leading
chapter that introduces readers to the key concept of patient-centred
communication and its cultural differences. Patient-centred communication is
expected to be an interaction in which clinicians fully take care of patients
from factors listed in its multidimensional frameworks (see a systematic
review by Scholl et al., 2014), an important framework being the
Calgary-Cambridge Guide (Silverman et al., 2013). However, its realisation is
quite different among cultures, in that Asian countries seem more hierarchical
and paternalistic than the US. Thus, it is necessary to assess the PCC
concepts and theories in practical contexts among various cultures.
  Chapter 2 (Face and Linguistic Politeness) continues to explore
interpersonal concerns in medical consultation contexts. It sets out from the
pragmatic linguistic concept of face and linguistic politeness (Brown and
Levinson, 1987) to discuss its utilisation in healthcare studies within
different cultures. This chapter presents key concepts and terms involved in
face and linguistic politeness. Terms in this theory, such as positive face
and negative face, are examined through critiques considering 
cultural/contextual variances such as individualism versus collectivism,
high-/low-context, and honorifics. The author concludes that despite its
limitations, the classical work of Brown and Levinson’s politeness theory
offers an efficient tool for the conceptualisation of the patient’s face.
  Moving from face and politeness theories to fieldwork observation, Chapter 3
(Fieldwork and Data) presents the specific details of the author’s
ethnographic fieldwork experience in in-home authentic consultations. The
overall procedure of the consultations is illustrated in detail in the
healthcare system in Japan; this procedure  includes the  preparation stage
(e.g., data collection method, methodological positions, data sample), the
consultation recording stage, and the translation and coding stage according
to the Calgary-Cambridge Guide (Silverman et al., 2013) as well as the
concepts of face/politeness theory (Brown and Levinson, 1987).
  Chapter 4 (Listening to Patients and Identifying Issues) explores PCC
communicative acts emerged from the analysis of the consultations in which
physician questioning and listening techniques could bring about more from
patients. Extracts from the analysed consultations present the linguistic
instantiations of the represented Face-PCC categories. Techniques mentioned
include ‘initial general remarks’, ‘gradually moves from open to closed
questions’, and ‘repetition, paraphrasing and interpretation’, in comparison
to non-PCC facts, illustrated with extracts from the transcripts of the
consultations. 
  Chapter 5 (Empathy and Acceptance) looks into empathy, a core of clinical
PCC, understood as the doctor’s engagement with patients’ experiences and
perspectives. Prominent features of empathy and acceptance are discussed
through an authentic consultation corpus, in which ‘understanding and
appreciation of the patient’s feelings’, ‘expressions of positive regard’ and
‘silence as empathic anticipation’ are crucial for doctors, in comparison to
‘being judgmental’ as a potential non-PCC aspect. These approaches to the
patients’ feelings address patients' positive face; but in fact, the
combinations of positive and negative face shown in some examples do not only
overtly express empathy but give patients spaces to think.
  Chapter 6 (Work Towards Shared Decision-making) addresses another crucial
component in PCC, shared decision-making. Its involvement in a greater use of
negative politeness strategies shows the importance of understanding and
respecting patients' problems and desires in decision-making. ‘Sharing
understanding’, ‘sharing thinking’ and ‘offering suggestions’ are key aspects
of a shared decision-making while ‘no shared discussion’ is considered as a
potential non-PCC aspect. However, cultural differences may play a role, as a
patient's involvement varies according to different contexts, which might be a
challenge for young doctors.
  Chapter 7 (Leave Space for the Patient and Respecting the Patient’s Freedom)
concerns physicians' responses that leave space for patients and show respect
for their freedom. Key aspects concerning patients’ space involve ‘open
questions that occur throughout the session’, ‘checking for understanding’ and
‘linguistic deference’, while potential non-PCC aspects such as ‘directives’
and ‘touching without asking’ seem intrusive. Cultural variations here occur
with regard to ‘physical touch’ and ‘proximity – closeness/distance’.
  The final chapter (Chapter 8 “Transferring into Future Training”) concludes
the primary factors considered throughout the consultation, contexts (home
consultation and family member involved or not), empathy and politeness
strategies, as stated in the Calgary-Cambridge Guide, only with cultural
differences as seen in Japan. As for future direction, the author points out
the significance of linguistic politeness as an educational and analytical
tool in medical consultation, as well as the contributions and limitations of
this study for further investigations. Appendices are listed in Chapter 9. 

EVALUATION

  This book functions as a practical guidance to physicians and to students in
medical school. Through the authentic consultation data, readers could get a
hint of the importance of communication skills such as politeness and
face-protecting during conversations. As noted by the author in her interview
with physicians, they emphatically reported the lack of communication skills
in medical education. PCC skills training for young professionals and medical
and nursing students would become a tool to encourage them to apply their
human skills in their interactions with patients and help to reduce the
negative effects from physical impairment and anxieties in their patients
(Kondo, 2022, p148). 
  As for its theoretical significance, the combination of face theory with PCC
elements in authentic consultations examines the theory in practice and offers
potential future directions. Among which, cultural differences play a crucial
role in face theory and PCC. Just as the author has mentioned, western
concepts, terms such as patient/person-centred care and communication, have
been disseminated worldwide and are now being embedded into real-life practice
in health and social care. However, different countries exhibit various
cultures, which may influence their language preference, way of communication,
and even everyday lifestyle, not to mention their inter-relationship between
patients and doctors.  Eastern countries like Japan prioritize collectivism
instead of individualism. People from collectivistic cultures emphasise the
values of group orientation, collaboration, and conformity. The way of
perceiving the concept of ‘self’ in society could reflect the differentiation
between individualistic and collectivistic cultures. This might influence the
overall background where face theory and politeness theory are built upon,
thus, leaving space for modifications in related theories. People who are
interested in linguistics, especially in pragmatics (the study of language in
use/contexts), may find this book fascinating in its quite novel perspective
looking into face theory in PCC. The multiple qualitative methods of
integrating the findings of literature review with empirical investigation in
a culturally specific context shows both its practical and theoretical
significance.
  Though the concept of PCC in consultation seems to be demanding in the first
place, the story-telling style in this book using first person narrative is
reader friendly. In Chapter 3, the author mentioned gatekeepers who allowed
her to gain access to the medical teams and their patients. Her experience and
interaction with them provide a more comprehensive picture of her fieldwork.
The reflection part among chapters, such as a diary of a young doctor
reflecting on his experience in shared decision-making in Chapter 6, is also
first-person narrative. To some extent, discourse comprehension is the
interaction between readers and the texts (Alptekin & Ercetin, 2011). This
first-narrative style can bring about a connectedness and closeness between
the readers and the text, possibly eliciting empathy among readers.
  The structure of the book basically follows the time sequence, in presenting
the  theoretical background stage, preparation stage, consultation recording
stage, and interpretation of the PCC transcription. During the authentic
consultation stage, some specific aspects from politeness and face theory are
chosen by the author as a lens to PCC with evidence of extracts from the
consultation data. The data is analysed in its concern or neglect of PCC. This
comparison between PCC and potential non-PCC made the discussed component more
easily understood with regard to its relationship to PCC. However, this
overall time-line structure is not explicitly stated in the book as the
division of chapters is mainly based on different aspects of PCC methods. With
a more clearly stated structure, the reading might be smoothly paved for
readers in a more general sense.

REFERENCES

Alptekin, C., & Erçetin, G. (2011). Effects of Working Memory Capacity and
Content Familiarity on Literal and Inferential Comprehension in L2 Reading.
TESOL Quarterly, 45(2), 235–266. https://doi.org/10.5054/tq.2011.247705
Brown, P. and Levinson, S.C. (1987) Politeness: Some Universals in Language
Usage. Cambridge: Cambridge University Press.
Kondo Kayo (2022). Patient-centred Communication: Discourse of In-home Medical
Consultations for Older Adults. Multilingual Matters. Bristol.
Silverman, J., Kurtz, S. and Draper, J. (2013) Skills for Communicating with
Patients (3rd edn). London: Radcliffe Publishing.
Scholl, I., Zill, J.M., Harter, M. and Dirmaier, J. (2014) An integrative
model of patient-centeredness – A systematic review and concept analysis. PLOS
One 9 (9), e107828.


ABOUT THE REVIEWER

Yufei Ren: PhD student, Tsinghua University. Research interests:
neurolinguistics, psycholinguistics, psychiatry





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