Doctor-patient discourse

Wed Mar 2 21:22:49 UTC 2005

I agree that CDA would be good for looking at doctor-patient
interaction.  I think any situation in which one participant in the
discourse has control over the resources another participant needs (in
this case, the doctor has knowledge that the patient requires, as well
as the power to prescribe), CDA can be a fruitful approach.  Besides,
özge, if you're working with Ruth Wodak, as I think you mentioned, it
would be a shame not to use CDA as an analytic tool!

I found a number of references in LLBA (Linguistics and Language
Behavioral Abstracts) that deal with medical discourse (sources and
abstracts pasted below).  A couple of them are labelled as CDA in the
database, but even those that aren't still look like they may qualify.

Articles list below.

Best,
Linnea

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1. Verbal Play on the Hospital Ward: Solidarity or Power?
Grainger, Karen, Multilingua, 2004, 23, 1-2, 39-59

This paper looks at the function of humorous interchanges in the
negotiation of roles & identities on an acute geriatric ward. Humor is
not often discussed as a feature of interactions between medical
professionals & patients, but some authors have noted that joking
interactions often characterize care-giving relationships & may be
interpreted as a way of easing the face-threat of physical examinations.
In many studies, Brown & Levinson's (1987) theory of politeness is
invoked, assuming that joking behavior is one manifestation of face
work, being a form of positive politeness (since it is based on shared
knowledge). However, Brown & Levinson's alternative explanation may be
applicable in the hospital ward context: joking may be seen as an
exploitation of politeness strategies, wherein the speaker seeks to
redefine the face-threatening act through humor. A full account of the
relational impact of playful talk needs to take account of both the
macro context & the local, sequential unfolding of turns at talk. I
argue that the function of these exchanges is somewhat ambiguous, giving
the impression of a solidarity relationship on the one hand, but also
having the potential for underlying controlling & aggressive messages on
the other. As such, it can be argued, it is a strategy which seeks to
maintain power & control over the interaction.
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2. Laughter in Medical Interaction: From Quantification to Analysis, and
Back
Haakana, Markku, Journal of Sociolinguistics, 2002, 6, 2, May, 207-235

This study discusses the use of quantification in analyzing
interactional practices, especially in conversation analytical work. The
paper concentrates on laughter in medical interaction & starts from a
quantitative point of view. West (1984) found certain statistical
patterns of laughter in medical interaction: the patients laugh more
than the doctors & most laughter is not reciprocated, ie, the
interactants mostly laugh alone. This statistical pattern is also found
in Finnish data but it is approached again from the micro-analytical
point of view & some features of it are problematized through analyzing
in more detail (1) how laughter is made relevant, (2) how laughter is
responded to, & (3) the interactional functions laughter can have. The
paper shows that Schegloff's (1993) critique of quantitative
interactional work is indeed called for, but nevertheless also presents
advantages of quantification: the distribution of laughter between the
participants in medical interaction turned out to be an interesting
issue, one which is revealing of their different interactional roles &
footings.
********************************************
3.  On Predicating a Diagnosis as an Attribute of a Person
Maynard, Douglas W , Discourse Studies, 2004, 6, 1, Feb, 53-76

This article explores the relation between 'citing the evidence', or
implicating a particular diagnosis, & 'asserting the condition', or
overtly predicating the diagnosis as an attribute of a person.
Clinicians regularly postpone or delay asserting the condition, which is
interactionally more confrontational & presumptive. They regularly do
the postponement by citing the evidence prior to asserting the
condition, using the evidence as kind of predecessor account for
predicating the diagnosis as an attribute of the person. Citing the
evidence as leading to asserting the condition enhances the likelihood
of recipients realizing some bad news or other kind of diagnostic
upshot. This study has implications for the relation between interaction
& authority in medical discourse.
********************************************
4. Practices for Reporting and Responding to Test Results during Medical
Consultations: Enacting the Roles of Paternalism and Independent
Expertise
Pomerantz, Anita; Rintel, E Sean, Discourse Studies, 2004, 6, 1, Feb,
9-26

When physicians take readings of health indices such as temperature or
blood pressure, the practices that physicians & patients employ in
discussing the readings both reflect & propose a set of expectations
regarding the level of technical medical information the patients should
acquire & understand. In this article we demonstrate how physicians'
reporting practices reflect & propose the roles of paternalism or
independent expertise & how patients' responding practices either ratify
or contest the roles cast by the physicians' practices. In contrast to
the usual assumption that roles are relatively stable for individuals
over the course of encounters, we treat role enactments as matters that
are negotiated turn by turn in interaction. Physicians' practices for
reporting test results implicate various sets of expectations about the
knowledge, interest, & responsibility state of each participant;
patients employ responding practices that ratify or contest the
expectations implicated by the physicians' prior report. In each
subsequent turn within the information exchange sequence, a speaker
indicates (explicitly or implicitly) whether the level & kind of
information being exchanged is appropriate/inappropriate &
sufficient/insufficient for the participants. 20 References. [Copyright
2004 Sage Publications Ltd.]
********************************************
5. Medical Talk and Moral Order: Social Interaction and Collaborative
Clinical Work
Maseide, Per, Text, 2003, 23, 3, 369-403

Medical problem solving is to a large extent accomplished through
interprofessional collaboration. It may be imagined as a socially
distributed cognitive process. Discourse provides access to this process
while it also is the major tool for accomplishing collaborative work.
The major topic of the article is the role played by moral discourses in
collaborative medical reasoning & problem solving in a hospital setting.
It is claimed that the medical order of collaborative work in hospitals
is also a form of moral order. When disruption of the medical order
occurs, it generates a disruption of the moral order. Hence, monitoring
& regulation of the moral order turns out to be an important part of
collaborative clinical work. Another claim is that the moral order acts
as a medical problem solving resource. It allows assignment, management,
& negotiations of statuses & identities for doctors as well as for
patients. Through talk or formulations & reformulations, medical
practitioners move in & out of moral frames, fabricate necessary &
accountable facts, & produce & reproduce a flexible medical problem
solving system.

Lutfi M Hussein wrote:

>Dear Zge,
>
>I think CDA could be useful in analyzing
>doctor-patient disocurses. Fairclough has examined
>this in a few different places; you could check his
>_Discourse and Social Change_, for example.
>
>CDA could examine how the doctor and patient are
>positioned socially through discourse. For example,
>Fairclough argues this interaction is variable.
>Traditionally, in western medicine, the doctor is the
>expert who asks the questions while the patient who is
>in need of the expert is expected to answer these
>questions.
>
>On the other hand, in holistic medicine, the doctor
>may not play the role of the expert and try to solve
>the problem or treat the patient by having the patient
>play a more active role in this process. This may also
>be a side-effect or a result of the democratization of
>contemporary discourse in some professions or
>activities like medicine, another interesting issue
>that Fairclough discusses in later work.
>
>Finally, I think at least one approach to CDA --
>Fairclough's -- could be helpful in analyzing the
>doctor-patient discourse.
>
>Best wishes, Lutfi
>--- özge çaglar <caglarozge at HOTMAIL.COM> wrote:
>
>
>---------------------------------
>
>
>
>
>
>
>Hello everyone!
>
>I have been thinking about this for a time and i
>wanted to ask it to you and have your ideas too. I am
>thinking about applying CDA to my analysis about the
>doctor-patient interaction. What do you think the
>advantages and disadvantages of using CDA for this
>type of a topic as you know CDA is mostly used for
>another topics such as politics, gender and other
>critical topics as these. I am really confused about
>this, as no study has used CDA in such a topic before.
>
>Could you please comment about this??
>
>Thank you!
>
>özge
>
>
>
>
>
>---------------------------------
>Hazirliksiz yakalanmamak için MSN hava durumu
>hizmetinizde! Burayi tiklayin!
>
>
>=====
>Lutfi M Hussein
>lutfi_hussein at yahoo.com
>http://www.public.asu.edu/~lhussein/
>
>
>