Medical Discourse Analysis

Definition Discourse plays an important role in medicine, and medical discourse in the broadest sense (discourse in and about healing, curing, or therapy; expressions of suffering; and relevant language ideologies) has profound anthropological significance. As modes of social action, writing and speaking help constitute medical institutions, curative practices, and relations of authority in and beyond particular healing encounters. Communication can be seen as the main ingredient in medical care. In reviewing doctor-patient communication, the following topics are addressed: (1) different purposes of medical communication; (2) analysis of doctor-patient communication; (3) specific communicative behaviors; (4) the influence of communicative behaviors on patient outcomes (5) concluding remarks. Three different purposes of communication are identified, namely: (a) creating a good inter-personal relationship; (b) exchanging information; and (c) making treatment-related decisions. Communication during medical encounters can be analyzed by using different interaction analysis systems (IAS). These systems differ with regard to their clinical relevance, observational strategy, reliability/validity and channels of communicative behavior. The interaction between doctor patient Certain aspects of doctor-patient communication seem to have an influence on patients' behavior and well-being, for example satisfaction with care, adherence to treatment, recall and

understanding of medical information, coping with the disease, quality of life, and even state of health [3-20]. Interaction and communication are especially important in the case of life threatening diseases, such as cancer. The 'bad news consultation' for instance, has become an important topic for research during the past decade [21-34]. Recently, researchers of communication have increasingly been paying attention to psychosocial aspects of cancer. For this reason, studies from psychosocial oncology will serve as examples in the following review. The presented literature refers mainly to British, Dutch and American data with cross-cultural references where they are thought appropriate. To understand more fully why communication between doctors and patients (and cancer patients in particular) is such a powerful phenomenon, it is important to look at: (1) the different purposes of medical communication; (2) the analysis of doctor-patient communication; (3) the specific communicative behaviors displayed during consultations; and (4) the influence of communicative behaviors on certain patient outcomes. Simple Conversation with A Doctor : Doctor : Hello! What can I do for you?

Patient : Good Morning Doctor. I am not well. Doctor : Come and sit here. Doctor : Open your mouth. Doctor : How long are you not well? Patient : Since yesterday. Doctor : No problem-did you have Motion yesterday? Patient : No Doctor-not so freely. Patient : Doctor I feel giddy. Patient: I don’t feel like eating at all. Doctor : then? Patient : I feel like vomiting. Doctor : Do you take a lot of water? Patient : No, doctor I don’ take too much. Doctor : Did you take any medicine? Patient : Yes Doctor, I took Anacin. Doctor : who told you to take it? Patient : Nobody Doctor I took it myself. Doctor : why did you take it? Patient Because I felt headache. Doctor : Nothing to be worried at. Doctor : Do you need immediate relief? Patient : No need sir. It is enough you give medicines. Patients communication Patients are advising each other to "educate yourself and ask questions". Patient satisfaction with their care, rests heavily on how successfully this transition is accomplished.

Speech acts revisited In accordance with the research which has already been completed, I under-stand speech acts as acts of communication “performed by the use of lan-guage, either in speech or writing, involving reference, force, and effect” (Widdowson 1996: 131). These acts are usually classified into five categories: namely declarations, representatives, expressives, directives,

and commis-sives (e.g. Searle 1976). A distinction is also made between direct speech acts and indirect speech acts. Despite what the motto at the beginning of the paper suggests, the speech act theory has been heavily criticised.3 Conversation analysts have specifically argued that speech act theorists “do not address a cultural, or contextual, so-ciological analysis”, and that “the basic unit of analysis used is the self-contained action rather than the interaction unit, where context and the role of all the participants are important” (Todd 1983: 161). Nevertheless, I still find this approach useful as it contributes to a broader view of how power and asymmetry are distributed in the medical encounter. In order to satisfy the specific needs of doctor-patient communication, Todd’s classification of speech acts has been adopted.4 As a result, five cate-gories: statements (Example 1), questions (Example 2), answers (Example 3), directives (Example 4), and reactives (Example 5), have been distinguished. The distinction between answers and reactives consists in the fact that the re-actives usually follow the answers and are provided by doctors, who use them to acknowledge the answers provided by patients. Example 1 D: Some of the slides that I’ll take from you today will be looked at in clinic, and from these I’ll decide whether you require treatment or not. Example 2 D: Could you describe what the vomiting is like Mrs Smith, for example, does it clear your lap and land on the floor? Example 3 D: Was it managerial – did you have a lot of responsibility? P: Yes, I was in charge of a large department. Example 4 D: Now let me have a look at you. Sit down, open your mouth, head slightly forward. Let me put this tongue depressor on your tongue. Example 5 D: Have you been abroad to any tropical or developing coun-tries recently?

P: Yes, I just came back from Thailand a few months ago. D: I see. Compared to Searle’s classification, there are a few differences in my ap-proach. Noticeably, besides others, two speech acts, namely expressives and commissives, have been excluded from the analysis. Although speech acts of these types do emerge in doctor-patient talk, their occurrence is not conspicu-ous and is rather infrequent (Examples 6 and 7). As Todd (1983: 161) main-tains: “Strong emotion is not considered appropriate … and actions such as vowing and exasperation tend to be played down and absorbed into other acts.” Example 6 D: Do you have a job at the moment? P: No, I’ve just been made redundant. D: Oh, I am sorry. What was your job? P: I was desk-bound, I’m afraid. (expressive) Example 7 P: Oh, Thank God! No sign of cancer! No sign at all? D: Yes, that’s right. But listen for a moment. … In the future you really must try to stop smoking, as long as you keep smoking you can get more trouble with your voice, and one day it could turn nasty. P: Oh, yes, Doctor. I am trying – I’ve cut d. 5- Medical terminology : Medical terminology is the core point in the analysis of the medical discourses for both written and spoken form, also the breaking up of words is very crucial. First of all, some words would be written and uttered differently like: skin, bone, …etc. These words in medicine refer to derm , oste(o),…etc. Besides, there are several examples of breaking up words especially those which are related to affixes such as: Prefixes Related to : size, color ,direction,…etc

Root Related to: a part of the body

Like: hypo, hyper 4- Illness language Vs disease language :

like : eryth ,leuk

Medical language, as various observes have pointed out ( McCullough 1989 ; Mintz 1992 ) , is an abstract discourse about diseases and organs. It’s not about patients and their experience of illness language , physicians have no other language at their disposal than the abstract language of disease . ( illness language related to the patients whereas the disease language related to the physians ) .