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Insights Into Medical Communication

by Maurizio Gotti (Volume editor) Stefania Maria Maci (Volume editor) Michele Sala (Volume editor)
Edited Collection 422 Pages
Series: Linguistic Insights, Volume 203

Table Of Content

  • Cover
  • Title
  • Copyright
  • About the author
  • About the book
  • This eBook can be cited
  • Contents
  • Introduction
  • Experts on Experts: Sustaining ‘Communities of Interest’ in Professional Discourse Studies
  • Communication in Medical Practice
  • Social Media and Professional Practice in Medical Twitter
  • Medical Doctors on Twitter: How and Why MDs Tweet
  • ‘Descriptive Psychopathology’ in Asylum Case Histories: The Case of John Horatio Baldwin
  • Dialectal Variation and Miscommunication in Medical Discourse: A Case Study
  • Communicating with Patients
  • Attempting the Easification of Patient Information Leaflets (PILs) in Brazil
  • ‘Can you Read this Leaflet?’: User-friendliness of Patient Information Leaflets in the UK and in Italy
  • Patient (Mis)understanding of Prescription Drug Ads in Social Media: Multimodal Discourse Analysis of eDTCA
  • Empowering Patients to Self-Care in Web-mediated Communication: A Multimodal Discourse Analysis
  • Communicating Healthcare Information
  • Living with Diabetes: the Discourse of Medical Information on the Internet for Young People
  • The Representation of Gambling in Gambling Awareness Campaigns: The Discursive Construction of Addiction
  • Authority and Solidarity: How Institutional Websites in the US and the UK Communicate Nutritional Guidelines for Children
  • Communicating Research Findings
  • Media Representations of Scientific Research Findings: From ‘stilbenoids raise CAMP expression’ to ‘red wine protects against illness’
  • Recontextualizing Expert Discourse in Weblogs: Strategies to Communicate Health Research to Experts and the Interested Public
  • Semantic Sequences and the Pragmatics of Medical Research Article Writing
  • ‘Health slips as the financial crisis grips’: Tensions and Variations in Medical Discourse
  • Knowledge Dissemination in Genetics Blogs
  • Notes on Contributors
  • Series index

STEFANIA M. MACI / MICHELE SALA / MAURIZIO GOTTI

Introduction

1.  Investigating medical communication

Medical knowledge is represented, conveyed and questioned through communicative practices. However, the relation between medicine and communication is complex. Despite the fact that knowledge is still commonly transferred and disseminated through language, medical knowledge implies the exploitation of other means of communication, such as formulae, graphs, images, etc. as well as other communicative modes, such as traditional academic and popular genres, in addition to newly-emerging procedures offered by information technology.

Medical discourse is not just a matter of communicating with patients, about patients, and for patients. Indeed, this specialised type of communication is a very complex phenomenon, mainly relying on the fact that practitioners and researchers need to communicate in different ways, for different aims, and to different targets. As rightly pointed out by Hyland (2004, 2011), the ways in which members of the various disciplines communicate encompass different viewpoints embracing both the issue under investigation as well as their standpoints on that issue. For this reason, specialists employ as many registers as possible according to the many different options available so as to target the various audiences they need to address. Furthermore, in order to reach their goals, they need to exploit a number of interdisciplinary and multimodal strategies, both in public and in private interactions.

This new trend, therefore, has led investigators of medical communication to take into consideration newer theoretical perspectives, and to adopt a more varied range of methodological approaches. Indeed, in communicating medical research findings, this new trend has promoted the recourse to a more ‘open genre network’ (Swales/Feak 2000) of ← 9 | 10 → academic writing, which includes – besides the well-established and visible public research genres such as research articles, abstracts, or conference proposals – more modern communicative procedures such as posters, research letters and blogs (Maci 2012a, 2012b; D’Angelo 2012) in addition to newer forms of popularization, by means of which medical science can be disseminated to laymen as well to practitioners not belonging to the same professional sector (Myers 2003; Gotti 2014).

One of the challenges in medical communication studies is the ethnographic positioning of the applied linguist when studying specialised discourse in professional domains. As Sarangi states in this volume, professional practice is not easily reducible to mere language or communication because it relies on different layers of understanding involving scientific, organizational and technological knowledge, all of them explicitly realized by different discourses and not immediately recognizable at a linguistic level. This perspective has given way to a vast literature concerning the relationship existing between medical communication and professional settings. Just to quote a few contributions, we can cite: Sarangi/Roberts (1999), who propose an interdisciplinary approach to professional talk and its role in institutional settings, while offering theoretical and methodological tools for further linguistic analysis; Candlin/Candlin (2002), who focus on the discoursal strategies employed by both professionals and laymen in the achievement of rhetorical and professional goals; Roberts/Sarangi (2005), who provide an ethnographic approach to discourse analysis in order to reveal how language constructs professional practices; Gotti/Salager-Meyer (2006), who analyse both oral and written communication in medical discourse in professional settings; Garzone/Sarangi (2007), who consider issues of ideology in specialised communication in various professional, institutional and disciplinary settings, medicine included; Sarangi/Candlin (2011), who investigate medical professional practice from a linguistic standpoint.

Medical discourse has also been examined from other angles, particularly from the perspectives of conversation-analysis, pragmatics, and sociolinguistics (Bowles 2006; Heritage/Maynard 2006; Roberts 2006; Ferguson 2013). In some cases, analyses have been carried out also from a diachronic viewpoint (Taavitsainen/Pahta 2004, 2010, ← 10 | 11 → 2011). In other cases, a closer intersection between health communication and applied linguistics has been sought, thus offering a multifaceted contribution in terms of methodological approach to the understanding of healthcare communication in the global context (Hamilton/ Chou 2014).

Nowadays, attention is more and more frequently paid to the way in which traditional medical interaction can be carried out in new forms of communication, such as those offered by the social media, blogs and Twitter in particular (Myers 2010; Bjerglund/Söderguist 2012; Prasad/ Kumar 2012). Although medical discourse is realized in a highly codified structure that transcends national cultures (Dahl 2004), the way in which interaction can be expressed in these new communicative modes seems to enhance a more direct access to medical information and practice. While institutional agents seem to promote health communication mainly through traditional channels (such as Doctor-Patient Communication, Patient Information Leaflets, Direct-to-Consumer Advertising), Web 2.0 has been making available medical information to an unprecedented level, sometimes revealing, unfortunately, sociolinguistic misuses of medical terminology, with serious implications. Indeed, not only are such social networks as Twitter or blogs used as new media of communication by medical professionals, these new channels are also used to present medical information to the public. Furthermore, the availability of medical information on the Net has, on the one hand, changed the relationship between doctor and patients, and, on the other, made it the place where patients look for plain explanations of complex and specialised medical concepts, for medical advice and self-medication (Eysenbach/Diepgen 1999; McMullan 2006).

Given the importance of these different perspectives – which sometimes may be perceived as divergent – in the investigation of traditional and technological interactions, this multifaceted volume tries to bridge the gap between conventional and up-to-date medical communication. Indeed, the goal of this volume is to highlight the various viewpoints and strategies that are adopted in the different ways in which medicine and healthcare are practised, communicated and understood by both professionals and non-professionals. The following section ← 11 | 12 → shows how the organization of this volume tries to reflect the rich complexity of this type of communication.

2.  Contents of the volume

The present volume is divided into four sections, each investigating a particular issue relevant to medical communication from a different angle, namely, communication in medical practice, communication with patients, communicating healthcare information and, finally, the communication of research findings.

In the introductory chapter SRIKANT SARANGI discusses issues surrounding interdisciplinary research and interprofessional practice, specifically in the domain of healthcare. In fact, although collaboration across disciplines and professions is usually highly appreciated, it is at the same time challenging and problematic both for epistemological and ontological reasons. After discussing the notions of discourse community and community of practice, the chapter introduces the concept of community of interest, that covers long-term interprofessional collaborations which exceed the purely discursive and practical dimension of professional-client relationship yet being part of the same profession-specific system. This type of communities, though aware of the differences existing between members at the epistemological and ontological level, tend to privilege mutual interests and commitment over differences. Based on comments exchanged between a discourse analyst and a professional practitioner regarding a case instance of genetic counselling (more precisely a joint clinic session involving patients, medical experts and a genetic counsellor), the chapter illustrates the tensions and the interpretive challenges arising when discourse analysts and healthcare professionals, both part to the same community of interest, interact with the purpose of categorizing data, and discusses the strategies of negotiation which are required in the process of meaning-making. ← 12 | 13 →

2.1 Communication in medical practice

In the opening chapter of the first section, GREG MYERS provides a corpus analysis of sample tweets from medical professionals with the aim to illustrate the range of modes which may be found in a 140-character tweet by members of the medical community. The analysis examines the most frequent keywords and strings, considering their key semantic domains and pragmatic functions in their broader communicative context, and provides a framework to investigate how experts construct their professional persona by selecting and combining a plurality of modes. While the personal mode seems to be the least relevant (occurrences of the first person are not statistically relevant, especially when compared to those found in a reference corpus of tweets), the professional mode is highly relevant and is realized through expressions whereby actors are represented through professional categories (as consultant, as patients), the exclusive we or the use of domain-specific terms. The institutional mode has to do with more abstract, general or bureaucratic aspects of the medical profession, usually instantiated by general terms (the singular patient, such words as care, team, board, etc.) as well as conventional expressions (teaching objectives, teaching evaluation, etc.). Finally, the public mode is expressed by those terms lying outside the strictly institutional domain and referring to political, financial or even ideological issues.

ANNA TERESZKIEWICZ investigates how and why medical doctors (MDs) use Twitter as a medium for professional communication. The chapter analyses a corpus of tweets (and the relevant profile) of ten MDs (selected from the Doctor registry on Tweeter on the basis of their popularity in terms of followers), and groups them (according to their content and function) into three categories: updates, addressed messages and retweets. She then considers the resources writers use in order to establish a reliable persona, convey professional expertise and authority, and engage and attract their readers. Hyperlinking and multimodality (i.e. audiovisual elements) are the genre-specific resources made available by the web-based medium, and exploited to frame MDs and the meaning they communicate within a recognizable and reliable disciplinary and institutional community. At the discourse level, the chapter shows how self-representation, stance-taking, evaluation and ← 13 | 14 → the expression of affective and epistemic modality are used for the dissemination of information, for self-promotion and to enhance community engagement and integration.

CAROL BENKENKOTTER, CRISTINA HANGANU-BRESCH and KIRA DREHER analyse the way and the degree to which medical terminology may influence the definition of conceptual frameworks and the interpretation of medical/psychiatric phenomena. The chapter focuses on the clinical case of John Horatio Baldwin, the first patient formally diagnosed with Manic Depressive Insanity (MDI) in terms of Emil Kraepelin’s nosology, and deals with the difficulties encountered by doctors in recognizing and interpreting the patient’s symptoms − namely, mania, depression and occasional ‘lucid intervals’, all characteristics of MDI − hence failing to cure him, until the adoption of a new nomenclature which included MDI as a diagnosis of insanity. The authors point out how the notion and the actual phenomenon of MDI became easier to deal with once it was linguistically represented in a way that allowed experts to conceptualize and frame an array of symptoms as varied as those experienced by Baldwin in a coherent way.

While current research on doctor-patient interaction focuses primarily on felicitous types of exchange, SYELLE GRAVES, REBECCA R. BURSON and VICTOR A. TORRES-COLLAZO consider how the use of a non-standard variety of the language on the part of the patient may provoke miscommunication and misconceptions, and may ultimately lead to misdiagnosis. Reporting the case study of a minority English-speaking patient (speaking African America Vernacular English) suffering from Stiff Person Syndrome, whose real condition was not detected for over a decade and was instead misdiagnosed as being mental illness, the study shows how doctor-patient dialect discord and possible − even unconscious − bias towards non-standard and stigmatized language variants may alter the interpretation of the symptoms of the patient. The chapter presents the retrospective medical chart review containing the doctor reports of the patient’s description, signalling how the correct interpretation was made difficult by the patient’s idiosyncratic ways of describing her condition (in terms of lexical choices, syntax and pronunciation) and by the doctors’ inability to disambiguate her words. This study indicates how important it is for caregivers to be aware of ← 14 | 15 → and understand dialectal differences and non-standard language use in order to take better care of their patients.

2.2 Communicating with patients

In the second section, CELINA FRADE examines popularization in patient information leaflets (PILs) by exploring the attempts at easification in the language of Brazilian PILs, meant to enhance clarity, consistency and domain-specific literacy. In Brazil, best practice guidance on PILs is promoted by the national health surveillance agency, and is aimed at the standardization and clarity of the genre, even though, as shown in this chapter, the practice has had to face major problems due to the very nature of PILs discourse, which looks somewhat ‘unnatural’, as it has to harmonize diverse and even conflicting aspects ranging from healthcare practice and policies to legal constraints, patients expectations and also genre-related requirements (i.e. its internal move structure). The chapter offers a contrastive analysis between an official PIL for a generic medicine used to cure panic and anxiety, and the ‘easified’ version of the same text, which illustrates how (cognitively, discursively, terminologically) the text of the original PIL suffers from lack of consistency and clarity.

ROSITA MAGLIE also analyses the genre of PILs from a contrastive angle, by comparing UK and Italian versions of the same texts, with a specific focus on those rhetorical features meant to enhance user-friendliness. Indeed, PILs, for their very nature, contain highly domain-specific contents, i.e. information about medical product provided by pharmaceutical companies but, at the same time, they have to be easily understood by the lay public; hence they need to be semantically comprehensible and cognitively clear. By investigating PILs of three different types of medical products (i.e. on-the-counter drugs, drugs requiring the supervision of an expert, and expert prescribed drugs), this chapter highlights the popularizing strategies found in the different sections of the English texts to facilitate text readability (i.e. layout and text structuring, terminological and syntactic simplification, etc.). It then compares these occurrences with those found in the Italian version of the same texts, emphasising both similarities and idiosyncrasies, the ← 15 | 16 → latter mainly due to different legal requirements, cultural traditions or domain-specific epistemological assumptions.

ANNA FRANCA PLASTINA offers a multimodal discourse analysis of electronic direct-to-consumer advertising (eDTCA) aimed at revealing how prescription drug ads are understood (or misunderstood) by patients. Given the proliferation of eDTCA, due both to pharmaceutical needs to promote their products and the lack of regulation on the matter in social media, the multimodal discourse found in those ads provides an interesting ground for investigation. Studying a corpus of 24 eDTCA sample videos (covering three common symptoms such as insomnia, high cholesterol and depression) and focussing both on linguistic elements and other semiotic resources (primarily audio), the chapter compares on-screen text with audio information when conveying risk/ benefit − that is, negative and positive pieces of information respectively − in order to evidence parallelism and possible discrepancies between the two semiotic levels. Besides the overall (expected) tendency to emphasize positive aspects over negative ones, major differences are found between the clarity of the linguistic level when presenting risks and the inconspicuousness of other semiotic modes, which can be realized either by superimposing text on audio information or by presenting visual images not consistent with the written and spoken messages.

GIROLAMO TESSUTO presents a multimodal discourse analytic description of online self-care communication, with a particular emphasis on the possibilities that such a dynamic medium offers to empower people to self-care and engage them in matters concerning their own health. Using the UK-based Self-Care Library website as a corpus − a medic-led and evidence-based repository of patient health care information − the analysis uses an integrated framework, combining quantitative and qualitative parameters, to investigate the interplay between words and visuals and the way such resources complement each other for the benefit of effectiveness. The first part of the chapter identifies the ideational, interpersonal and textual meanings expressed in establishing identities, roles, systems of knowledge and beliefs between the participants, by emphasizing linguistic elements such as personal pronouns (inclusive and exclusive), engagement markers (imperatives and questions), active and passive voice, modal auxiliaries, adjectives, ← 16 | 17 → register and style. The second part focuses on visual aspects and, more specifically, the representational, interactive and compositional meanings implicit in the text on the basis of visual parameters such as framing, focus, frame size and colours.

2.3 Communicating healthcare information

The third section is introduced by a chapter where JUDITH TURNBULL discusses the discourse of medical information for young people in websites specifically addressed to children and teenagers. Since these sites (which are usually sections of larger medical websites targeted at adult patients) are meant to provide specialised knowledge and specific contents as to how to live with diabetes in a way that is appropriate and effective, the chapter analyses the cognitive and communicative resources used to achieve this aim and compares them with those usually exploited in websites for adults. As regard the cognitive level – that is, the transfer of domain specific meanings – the main difference between young-oriented and adult sites concerns the information load, whereas at the communicative level the tendency is to emphasize the interpersonal dimension by using a more personalized tone and an emphatic and engaging style, thus combining the scientific and rational elements typical of medical communication with emotional components particularly appreciated by young audiences.

PAOLA CATENACCIO explores the discursive construction of addiction in gambling awareness campaigns in different English-speaking countries (USA, Canada, Australia) considering how linguistic and rhetorical strategies may be exploited to represent gambling as either a pathological issue, a personal problem or a social challenge, hence by differently attributing responsibility and by presupposing different ways as to how to control and contrast it. In the course of the last decades gambling has progressively been considered as a deviant behaviour and as such dealt with: its conceptualization has been highly affected by a disease-related terminology and a medicalization-oriented interpretive framework. As the analysis of the campaigns in the corpus reveals, gambling (a term almost exclusively referred to excessive and/ or compulsive gambling, and not to responsible gambling, which is usually ← 17 | 18 → lexicalized through the more positively connoted term gaming) tends to be either fully institutionalized or co-constructed as being pathologic; hence such campaigns contribute to replicating, corroborating and, in a way, ‘normalizing’ the idea of gambling as illness, and by this very same act they also contribute to the de-stigmatization of this behaviour by representing it as a medical condition rather than a moral flaw.

The chapter by MIRIAM BAIT discusses the communicative strategies adopted by government agencies in the UK and US on their websites in order to promote healthy eating for children and provide food advice, nutritional tips and dietary recommendations. Such texts have both an informative and persuasive function, and this is mirrored in their conventional two-move structure which comprises an introductory section (usually reporting scientific definitions) and a section providing guidelines for the appropriate selection of food (in terms of both quantity and quality). The investigation of the way actors and agency are differently represented in the UK and US shows how institutional websites contribute to the ideological construct of power by balancing authority and empathy.

2.4 Communicating research findings

The fourth section opens with a chapter by RUTH BREEZE in which the author investigates the communication of scientific research findings in the media focussing specifically on the transformations affecting both the language and the content of a scientific research article when it is recontextualized and made to fit the generic conventions typical of media communication. The chapter compares the text of the original paper with the way laboratory findings and health implications are reformulated in an online press release issued by the Oregon State University, on the one hand, and, on the other, three news stories (published in the Daily Telegraph, the Daily Express and the Mirror), focusing in particular on the substitution of domain specific terms and phrases (stilbenoids) with more transparent expressions (red wine and blueberries). Using the Appraisal system as a methodological framework, the chapter outlines the popularizing strategies used to transform the original claims so as to make them appropriate for media communication in terms of ← 18 | 19 → dialogistic positioning and graduation. The analysis shows that, while the text of the press release is more mitigated – displaying neutral attribution and hedging −, the newspaper articles show a more assertive and monoglossic style, combined with intensification resources.

MARÍA JOSÉ LUZÓN’s chapter examines the rhetorical phenomenon of recontextualization of specialised discourse in medical weblogs. Unlike traditional media of written expert communication, blogs, like most part of Internet-based channels, offer the possibility for a dialogic type of exchange between experts and lay public, hence between informative comments and interested requests. On the basis of this assumption, the chapter analyses the strategies exploited by experts to communicate health research to blog users, with a specific focus on how they popularize specialised contents not only through reformulation, but by recontextualizing them, that is, by adjusting them with respect to the participants, their expectation, their roles, their assumed background knowledge, the purpose of the their exchange and the channel. The study shows that the resources used to accomplish this purpose may range from the use of hyperlinks and visuals, to that of code glossing such as explanations, examples, comparisons, metaphors, etc., to the use of interactional resources like personalization, engagement markers and evaluative comments.

DAVIDE MAZZI investigates the pragmatics of the most frequent semantic sequences − i.e. co-occurring items, phrases or lexical clusters − found in medical RAs. Today doctors are required to be experts not only in carrying out research but also in communicating it, and they are expected to do so in the most effective way, that is, by respecting the domain-specific discourse conventions to shape hypotheses and discuss results on the one hand, and by framing meanings with respect to the epistemology underlying the discipline on the other. The data retrieved from a corpus of 280 medical RAs indicate that at the micro-level of the language there are indeed preferred semantic sequences occurring more frequently than others in the Introduction section, used to make topic generalizations and present new evidence to be discussed (namely the sequence for patients with), in the Methods section, to introduce the research criteria (used for the; on the basis of), in the Results part, to describe salient phenomenological features and cause-effect relationships ← 19 | 20 → (as a potential […] for; in the pathogenesis/regulation of) and, finally, in the Discussion section, where data are interpreted with respect to existing knowledge (the finding/possibility/observation that; our hypothesis that).

The chapter by STEFANIA MACI discusses the changes affecting medical discourse as a consequence of discipline-external factors such as globalization and, more specifically, the global crisis, on the one hand, and the urge represented by marketing or corporate concerns and competitive publishing, on the other. The ties between medicine and business are becoming more and more evident since members of the medical community engaged in clinical research are increasingly adopting a marked business-oriented approach in order to cope with the economical crisis when collecting funds, upon which medical research highly depends. This tendency also seems to be reflected in the way medical experts represent and discuss their research. Based on a corpus of 50 Research Letters published in the Journal of American Medical Association and The Lancet, the chapter points out that, beyond the traditional and conventional generic organization (replicating the IMRD structuring typical of academic genres), the micro-linguistic level of such texts displays a range of lexical elements pertaining to the corporate representation of the medical world and the financial aspects of healthcare and medical research (through words such as management, funding, free, sponsor, cost, etc.), thus evidencing the progressive dissemination and appropriation of marketing and corporate thinking when discussing discipline-specific contents.

Finally, the chapter by ANNA STERMIERI focuses on the dissemination of specialised knowledge in academic weblogs written by scientists working in the field of genetics, with the aim to discover how experts manage to communicate scientific contents in a way that is comprehensible and effective to audiences lacking specialised competence. Based on a corpus of posts taken from four genetics blogs, and with the aid of a reference corpus, the chapter provides an analysis of the keywords selected on the basis of their semantic category and concordances, and then focuses on the collocates of two relevant terms – namely disease and risk – in order to reveal how experts popularize the presentation of disease (i.e. by introducing and reformulating ← 20 | 21 → specialised concepts) and how they communicate risk or their own perspective on a medical condition (i.e. how they categorize and assess risk in terms of observation, hypothesis or investigation).

3.  Closing remarks

This book analyses the subject of medical communication from a range of innovative perspectives, covering a broad spectrum of approaches and procedures that are particularly significant in this field. As the various chapters of this volume show, medical communication has been analyzed from many viewpoints: not only from a merely linguistic angle, with a focus on the description of the genres used in medical and healthcare contexts, but also from a social and cultural standpoint, with an emphasis both on the doctor-patient relationship and on the social relevance of the other types of communicative links existing between the many communities involved in this type of interaction. This richness of viewpoints is mainly due to the influence of the results of studies carried out in parallel disciplines and linguistic branches, which have promoted a more integrated approach. This interdisciplinary perspective has been favoured by the recent developments of linguistic studies, which have adopted theoretical approaches and analytical tools typical of various disciplines other than linguistics, such as sociology, anthropology and psychology.

Details

Pages
422
ISBN (PDF)
9783035108446
ISBN (ePUB)
9783035193015
ISBN (MOBI)
9783035193008
ISBN (Book)
9783034316941
Language
English
Publication date
2015 (June)
Published
Bern, Frankfurt Am Main, Berlin, Bruxelles, New York, Oxford, Wien, 2015. 422 pp., 10 b/w ill., 9 coloured ill., 30 b/w tables

Biographical notes

Maurizio Gotti (Volume editor) Stefania Maria Maci (Volume editor) Michele Sala (Volume editor)

Maurizio Gotti is Professor of English Language and Translation, Head of the Department of Foreign Languages, Literatures and Communication, and Director of the Research Centre for LSP Research (CERLIS) at the University of Bergamo. His main research areas are the features and origins of specialized discourse. Stefania Maci is Associate Professor of English Language and Translation at the University of Bergamo, where she teaches English linguistic courses at graduate and undergraduate level. Her research is focused on the study of the English language in academic and professional contexts, with particular regard to the analysis of medical, legal and tourism discourse. Michele Sala is a researcher in English Language and Translation at the University of Bergamo. His research activity deals with language for specific purposes and, more specifically, the application of genre and discourse analytical methods to legal-academic discourse and to the analysis of the linguistic, textual and pragmatic aspects of legal translation.

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Title: Insights Into Medical Communication