There has been a growing emphasis on the use of diaries and journals by caregivers and people living with dementia as ways to document and understand their lived experiences. Non-literary diaries that act as ledgers and inventories of life can also serve similar functions. We present the case of "Mr. Bennett," who apparently kept a non-literary journal throughout his adult life and continued this practice as he lived with dementia. We adopt a discourse-level approach to the study of a non-literary journal given us by his family, which is monologic in terms of not expecting responses from any readers beyond himself but dialogic in his use of rhetorical pointing and comments to himself. When monologic, Bennett's notebooks contain personal journals; when dialogic, the entries slide into being personal diaries: the dialogic priming, most frequently marginal for a specific entry, shows Bennett as he is writing/thinking to himself. Indeed, Bennett's use of priming and his occasional hand-drawn illustrations incorporate multimodality into what he must have seen as his private writing.
This exploratory study examines communication and intercultural barriers faced by Spanish-Galician migrants in Swiss health care across two migration waves (1961 to 1980 and post-2008) and three generations. Drawing on ten semistructured interviews, the study explores how migration backgrounds, linguistic repertoires, and intercultural expectations shape health care experiences. Using a sociolinguistic framework combined with a thematic and discourse analysis, the findings show that the first-wave migrants, often with limited formal education, relied on Italian as a lingua franca and frequently involved their children and other family members as ad-hoc interpreters. In contrast, the second-wave migrants, who were generally better educated, were prepared for medical consultations in German and sought greater linguistic independence, though certain challenges persisted with Swiss German and interactional norms. Across both waves, multilingual health care staff, often with migrant backgrounds, played a central role in facilitating communication and trust, while professional interpreting services remained underused. The participants appreciated the longer consultations and shared decision-making in Swiss health care. However, they reported feeling emotionally isolated during critical life events, such as maternity, due to differing cultural norms. Thus, beyond language proficiency, cultural expectations shaped their perceptions of care. These findings highlight the interplay of linguistic and intercultural factors in shaping health care experiences and can potentially inform future research and policy on equitable health care access for migrant communities.
In this forum discussion piece, I first delineate the many contours of the label "medical humanities." In readily acknowledging its interdisciplinary makeup, I then attempt to cover two ends of the spectrum as signaled in the title-at one end, a case is made for humanities and medicine as being synergistic and forging an alliance; at the other end lies a fundamental critique that medicine and humanities are incompatible and even an aberration. For the most part, I position myself in the alliance camp. Although the dominant trend is to approach the topic of medical humanities from philosophical, moral, and ethical angles, given my own disciplinary background in communication and discourse studies, the bulk of my discussion relates to the adoption of a communication compass on medical humanities.
Difficulties with communication present a challenge not just for people living with dementia (PLWD) themselves but also for those who care for them. This challenge is amplified in acute care environments with unfamiliar surroundings and staff. Drawing on a wider study using video-recorded data to identify practices to manage or avoid distress for PLWD in the acute hospital, we use conversation analysis to explicate some of the reasons why challenges can arise and consider the implications of this. Previous work has shown that while PLWDs' transactional ability with language may decline, more foundational skills can still persist, notably abilities to produce responsive talk, which follows the rules of turn-taking and displays an orientation to sequence organization. We show that these abilities can also extend to recognizing the lack of orientation to these features in the talk of others. Examples include PLWD drawing attention to missing or inadequate responses to questions from staff, seeking accounts for unaccounted-for actions, and identifying inappropriate referents. Our findings show that even when PLWD are not oriented to time or place and their talk is hard to interpret semantically, staff should not assume that interactional competence is entirely absent.
This qualitative study explores nurses' perspectives on consultations in the treatment of atrial fibrillation (AF). The aim is to discover whether and how nurses support patient participation and how they talk about it. The data consist of transcribed interviews with ten nurses working in cardiac care at four Swedish hospitals. The analytical approach is a combination of content analysis and discourse analysis. The findings reveal the following interactive and communicative themes in supporting patient participation: Nurse's Routine Components: Routine interactions such as providing information during each visit, ensuring patient understanding, and encouraging active patient questions. Nurse's Knowledge-Based Contributions: Providing patients with knowledge about treatment options, their mechanisms, and the associated pros and cons. Nurses observe and address patient concerns, taking an active role in guiding patients through the AF treatment. Nurse's Intersubjective Alignment with the Patient: Forming genuine connections. This involves exchanging experiences, demonstrating empathy, and recognizing a shared humanity; accepting patients' vulnerabilities, showing compassion, creating a safe space for expressing concerns; and allowing patients the necessary time to make decisions. All contribute to a person-centered approach involving patient participation. The study's communication-based approach offers useful insights for reflecting on how patient participation and the social values of nurses' professional caring work within cardiology can be understood and developed as a caring communication activity type (CCAT).
Becoming seriously and/or chronically ill can challenge and disrupt our sense of who we are in terms of our bodies, minds, and social roles. Although a substantial literature exists on metaphor and illness, the use of metaphor to represent identities has received little attention. This article focuses on similes as a particularly relevant manifestation of metaphoricity in language. An 8-million-word corpus of contributions to the Pain Concern online forum is investigated via a combination of corpus linguistic methods and in-depth qualitative analysis. We explore how contributors to the forum use similes to describe their own (changing) self-perceptions due to living with pain and its consequences. To this end, we introduce and demonstrate a multicomponent analytical framework, which, as we show, is equally applicable to the analysis of metaphorical expressions. The framework includes a consideration of source concept, type of identity, and viewpoint. With regard to our data, we show how similes are used to convey mostly unwelcome changes in the person's perception of themselves in physical, psychological, and/or social terms, potentially resulting in estrangement, low self-esteem, isolation, and disempowerment. More broadly, we suggest that our framework is applicable to the study of metaphorical representations of identities in the context of illness generally.
Interpreted communication in the medical domain is inherently complex, but due to the cost of professional interpretation in outpatient settings, qualified bilingual speakers or even untrained interpreters are common in the United States. With its focus on the use of language, conveyed meanings, and construction of social relationships, linguistic pragmatics provides a useful framework to analyze interpreted communication. The data comprised 57 video-recorded encounters between Spanish-speaking patients and family medicine clinicians, mediated by Spanish-speaking medical personnel who also served as interpreters. This study applied the framework of voices (forms of talk) to examine the roles of untrained, dual-role interpreters with Spanish-speaking patients in medical conversations. A grounded qualitative analysis revealed communicative functions and discourse strategies within four different voices. The analysis further identified recurring ways that speakers frame meaning to align with both doctors and patients. The findings elucidate the language mediators' dynamic medical, linguistic, and interpersonal roles, highlighting the importance of context in health communication practice. The excerpts from selected interactions illustrate the complex collaborative work that these language mediators accomplish, including professional teamwork, explaining medical facts, creating natural conversation, and fostering human connection. The findings can be applied to training dual-role interpreters for specific contexts in outpatient settings.
Typically, one of the necessary conditions for accessing medically assisted suicide (MAS) is the presence of suffering that the patient deems intolerable, which is then communicated to the physician. During the consultation, the physician has the responsibility to explore this suffering, if the patient so wishes, to identify appropriate palliative care (PC) options to propose. However, the patient might desire to end life; thus, the physician is in the difficult position of offering forms of care directed at symptom relief and the preservation of life while the patient approaches the physician to request death through medical intervention. How can the physician's duty to verify the presence of intolerable suffering (a crucial yet inherently subjective and indisputable criterion based on the principle of self-determination) be reconciled with their obligation to offer PC, thereby encouraging the patient to actively engage in the therapeutic relationship through communication? This complex question, which intertwines ethical and psychological dimensions, will be the central focus of this contribution.
In contemporary health care practices, clients often ask professionals to take into account, position toward, or otherwise deal with what other absent professionals (are said to) have said or done about the same issue. We call this phenomenon discursive interprofessionality (DI). This article focuses on a perspicuous case involving DI in childcare (i.e., how a pediatrician deals with the voice of the nursery educators reported by the parent of a 1-year-old baby in the pediatric clinic). Adopting a conversation analysis approach, this single-case study shows the pediatrician's reluctance to affiliate with a mother who constructs the nursery educators as unreliable witnesses of what occurs at the nursery. The analysis illustrates how the pediatrician's stance-taking toward the nursery educators' reported voice is locally occasioned and changes along a continuum, ranging from avoiding stance-taking to displaying affiliation with the nursery educators' reported voice. We contend that this varying positioning depends on what the client is doing by reporting the other professional's voice (i.e., undermining the professional's credibility). In conclusion, we stress the relevance and possible risks of DI for childcare professionals, who are regularly asked by parents to take a stance on what other institutional caregivers have (reportedly) said or done.
Disclosure of HIV status is critical for HIV prevention and control. However, although the benefits of HIV disclosure have received extensive documentation, the same cannot be said for its drawbacks. In the current study, we used a descriptive qualitative study design to highlight the implications of disclosure among 30 pregnant and postpartum women living with HIV in Uganda. We conducted a qualitative content analysis and found that healthcare professionals responded positively and supportively when HIV-positive pregnant and postpartum women disclosed their status, and that individuals who disclosed their status to their husbands but not to wider circles also experienced no mistreatment or discrimination. Contrarily, however, some husbands reacted unfavourably to their wife's HIV-positive status when a larger audience was involved in the disclosure. In particular, we discovered that co-wives and in-laws promoted stigmatization, including violence, by husbands. The interaction between these HIV-positive women and their mothers also demonstrated both positive and negative implications. This counterintuitive attitude has the consequence of reducing the uptake of antiretroviral drugs. There is therefore a need for policies and initiatives that not only encourage disclosure to health professionals, spouses and a few close relatives or friends but prevent stigmatization, violence and other forms of abuse against HIV-positive women.
This study examines face-work and politeness strategies during interactions between a female doctor and two male patients presenting with sexual and reproductive health issues at a public hospital in Kenya. Grounded in the conceptual frameworks of face-work and politeness, this study explores how face-saving and face-threatening acts are managed in medical encounters. It considers the cultural and gendered aspects of politeness in these interactions. The analysis of the qualitative data collected through recordings, participant observation, and a follow-up interview with the doctor has led to the following findings. The doctor uses indirect language and culturally sensitive communication to preserve the male patients’ positive face, particularly around stigmatized issues such as sexually transmitted infections. The male patients employ defensive face-work to maintain their social image and masculinity. This study sheds light on the power dynamics, politeness strategies, and cultural norms that shape doctor–patient interactions in reproductive health settings, contributing to a deeper understanding of gendered communication in healthcare.
This paper is a discourse analysis based on three illness narratives, known as autopathographies/memoirs, selected from a larger study. The memoirs were written in English by patients who suffered from contested illnesses. The memoirists report that as patients, they have encountered skepticism from their doctors regarding the doctorability of their conditions. Drawing on the theory of dialogism, the theory of memoirs, narrative analysis, and evaluation in linguistics, this paper argues that these memoirists answer their doctors, among other addressees, to vindicate themselves. They covertly claim that (a) their visceral authority is right and (b) their illness narratives are credible and real rather than imaginary. The close reading technique is used to analyze the memoirists' use of devices in the orientation section of the memoirs. Direct evidentials, combined with the mirative stance and deferred realization, are observed as firsthand sources of information. More specifically, prolepsis, ventriloquism, quotative evidential, and intertextuality are observed as secondhand sources of information. Whereas the devices associated with the firsthand sources of information enhance the subjective stance of the visceral authority as inalienable, the devices associated with the secondhand sources vouch for credibility by providing an objective source of information. In constructing credibility, these memoirs contribute to normalizing contested illnesses.
This study aims to explore the nature of interprofessional collaboration between radiation therapists (RTTs) and radiation oncologists (ROs) during radiation therapy (RT), with the shared goal of treating patients with radiation. Generally, there seems to be a lack of studies describing the nature of interprofessional collaboration between RTTs and ROs. The present study adopts an exploratory descriptive qualitative research design. The setting is the private and public RT departments situated in the Tshwane municipal area, Gauteng, South Africa. A variation is noted between the Health Professions Council of South Africa (HPCSA) scope of practice for RTTs, published in 1979, and the new scope circulated for comment in 2021. Practising RTTs and ROs have been invited to take part in semi-structured interviews by using expert purposive sampling. Ten radiation therapists and seven radiation oncologists were interviewed, and data analysis included content and thematic analysis. Two main themes emerging from the data were the dual purpose of collaborative communication and grappling with the collaborative communication divide. The findings indicate team structure issues, the fact that the two disciplines mostly work in separate locations, and the status of current communication being dominated by intermediaries are perceived by the participants to hinder collaborative communication between the two professional groups.
This study aims to gain insight into participants’ use of gaze in sign language–interpreted consultations in health centres for babies and toddlers in the Norwegian context. The study investigates how gaze direction and eye contact frame the interaction between participants comprising mothers who are deaf and health personnel who are hearing. The empirical material is based on five video recordings of interpreted health consultations, and multimodal interaction analysis is used to examine the participants’ use of gaze in these interactions. The analysis demonstrates differences in eye contact that provide participants with access to different footings because of their language modalities and language knowledge. The mothers and the sign language interpreters take responsibility for the interaction when the health professional is unaware of the importance of a specific gaze in sign language. When taking responsibility, they shift between frontstage and backstage activity. In addition, the mothers do not have full access to the interaction, even with sign language interpreters present. The findings show that it is imperative that health personnel know how to communicate with deaf parents and how to work with sign language interpreters.
One of the main, unsolved controversies that has developed throughout the COVID-19 emergency concerned the safety and multifaceted communication of its vaccine. Therefore, it represents an exemplary starting place for reflections on the linguistic and discursive strategies of medical risk and uncertainty communication enacted by authorities who must reassure and guide nonspecialists and professionals. The present study compares two institutions with differing communicative frameworks, i.e., the US Department of Defense, which follows a militaristic "natural objectivism" model implemented in the course of an emergency, and the World Health Organization (WHO), which raises ethical questions on the equity and humanitarian aspects of any vaccination delivery by means of a "cultural relativism" framework. The study makes use of two corpora consisting of various texts and documents (guides, press releases, memos, and frequently asked questions [FAQs]) from the two websites to examine their discursive and stylistic practices. The analysis begins with the multimodal risk communication presented in the two institutions' webpages on COVID-19 vaccines, complemented by a corpus stylistics and corpus-assisted discourse analysis on the aspects of storytelling, transparency, trust building, hedging, probability, and approximation. The study highlights, on the one hand, the DoD's confidence and continuous experience, but also its limited public information and, on the other hand, the WHO's transparency and trust engenderment, but also its emphasis on uncertainty. In conclusion, it argues and reflects on a possible convergence of the two approaches in providing reassuring and trustworthy health care communication in the face of uncertainty.
Speech language therapists (SLTs) are often challenged in their work with patients with different communication vulnerabilities. Even though SLTs are trained experts in communication, experiences from the field indicate that they often feel uncertain in interactions with multilingual patients and their families. This paper explores how language discordance between SLTs and multilingual parents influences regular institutional interaction. A discourse analysis is conducted on 33 authentic transcripts of specific discourse types between SLTs, parents, and their children within a multilingual constellation. Three emerging themes are discussed: (a) applied interactional strategies (b) involving the child in interaction and (c) addressing future parental engagement in therapy. By reconstructing discourse it is apparent that the knowledge of SLTs and parents does not always align, which influences the transfer of this knowledge, resulting in less achievement of interactional goals. When a language discordance is present, the participants have no equal access to interpretative processes in communication due to different linguistic and cultural frameworks, leading to less successful interactions and an asymmetrical relation between the participants. In successful interactions, alignment and shared decision-making are achieved through discourse by actively involving the patients and the parents, creating shared responsibility, and applying supportive communicative strategies for inclusive multilingualism.
This article examines instructions on the handling of medicines produced by a Finnish hospital pharmacy from the perspectives of two reader concepts: the model reader and the reader-in-the-text. The former comprises virtually all the medical professionals working in diverse wards, and two group interviews with hospital pharmacists are used to explore how instruction writers orientate to this versatile readership and construct model readers. The concept of "reader-in-the-text" is then used to examine 22 instruction texts from the perspective of textual interaction. The analysis reveals that the writers construct an "official" model reader, who is anyone working in healthcare, but also that more informal, profession-specific model readers are introduced. The official model reader is reflected in the text documents as a collection of impersonal features and term explanations. What is required from the reader-in-the-text to navigate the instructions successfully is background knowledge of the organizational division of labor.
This article presents a critical discourse analysis comparing linguistic representations of the public, experts, and politicians in UK newspaper reporting on COVID-19 policies. The analysis focuses on 120 articles published between 2020 and 2022, sourced from four national newspapers representing a cross-section of political leanings and formats. Quantitative and qualitative analyses of references and quotations suggest that the public is primarily represented as a collective entity, with functional references, rather than as distinct individual actors. Moreover, although the public is the most frequently mentioned among the groups considered, their engagement is mostly conveyed through emotional expressions of vulnerability, with little representation of individual voices. In contrast, politicians are depicted as individuals with far greater agency. Public health experts, meanwhile, are represented as having a marginal role in influencing policy decisions. The analysis of direct quotations carried in the media demonstrates that the stances expressed toward policies in such quotations consistently align with the ideological orientations of the newspapers across all three social groups. In newspapers with distinct left- or right-leaning perspectives, direct quotes tend to show greater levels of policy disagreement than in less ideologically polarised publications. Given that news discourse has been found to strongly influence public perceptions of public health policies, we suggest that the public might be better served by newspaper coverage of health crises that counters the trend of prioritising political biases over evidence-based conclusions. Moreover, featuring the perspectives of the public more prominently in such coverage might enhance positive policy engagement from some sections of the public.
In the last decade, a number of studies from medical sciences have analyzed data from the reviewing platform Yelp to explore patient satisfaction. Many of these have adopted a thematic analytic approach and have consistently found that patients tend to discuss nonclinical issues far more frequently than they do clinical issues. Specifically, patient narratives frequently mention interpersonal interactions and communications with physicians and staff. Our study builds on this scholarship by providing a more fine-grained discourse analysis of Yelp reviews in order to better understand the ways in which patients refer to their encounters and interactions with doctors, nurses, and staff members in a set of hospital reviews. Our analysis of 100 positive and negative reviews of 10 hospitals found that reviews were often written by family members on behalf of patients rather than by the patients themselves. In addition, reviewers were far more likely to name specific individuals in positive reviews; conversely, negative reviews featured more impersonal constructions. The study also found that different types of linguistic resources (i.e., adjectives versus verbs) were used by reviewers for positively evaluating physicians and nurses, respectively, and that negative reviews of physicians, nurses, and staff discussed a range of different communicative behaviors. Finally, our findings suggest that some complaints about hospital employees may, in fact, point to larger, organization-level problems.
To examine change in psychotherapeutic conversations, Conversation Analysis (CA) can be a powerful tool. The present study goes beyond previous studies for conducting a longitudinal analysis of psychotherapy by focusing on both conversational partners equally-the therapist and her interventions and the patient and her responses. Video recordings of sessions involving an entire outpatient psychodynamic psychotherapy in the German language serve as database. The analysis demonstrates evidence of change in the actions of both participants. The therapist, for example, changes her choice of words over the course of the therapy, indicating in later sessions that she relies on previous interventions and assumes that the patient has gained knowledge. In the first half of the therapy, the patient offers usually dispreferred responses. Toward the end of the therapy, she offers less dispreferred responses but still does not cooperate completely. This study shows how changes in both the therapist's interventions and the patient's responses can be recognized over the course of psychotherapy sessions, even if these changes are rather small.
