Theme-oriented discourse analysis of medical encounters
Approach Theme‐oriented discourse analysis looks at how language constructs professional practice. Recordings of naturally occurring interactions are transcribed and combined with ethnographic knowledge. Analytic themes drawn primarily from sociology and linguistics shed light on how meaning is neg...
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| Vydané v: | Medical education Ročník 39; číslo 6; s. 632 - 640 |
|---|---|
| Hlavní autori: | , |
| Médium: | Journal Article |
| Jazyk: | English |
| Vydavateľské údaje: |
Oxford, UK
Blackwell Science Ltd
01.06.2005
Blackwell Wiley Subscription Services, Inc |
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| ISSN: | 0308-0110, 1365-2923 |
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| Abstract | Approach Theme‐oriented discourse analysis looks at how language constructs professional practice. Recordings of naturally occurring interactions are transcribed and combined with ethnographic knowledge. Analytic themes drawn primarily from sociology and linguistics shed light on how meaning is negotiated in interaction. Detailed features of talk, such as intonation and choice of vocabulary, trigger inferences about what is going on and being talked about. These affect how interactants judge each other and decisions are made. Interactions also have larger rhetorical patterns used by both patients and doctors to persuade each other.
Examples Two settings are used to illustrate this approach: genetic counselling and primary care consultations in multilingual areas. In genetic counselling, interactions are organised around the tension between the risks of knowing and the risks of occurrence. This can lead to a ‘rhetorical duel’ between health professionals and patients and their families. In intercultural primary care settings, talk itself may be the problem when interpretive processes cannot be taken for granted. Even widely held models of good practice can lead to misunderstandings under these conditions.
Conclusion Through discourse analysis, the talk under scrutiny can be slowed down to show the interpretive processes and overall patterns of an activity. Discourse analysts and health professionals, working together, can look at problems in new ways and develop interventions and tools for a better understanding of communication in medical life. |
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| AbstractList | Theme-oriented discourse analysis looks at how language constructs professional practice. Recordings of naturally occurring interactions are transcribed and combined with ethnographic knowledge. Analytic themes drawn primarily from sociology and linguistics shed light on how meaning is negotiated in interaction. Detailed features of talk, such as intonation and choice of vocabulary, trigger inferences about what is going on and being talked about. These affect how interactants judge each other and decisions are made. Interactions also have larger rhetorical patterns used by both patients and doctors to persuade each other.APPROACHTheme-oriented discourse analysis looks at how language constructs professional practice. Recordings of naturally occurring interactions are transcribed and combined with ethnographic knowledge. Analytic themes drawn primarily from sociology and linguistics shed light on how meaning is negotiated in interaction. Detailed features of talk, such as intonation and choice of vocabulary, trigger inferences about what is going on and being talked about. These affect how interactants judge each other and decisions are made. Interactions also have larger rhetorical patterns used by both patients and doctors to persuade each other.Two settings are used to illustrate this approach: genetic counselling and primary care consultations in multilingual areas. In genetic counselling, interactions are organised around the tension between the risks of knowing and the risks of occurrence. This can lead to a 'rhetorical duel' between health professionals and patients and their families. In intercultural primary care settings, talk itself may be the problem when interpretive processes cannot be taken for granted. Even widely held models of good practice can lead to misunderstandings under these conditions. CONCLUSION; Through discourse analysis, the talk under scrutiny can be slowed down to show the interpretive processes and overall patterns of an activity. Discourse analysts and health professionals, working together, can look at problems in new ways and develop interventions and tools for a better understanding of communication in medical life.EXAMPLESTwo settings are used to illustrate this approach: genetic counselling and primary care consultations in multilingual areas. In genetic counselling, interactions are organised around the tension between the risks of knowing and the risks of occurrence. This can lead to a 'rhetorical duel' between health professionals and patients and their families. In intercultural primary care settings, talk itself may be the problem when interpretive processes cannot be taken for granted. Even widely held models of good practice can lead to misunderstandings under these conditions. CONCLUSION; Through discourse analysis, the talk under scrutiny can be slowed down to show the interpretive processes and overall patterns of an activity. Discourse analysts and health professionals, working together, can look at problems in new ways and develop interventions and tools for a better understanding of communication in medical life. Approach Theme‐oriented discourse analysis looks at how language constructs professional practice. Recordings of naturally occurring interactions are transcribed and combined with ethnographic knowledge. Analytic themes drawn primarily from sociology and linguistics shed light on how meaning is negotiated in interaction. Detailed features of talk, such as intonation and choice of vocabulary, trigger inferences about what is going on and being talked about. These affect how interactants judge each other and decisions are made. Interactions also have larger rhetorical patterns used by both patients and doctors to persuade each other. Examples Two settings are used to illustrate this approach: genetic counselling and primary care consultations in multilingual areas. In genetic counselling, interactions are organised around the tension between the risks of knowing and the risks of occurrence. This can lead to a ‘rhetorical duel’ between health professionals and patients and their families. In intercultural primary care settings, talk itself may be the problem when interpretive processes cannot be taken for granted. Even widely held models of good practice can lead to misunderstandings under these conditions. Conclusion Through discourse analysis, the talk under scrutiny can be slowed down to show the interpretive processes and overall patterns of an activity. Discourse analysts and health professionals, working together, can look at problems in new ways and develop interventions and tools for a better understanding of communication in medical life. Theme-oriented discourse analysis looks at how language constructs professional practice. Recordings of naturally occurring interactions are transcribed and combined with ethnographic knowledge. Analytic themes drawn primarily from sociology and linguistics shed light on how meaning is negotiated in interaction. Detailed features of talk, such as intonation and choice of vocabulary, trigger inferences about what is going on and being talked about. These affect how interactants judge each other and decisions are made. Interactions also have larger rhetorical patterns used by both patients and doctors to persuade each other. Two settings are used to illustrate this approach: genetic counselling and primary care consultations in multilingual areas. In genetic counselling, interactions are organised around the tension between the risks of knowing and the risks of occurrence. This can lead to a 'rhetorical duel' between health professionals and patients and their families. In intercultural primary care settings, talk itself may be the problem when interpretive processes cannot be taken for granted. Even widely held models of good practice can lead to misunderstandings under these conditions. CONCLUSION; Through discourse analysis, the talk under scrutiny can be slowed down to show the interpretive processes and overall patterns of an activity. Discourse analysts and health professionals, working together, can look at problems in new ways and develop interventions and tools for a better understanding of communication in medical life. |
| Author | Sarangi, Srikant Roberts, Celia |
| Author_xml | – sequence: 1 givenname: Celia surname: Roberts fullname: Roberts, Celia organization: Department of Education and Professional Studies, King's College London, London, UK – sequence: 2 givenname: Srikant surname: Sarangi fullname: Sarangi, Srikant organization: Health Communication Research Centre, Cardiff University, Cardiff, UK |
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| References | Freeman S, Heller M, eds. Medical Discourse. [Special issue of:] Text 1987;7 (1). Sarangi S, Bennert K, Howell L, Clarke A. 'Relatively speaking': relativisation of genetic risk in counselling for predictive testing. Health, Risk Soc 2003;5 (2):155-69. Ainsworth-Vaughn N. Claiming Power in Doctor−Patient Talk. New York: Oxford University Press 1998. Levinson S. Activity types and language. Linguistics 1979;17: 356-99. Roberts C, Sarangi S. Uptake of discourse research in interprofessional settings: reporting from medical consultancy. Appl Linguistics 2003;24 (3):338-59. Sarangi S, Bennert K, Howell L, Clarke A, Harper P, Gray J. Initiation of reflective frames in counselling for Huntington's Disease predictive testing. J Genetic Counseling 2004;13 (2):135-55. Jaworski A, Coupland C, eds. Discourse: A Reader. London: Routledge 1999. Roberts C, Sarangi S, Southgate L, Wakeford R, Wass V. Oral examinations, equal opportunities and ethnicity: fairness issues in the MRCGP. BMJ 2000;320: 370-5. Roberts C. Transcription. London: King's College London; Fund for the Development of Teaching and Learning DfES. http://www.kcl.ac.uk/education/ftdl/docA.shtml. Barrett R. The Psychiatric Team and the Social Definition of Schizophrenia. Cambridge: Cambridge University Press 1996. Roberts C, Moss B, Wass V, Sarangi S, Jones R. Misunderstandings: a qualitative study of primary care consultations in multilingual settings, and educational implications. Med Educ 2005;39: 465-75. Elwyn G, Edwards A, Gwyn R, Grol R. Towards a feasible model for shared decision making: focus group study with GP registrars. BMJ 1999;319: 753-7. Van Dijk T. ed. Discourse Studies: A Multidisciplinary Introduction. Volumes 1 & 2. London: Sage 1997. Roberts C, Moss B. Doing the Lambeth Talk.[Video/DVD.]London: King's College London 2003. The DVD is available from the London Deanery, 20 Guildford Street, London, WC1N 1DZ, UK. Sarangi S, Roberts C, eds. Talk, Work and Institutional Order: Discourse in Medical, Management and Mediation Settings. Berlin: Mouton de Gruyter; 1999. Erickson F, Shultz J. The Counsellor as Gatekeeper: Social Interaction in Interviews. New York: Academic Press 1982. Sarangi S. Towards a communicative mentality in medical and health care practice. Comm Med 2004;1 (1):1-11. Brown P, Levinson S. Politeness: Some Universals in Language Usage. Cambridge: Cambridge University Press 1987. Cameron D. Working with Spoken Discourse. London: Sage 2001. Sarangi S, Coulthard M, eds. Discourse and Social Life. London: Longman 2000. Fisher S, Todd AD, eds. The Social Organisation of Doctor−Patient Communication. Washington DC: Centre for Applied Linguistics 1983. Schiffrin D, Tannen D, Hamilton H, eds. Handbook of Discourse Analysis. Oxford: Blackwell 2001. Roberts C, Sarangi S, Moss B. Presentation of self and symptom in primary care consultations involving patients from non-English speaking backgrounds. Comm Med 2004;1 (2):159-69. Sherzer J. A discourse-centred approach to language and culture. Am Anthropologist 1987;89: 295-309.DOI: 10.1525/aa.1987.89.2.02a00010 Roberts C. Developing Empathy.[Video.]London: King's College London 2001. Details of the video can be obtained from Celia Roberts (celiaroberts@lineone.net). Gumperz JJ. Discourse Strategies. Cambridge: Cambridge University Press 1982. Goffman E. Frame Analysis. New York: Harper & Row 1974. Ribeiro BT. Coherence in Psychotic Discourse. Oxford: Oxford University Press 1994. Goffman E. Forms of Talk. Oxford: Blackwell 1981. West C. Routine Complications: Troubles in Talk Between Doctors and Patients. Bloomington, Indiana: Indiana University Press 1984. 1979; 17 2002; 35 1998 1996 1974 1994 1997; 2 1993 2003 1992 2002 2004; 1 1979 1999 1987; 89 2001 2000 2004; 13 1987 2003; 24 1984 2003; 5 1983 1982 1981 2000; 320 2005; 39 1999; 319 e_1_2_13_23_2 e_1_2_13_25_2 e_1_2_13_22_2 Goffman E (e_1_2_13_19_2) 1974 e_1_2_13_8_2 e_1_2_13_5_2 Freeman S (e_1_2_13_13_2) 1987 e_1_2_13_9_2 Tannen D (e_1_2_13_20_2) 1983 Schiffrin D (e_1_2_13_7_2) 2001 Roberts C (e_1_2_13_27_2) 2002 West C (e_1_2_13_10_2) 1984 e_1_2_13_16_2 e_1_2_13_39_2 e_1_2_13_17_2 e_1_2_13_38_2 Goffman E (e_1_2_13_21_2) 1981 e_1_2_13_35_2 e_1_2_13_34_2 Roberts C (e_1_2_13_37_2) 2003 e_1_2_13_31_2 e_1_2_13_30_2 e_1_2_13_33_2 Cameron D (e_1_2_13_3_2) 2001 e_1_2_13_11_2 e_1_2_13_32_2 Sarangi S (e_1_2_13_28_2) 2000 Sarangi S (e_1_2_13_6_2) 2000 Roberts C (e_1_2_13_36_2) 2001 Gumperz JJ (e_1_2_13_24_2) 1992 Ribeiro BT (e_1_2_13_14_2) 1994 Fisher S (e_1_2_13_12_2) 1983 e_1_2_13_2_2 Roberts C (e_1_2_13_18_2) Gumperz J (e_1_2_13_41_2) 1993 Jaworski A (e_1_2_13_4_2) 1999 Sarangi S (e_1_2_13_15_2) 1999 Erickson F (e_1_2_13_26_2) 1982 Jefferson G (e_1_2_13_40_2) 1979 e_1_2_13_29_2 |
| References_xml | – reference: Levinson S. Activity types and language. Linguistics 1979;17: 356-99. – reference: Sarangi S, Bennert K, Howell L, Clarke A. 'Relatively speaking': relativisation of genetic risk in counselling for predictive testing. Health, Risk Soc 2003;5 (2):155-69. – reference: Roberts C, Moss B. Doing the Lambeth Talk.[Video/DVD.]London: King's College London 2003. The DVD is available from the London Deanery, 20 Guildford Street, London, WC1N 1DZ, UK. – reference: Elwyn G, Edwards A, Gwyn R, Grol R. Towards a feasible model for shared decision making: focus group study with GP registrars. BMJ 1999;319: 753-7. – reference: Sarangi S, Roberts C, eds. Talk, Work and Institutional Order: Discourse in Medical, Management and Mediation Settings. Berlin: Mouton de Gruyter; 1999. – reference: Sarangi S, Coulthard M, eds. Discourse and Social Life. London: Longman 2000. – reference: Schiffrin D, Tannen D, Hamilton H, eds. Handbook of Discourse Analysis. Oxford: Blackwell 2001. – reference: Roberts C, Sarangi S, Moss B. Presentation of self and symptom in primary care consultations involving patients from non-English speaking backgrounds. Comm Med 2004;1 (2):159-69. – reference: Ainsworth-Vaughn N. Claiming Power in Doctor−Patient Talk. New York: Oxford University Press 1998. – reference: Gumperz JJ. Discourse Strategies. Cambridge: Cambridge University Press 1982. – reference: Ribeiro BT. Coherence in Psychotic Discourse. Oxford: Oxford University Press 1994. – reference: West C. Routine Complications: Troubles in Talk Between Doctors and Patients. Bloomington, Indiana: Indiana University Press 1984. – reference: Goffman E. Frame Analysis. New York: Harper & Row 1974. – reference: Jaworski A, Coupland C, eds. Discourse: A Reader. London: Routledge 1999. – reference: Roberts C, Moss B, Wass V, Sarangi S, Jones R. Misunderstandings: a qualitative study of primary care consultations in multilingual settings, and educational implications. Med Educ 2005;39: 465-75. – reference: Goffman E. Forms of Talk. Oxford: Blackwell 1981. – reference: Fisher S, Todd AD, eds. The Social Organisation of Doctor−Patient Communication. Washington DC: Centre for Applied Linguistics 1983. – reference: Roberts C, Sarangi S. Uptake of discourse research in interprofessional settings: reporting from medical consultancy. Appl Linguistics 2003;24 (3):338-59. – reference: Sarangi S, Bennert K, Howell L, Clarke A, Harper P, Gray J. Initiation of reflective frames in counselling for Huntington's Disease predictive testing. J Genetic Counseling 2004;13 (2):135-55. – reference: Freeman S, Heller M, eds. Medical Discourse. [Special issue of:] Text 1987;7 (1). – reference: Van Dijk T. ed. Discourse Studies: A Multidisciplinary Introduction. Volumes 1 & 2. London: Sage 1997. – reference: Roberts C. Transcription. London: King's College London; Fund for the Development of Teaching and Learning DfES. http://www.kcl.ac.uk/education/ftdl/docA.shtml. – reference: Roberts C, Sarangi S, Southgate L, Wakeford R, Wass V. Oral examinations, equal opportunities and ethnicity: fairness issues in the MRCGP. BMJ 2000;320: 370-5. – reference: Brown P, Levinson S. Politeness: Some Universals in Language Usage. Cambridge: Cambridge University Press 1987. – reference: Sherzer J. A discourse-centred approach to language and culture. Am Anthropologist 1987;89: 295-309.DOI: 10.1525/aa.1987.89.2.02a00010 – reference: Barrett R. The Psychiatric Team and the Social Definition of Schizophrenia. Cambridge: Cambridge University Press 1996. – reference: Sarangi S. Towards a communicative mentality in medical and health care practice. Comm Med 2004;1 (1):1-11. – reference: Cameron D. Working with Spoken Discourse. London: Sage 2001. – reference: Roberts C. Developing Empathy.[Video.]London: King's College London 2001. Details of the video can be obtained from Celia Roberts (celiaroberts@lineone.net). – reference: Erickson F, Shultz J. The Counsellor as Gatekeeper: Social Interaction in Interviews. New York: Academic Press 1982. – volume: 319 start-page: 753 year: 1999 end-page: 7 article-title: Towards a feasible model for shared decision making: focus group study with GP registrars publication-title: BMJ – start-page: 401 year: 1999; end-page: 25 – year: 1983 – volume: 1 start-page: 159 issue: 2 year: 2004 end-page: 69 article-title: Presentation of self and symptom in primary care consultations involving patients from non‐English speaking backgrounds publication-title: Comm Med – year: 1981 – volume: 1 start-page: 1 issue: 1 year: 2004 end-page: 11 article-title: Towards a communicative mentality in medical and health care practice publication-title: Comm Med – volume: 35 issue: 2 year: 2002 – issue: 1 year: 1987 article-title: Medical Discourse. 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| Snippet | Approach Theme‐oriented discourse analysis looks at how language constructs professional practice. Recordings of naturally occurring interactions are... Approach Theme‐oriented discourse analysis looks at how language constructs professional practice. Recordings of naturally occurring interactions are... Theme-oriented discourse analysis looks at how language constructs professional practice. Recordings of naturally occurring interactions are transcribed and... |
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| SubjectTerms | Clinical Competence - standards Communication Curriculum subjects: programmes and methods Decision Making education Education, Medical, Undergraduate - methods Educational sciences Genetic Counseling medical Medical and paramedical education physician−patient relations Primary Health Care students Students, Medical Teaching methods undergraduate/psychology Wales |
| Title | Theme-oriented discourse analysis of medical encounters |
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