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: Roberts, Celia, Sarangi, Srikant
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Oxford, UK Blackwell Science Ltd 01.06.2005
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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.
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
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  fullname: Sarangi, Srikant
  organization: Health Communication Research Centre, Cardiff University, Cardiff, UK
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Keywords Medicine
Decision Making
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medical
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Doctor-patient relation
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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.
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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.
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– 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.
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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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StartPage 632
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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https://www.ncbi.nlm.nih.gov/pubmed/15910440
https://www.proquest.com/docview/202937245
https://www.proquest.com/docview/67866540
Volume 39
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