Published by De Gruyter Mouton

Volume 1 Issue 2

Issue of Communication and Medicine

Contents
Journal Overview

July 27, 2005

Editorial

Srikant Sarangi

Page range: 105-105

July 27, 2005

Multilingualism and healthcare in Nigeria: A management perspective

Bassey E. Antia, Fankep D. A. Bertin

Page range: 107-117

Abstract

Nigeria has a healthcare system that has been described as defective even by its managers. A year 2000 study by the World Health Organization (WHO) of health systems in 191 member countries ranked Nigeria 187th. These several evaluations consistently point to inadequate managerial skills. Regrettably, very little is known of the import of language and communication as management issues in healthcare delivery in this country of 400 languages. This article therefore proposes a language-driven audit of health management in Borno State (northeast Nigeria) as a means of sensitizing policy makers and implementers. Based largely on data from questionnaires completed by 129 health professionals belonging to various professional categories (physicians, nurses, pharmacy staff, laboratory staff, and medical and health workers) and drawn from four hospitals, the study explores the relationship between multilingualism and the following: (a) patients' rights; (b) staff recruitment, deployment and commitment; (c) human asset accounting; (d) physician–population ratio. This language-driven audit reveals a number of points, including: ethically questionable practices; distributional imbalance in personnel; commendable cases of employee commitment; and inequity in renumeration.

July 27, 2005

Information empowers but who is empowered?

Jill Kealley, Colleen Smith, Bill Winser

Page range: 119-129

Abstract

This article presents part of the findings of a study that examined an information pamphlet written by nurses and given to relatives of patients in a Critical Care Unit (CCU) in an Australian acute care hospital. The pamphlet, Information for Relatives , was analyzed using Systemic Functional Linguistics (SFL) and examines how a relatives' information pamphlet written by nurses constructs the reader-relatives' view of a Critical Care Unit. The results revealed how the language chosen by the nurse-writers of this pamphlet acts to restrict and constrain the reader-relatives while constructing the staff as ethical experts. Furthermore, it questions the notion that all information empowers healthcare clients and demonstrates how this information pamphlet is not value free but has embedded in it social values of the culture from which it emanates. The pamphlet empowers the writers and staff, not the relatives.

July 27, 2005

‘I didn't think I was at risk’: Interdiscursive relations in narratives of sexual practices and exposure to HIV

Henrike Körner, Olympia Hendry, Susan Kippax

Page range: 131-143

Abstract

This article is concerned with the discursive construction of sexual practices and ‘risk’ in gay men's accounts of exposure to HIV. The data are in-depth interviews from two Sydney-based studies. While the events reported in both studies were very similar, there are considerable differences in the language choices. Drawing on critical discourse analysis and systemic functional linguistics, this paper shows how language choices in individual narratives resonate intertextually with the public health discourse of safe sex, which emphasizes knowledge of safe sex, control over sexual practices and condom use. While in accounts of exposure to HIV in the context of prevention sexual practice is construed consistently as ‘doing’ with the speakers as Actor, in accounts of exposure to HIV in the context of transmission it is construed predominantly as ‘thinking’ and ‘being’. There are also differences in the negotiation of alternatives. All narratives resonate with the discourse of safe sex, however, it is not passively reflected in speech but is actively engaged with and shaped to fit the knowledge and understanding of individuals. The narratives also resonate with the private world of intimate relationships and everyday life. This suggests a notion of ‘risk’ as a hybrid of multiple, potentially conflicting discourses.

July 27, 2005

Reconceptualizing interruptions in physician-patient interviews: Cooperative and intrusive

Han Z. Li, Michael Krysko, Naghmeh G. Desroches, George Deagle

Page range: 145-157

Abstract

Results of past research on physician-patient interruption present an inconclusive picture. This study reconceptualizes interruption into cooperative and intrusive categories. Thirty physician-patient interviews, 13 male/male and 17 male/female, were audiotaped and microanalyzed. It was found that physicians did not interrupt patients more or vice versa. Rather, physicians and patients interrupted differently, the former more intrusively and the latter, more cooperatively. Furthermore, physicians did not dominate speaking turns nor speak more words than patients, as previously believed. We argue that their difference may not be measured by the number of words or speaking turns because it is embedded in their respective communication style. It was also found that female patients exhibited eleven times as much cooperative interruptions as did male patients. When physicians interrupted patients, they were unsuccessful only 6% of the time. When patients interrupted physicians, they were unsuccessful 32% of the time. The results of this study point out the necessity to reconceptualize interruptions in physician-patient interviews.

July 27, 2005

Presentation of self and symptoms in primary care consultations involving patients from non-English speaking backgrounds

Celia Roberts, Srikant Sarangi, Becky Moss

Page range: 159-169

Abstract

This paper draws on the PLEDGE research project (Patients with Limited English and Doctors in General Practice) The Patients with Limited English and Doctors in General Practice (PLEDGE) project was funded by Sir Siegmund Warburg's Voluntary Settlement (2001–2003). The research team was: Celia Roberts, Roger Jones, Becky Moss, Srikant Sarangi and Val Wass. which has a database of 232 video-recorded interactions from GP surgeries in South East London. We focus on the opening episodes—the first opportunity the patient has to report on why they have come to see the doctor—to explore some of the contrasts in self presentation and the interactional work that doctors do when faced with the unexpected. Patients who speak a local London or standard variety of English present three aspects: a description of symptoms, the context in which they occurred, and an affective or epistemic stance. These ‘micro discourse routines’ are accomplished interactionally through the design of figure/ground relationships, framing and metacommunication and presentation of the ‘moral self’. Although some patients from non-English speaking backgrounds use broadly similar ‘micro discourse routines’, the majority configure the relationship between medically salient facts, adequate contextual information and the stance which conveys the ‘moral self’ in different and apparently less ‘orderly’ ways. So openings often become protracted and harder work interactionally for both sides. While conversation analytic studies and communication skills textbooks represent the medical consultations as orderly, we suggest that such apparent orderliness must, at least, be partly the result of ironing out linguistic and cultural diversity. Interactional sociolinguistic analysis is used to shed light on the design of these routines and to provide analytic frameworks for doctors in reflecting on their own practice in ways which challenge patient-centred models.

July 27, 2005

Journalists and jabs: Media coverage of the MMR vaccine

Tammy Speers, Justin Lewis

Page range: 171-181

Abstract

The MMR vaccine became front-page news in early February 2002, in a much reported controversy about alleged links between MMR and autism. We examine both media content and public opinion and knowledge to explore how this controversy was presented, and, in turn, how this coverage influenced public perceptions. The news coverage of MMR was monitored over a seven and a half month period from 28 January to 15 September, 2002. Two national surveys were conducted—in April and in October, 2002—both based on over 1000 face to face interviews, with the purpose of exploring what the public learned from the coverage, and how this information may have influenced attitudes towards the vaccine. We will argue that the media's critical scrutiny of those supporting MMR was not matched by a rigorous examination of the case against it, and that the public was, as a consequence, often misinformed about the level of risk involved.

July 27, 2005

Helping people assess the health risks from lifestyle choices: Comparing a computer decision aid with customized printed alternative

Patricia Wright, Steve Belt, Chris John

Page range: 183-192

Abstract

Decisions about lifestyle play a key role in influencing health. Illnesses such as heart disease result from combinations of factors, making it hard for people to evaluate alternatives (e.g., knowing how much exercise might give similar benefit to eating more fruit and vegetables). Computers can provide customized risk leaflets and interactive displays, which may encourage people to explore potential lifestyle changes by showing the consequences for future health of specific combinations of lifestyle changes. This empirical study invited 24 adult volunteers to use the information from a customized leaflet or interactive display to advise hypothetical patients about lifestyle changes. Advisers used both leaflet and computer for different patients, with order counterbalanced across volunteers. It was found that more combinations of lifestyle factors were explored with the interactive display, especially by the younger volunteers, without this taking more time. Most of the older volunteers preferred interacting with the computer, and rated it as easier to use than the leaflet. It is concluded that easy to use computer interfaces can be devised that help people explore the health consequences of personal decisions about lifestyle, and that people prefer interactive assistance rather than using printed alternatives.

July 27, 2005

Telling the truth about genomics

Ruth Chadwick

Page range: 193-199

Abstract

Issues about communication in genomics have moved out of the clinic and into the public arena. Scientists other than clinicians are confronted by calls for public engagement. Genomics gives rise to these demands partly because it inevitably raises the three basic questions of philosophy as outlined by Kant: What can I know? What ought I to do? What may I hope? Genomics on its own cannot answer these questions. In relation to what can be known, its answer is at best partial. Nor can the ought question be settled by science. In fact, science is criticized for reducing options while claiming to be neutral in the pursuit of knowledge. The answer to the ought question is crucially related to the hope question in so far as this deals with issues about the point of human life generally. The role of public engagement in relation to all these questions may have different objectives. It is argued that there is more of a place for it in relation to the hope question than is commonly recognized, and in particular with regard to the role of science, which could benefit from developing a service ideal in the sense found in discussions of professional ethics.

July 27, 2005

Index of articles in Volume 1 (2004)

Page range: 201-201

About this journal

This journal has ceased publication.