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This thesis focuses on optimizing information provision in memory clinics, especially during consultations where amyloid test results are shared with individuals diagnosed with Mild Cognitive Impairment (MCI). In the first part of the thesis, the informational needs of patients and care partners visiting memory clinics were assessed. A three-round Delphi consensus study involving 80 memory clinic professionals, 66 patients, and 76 care partners identified 25 key topics to discuss during the diagnostic process, including diagnostic testing, test results, diagnosis, and practical implications. The study revealed that patients and care partners placed higher importance on understanding dementia risk and distinguishing between Alzheimer’s disease and dementia compared to health care professionals. These topics were used to create educational resources, including animation videos and a question prompt list, to better prepare patients and care partners for consultations. Subsequent research analyzed the extent to which these topics were actually discussed in clinical practice. An observational study of 174 audio-recorded consultations from eight memory clinics found that only about half of the identified topics were covered, with discussions about diagnosis and prognosis being the least frequent. These discussions were rarely initiated by patients or care partners. The study suggests that providing patients and care partners with a topic list before consultations could encourage more active participation and ensure that crucial topics are addressed. The thesis also explored the motivations of patients and their care partners for visiting memory clinics. Surveys and consultations revealed that while most patients sought to determine the cause of their symptoms or confirm/exclude dementia, about 20% had other motivations, such as seeking additional information or access to care. However, these motivations were often not expressed during consultations, highlighting the need

In dieser Arbeit wird untersucht, wie der Ansatz der korpusgestützten Diskursanalyse (CADS) genutzt werden kann, um Repräsentationen von Geschlecht sowie mögliche geschlechtsspezifische Asymmetrien in einem großen Korpus deutscher medizinischer Befunde zu untersuchen. Zu diesem Zweck wurde im Rahmen eines interdisziplinären Projekts zwischen der Universität Innsbruck und der Medizinischen Universität Innsbruck das linguistisch annotierte MedCorpInn-Korpus erstellt. Dieses Korpus besteht aus mehr als 5 Millionen schriftlichen radiologischen Befunden und kann nun zur Erforschung geschlechtermedizinischer sowie linguistischer Fragestellungen herangezogen werden. Die Texte repräsentieren das diskursive Geschehen im klinik-internen Alltag zwischen Radiolog*innenen und zuweisenden Ärzt*innen, stellen jedoch gleichzeitig auch juristische Dokumente dar, welche bildgebende Verfahren wie Röntgen, CT, MRT oder Sonographie protokollieren. Da medizinische Befunde bisher nur am Rande sprachwissenschaftlich untersucht wurden, werden verschiedene text- und korpuslinguistische Analysen durchgeführt, um Besonderheiten dieser zunehmend standardisierten Textsorte herauszustellen. Darüber hinaus werden die Daten mit Hilfe einer CADS-Methodik mit dem Fokus auf Sprache und Geschlecht (d.h. Repräsentationen von Geschlecht und potentielle Gender Bias) untersucht: Gibt es subtile Unterschiede und/oder Gemeinsamkeiten zwischen Berichten über Patientinnen vs. Patienten? Inwieweit werden Frauen und Männer in der klinischen Befundung ähnlich und unterschiedlich dargestellt? Wie wird über PatientInnen gesprochen und welche Informationen werden hervorgehoben und warum? Weisen bestimmte Sprachgebrauchsmuster möglicherweise auf geschlechtsspezifische Biases hin? Mit korpuslinguistischen Methoden (u.a. Keyness, Kollokation, Konkordanz) werden potenziell interessante Elemente isoliert und mit der Hilfe eines diskurs- und genderlinguistischen Analyserahmens interpretiert. Diese Kombination von sogenann, This thesis explores how a Corpus-Assisted Discourse Studies (CADS) approach can be utilized to investigate representations of gender as well as potential gender bias in a large corpus of German radiology reports. For this purpose, the linguistically annotated MedCorpInn corpus was compiled within an interdisciplinary project between the University of Innsbruck and Innsbruck Medical University. This corpus consists of more than 5 million written radiology reports and can now be used to research gender medicinal as well as linguistic questions. The texts represent discursive events in everyday clinical internal practice between radiologists and referring doctors while also being legal records documenting imaging procedures such as X-ray, CT, MRI or sonography. As medical reports only been marginally studied from a linguistic viewpoint, various text and corpus linguistic analyses are conducted in order to highlight specific features of this standardized text type. Furthermore, the data are investigated by using a CADS methodology with a focus on language and gender (i.e. representations of gender and potential gender bias): Are there subtle differences and/or similarities between reports on female vs. on male patients? To what extent are women and men discussed similarly and differently in internal clinical radiology reporting? How are patients talked about and which information is made salient and why? Do certain language use patterns possibly indicate gender biases? Corpus linguistic methods (keyness, collocation, concordance) are used to isolate items of potential interest, which are interpreted within a Discourse and Gender Linguistics framework. This combination of so-called quantitative and qualitative methods in the study of language use aims to broaden the current methodological framework of Critical Medical Humanities and to generate new impulses for interdisciplinary and gender medicinal questions., Karoline Irschara, MA, in englischer Sprache, Dissertation Universität Innsbruck 2023

The paper focuses on strategies of creating proximity in multimodal online communication. Based on the case study of a popular Polish YouTube medical channel (i.e. Najprościej mówiąc), the analysis examined how, relying on different modes of communication, the authors establish a relationship with the audience and how they create and display their identity and their position on the issues discussed. It was also the aim to determine whether the socio-cultural context of communication and the national identity of the YouTubers influences the construction of proximity. To uncover these aspects the study drew on the concept of proximity as introduced and defined by Hyland (2010). The results show a diversity of multimodal strategies of establishing proximity along five facets of organisation, argument, credibility, stance, and engagement. The original classification into the proximities of commitment and membership was extended to include a third type, i.e. the proximity of experience, which involves the demonstration of communality with and knowledge of the immediate socio-cultural context of communication., Článek se zabývá strategiemi vytváření blízkosti v multimodální online komunikaci. Cílem analýzy populárního polského YouTube kanálu se zdravotní tématikou je zmapovat, jak autoři budují vztah se svým publikem a jak vyjadřují svůj postoj k řešeným problémům. Článek se dále zaměřuje na roli socio-kulturního kontextu komunikace a národní identity youtuberů při vytváření proximity. Výsledky analýzy poukazují na diverzitu multimodálních strategií používaných při vytváření blízkosti a důležitost společného socio-kulturního prostředí.

Many physicians in Germany and the German-speaking part of Switzerland have been recruited from abroad or migrated to German-speaking countries. While studies on trained doctors with a migration background exist with regard to English-speaking countries, international medical doctors and psychologists who use (L2) German as their professional medium are underresearched. Based on a corpus of guideline-driven, semi-narrative interviews with international physicians and psychologists in German as a foreign or second language, the present study explores how these ‘international doctors’ working in a foreign healthcare environment linguistically reflect adjustment processes in their professional identities. Excerpts from interviews are analysed linguistically regarding speech actions that reflect adjustment processes. Finally, they are compared against a model of professional identity readjustment (Hohenstein & Lévy-Tödter, 2020) that allows them to be seen as a series of steps in developing a multilingual-intercultural, international professionalism.

The paper focuses on strategies of creating proximity in multimodal onlinecommunication. Based on the case study of a popular Polish YouTube medicalchannel (Najprościejmówiąc), the analysis examined how, relying on differentmodes of communication, the authors establish a relationship with the audienceand how they create and display their identity and their position on the issuesdiscussed. It was also the aim to determine whether the socio-cultural context ofcommunication and the national identity of the YouTubers influences theconstruction of proximity. To uncover these aspects, the study drew on theconcept of proximity as introduced and defined by Hyland (2010). The resultsshow a diversity of multimodal strategies of establishing proximity along thefacets of organisation, argument, credibility, stance, and engagement. Theoriginal classification into the proximities of commitment and membership wasextended to include a third type, i.e. the proximity of experience, which involvesthe demonstration of communality with and knowledge of the immediate socio-cultural context of communication, El artículo trata sobre las estrategias utilizadas para crear proximidad en la comunicación multimodal en línea. A partir del análisis de un conocido canal médico polaco en YouTube (Najprościejmówiąc), se ha comprobado de que manera, mediante diferentes modalidades, los autores crean una relación con su audiencia y cómo crean y expresan su identidad y actitud frente a los temas tratados. Otro de los objetivos ha sido determinar si el contexto sociocultural dela comunicación y la identidad nacional de los usuarios de YouTube determinan la forma de crear proximidad. El análisis de los aspectos mencionados se ha basado en el concepto de proximidad definido por Hyland (2010). Los resultados muestran una variedad de estrategias multimodales utilizadas para crear proximidad en función de la dimensión organizativa, la argumentación, la credibilidad, los indicadores de actitud y el compromiso por parte del receptor. La clasificación original, que distingue la proximidad a la comunidad y la proximidad al mensaje, ha sido completada con un tercer tipo, es decir, la proximidad a la experiencia, que abarca la expresión del sentido de comunidad y el conocimiento del contexto sociocultural de la comunicación.

Individuals with intersex variations fall outside the normative sex binary of male and female for various reasons. These individuals are highly stigmatized and discriminated against in the legal, medical and social spheres. In this paper, we analyze manifestations of such discrimination in the healthcare context and hypothesize that Patient Centred Care (PCC) and Shared Decision Making (SDM) approaches are improperly practiced with intersex individuals. Through a narrative review of current literature, we present evidence of improper practice of PCC and SDM and its effects on intersex individuals and, in the pediatric context, their parents. Misinformation by medical practitioners to parents of intersex individuals promotes the perpetuation of unnecessary surgical interventions. We propose strategies to improve intersex medical care, including better adherence to SDM and PCC guidelines as well as the sociocultural normalisation of intersex identity. Current perceptions of surgical interventions done on intersex infants and children need to better align with evidence-based physical and psychological health risks. All these strategies are part of preserving the autonomy and physical integrity of intersex individuals and ensuring that their well-being remains at the heart of their care in the medical context., Les personnes présentant des variations intersexuelles se situent en dehors du binaire sexuel normatif homme/femme pour diverses raisons. Ces personnes sont fortement stigmatisées et discriminées dans les sphères juridiques, médicale et sociale. Dans cet article, nous analysons les manifestations de cette discrimination dans le contexte des soins de santé et nous émettons l’hypothèse que les approches de soins centrés sur le patient (SCP) et de prise de décision partagée (PDP) sont mal pratiquées avec les personnes intersexuées. Un examen narratif de la littérature actuelle permet de présenter les preuves d’une pratique inadéquate des SCP et de la PDP, ainsi que leurs répercussions sur les personnes intersexuées et, dans le contexte pédiatrique, sur leurs parents. La désinformation des parents de personnes intersexuées par les praticiens médicaux favorise la perpétuation d’interventions chirurgicales inutiles. Nous proposons des stratégies pour améliorer les soins médicaux aux personnes intersexuées, notamment une meilleure adhésion aux directives de la SCP et du PDP ainsi que la normalisation socioculturelle de l’identité intersexuée. Les perceptions actuelles des interventions chirurgicales pratiquées sur les nourrissons et les enfants intersexués doivent mieux correspondre aux risques pour la santé physique et psychologique fondés sur des preuves. Toutes ces stratégies s’inscrivent dans le cadre de la préservation de l’autonomie et de l’intégrité physique des personnes intersexuées et de la garantie que leur bien-être reste au cœur de leur prise en charge dans le contexte médical.

This volume is the first to address multilingual healthcare communication around the globe and focuses on institutional, social and linguistic challenges and resources of the healthcare industry. It comprises studies from Canada, Australia, South Africa, Greenland, Italy, Germany, Switzerland and Belgium, and aims to introduce new paths of communicative and methodological agendas, casting a critical view on current linguistic practices in healthcare, nursing and medical interactions. With increased personal mobility in a global society, the need for multilingual staff is on the rise in medical institutions and healthcare organisations, and communicative competencies and practices involving different languages pose challenges for medical doctors, healthcare staff and patients alike. Many studies have highlighted the crucial role played by interpreters and interpreting staff, but the diversity of language situations in different countries requires very different approaches and solutions. Additionally, it may not be possible to develop a single agenda of language services for different medical areas with different needs for counselling, with various forms of treatment that require explanation and the patient‘s informed consent and with varying approaches to the relationship between medical professionals and patients. How to best organise medical (digital) language services in countries as different as South Africa, Greenland, Germany, Belgium and Australia calls for a diversity of possible solutions. The current volume makes a variety of such solutions and practices available for medical staff and healthcare institutions faced with international patients and working with international medical staff. It makes the challenges palpable on an international scale in a way that comparisons may be drawn between different solutions as well as their socio-cultural and institutional implications. This volume is intended for policy makers, medical and healthcare practitioners, ins

Els professionals de la salut disposen d’un gènere per a narrar les experiències clíniques dels seus pacients, amb finalitats didàctiques i de recerca. És el cas clínic (CC), un tipus de relat altament especialitzat i amb unes característiques retòriques específiques. Com que no es tracta d’articles d’investigació canònics, els CC havien quedat relegats a un rol secundari en les revistes científiques tradicionals. Tanmateix, estan adquirint una presència creixent en les revistes electròniques. A més, són molt utilitzats en la formació dels futurs professionals sanitaris. Per tant, qualsevol comunitat lingüística que aspiri a normalitzar la seva llengua haurà de procurar que estigui present també en aquest gènere. A partir de la revisió d’un corpus de CC de l’àmbit de la salut mental, en aquest article ens acostem a les característiques dels CC en català, observem la vitalitat que tenen i aportem algunes propostes per millorar la contribució d’aquest gènere a la difusió de la llengua catalana en l’àmbit de les ciències de la salut.Paraules clau: comunicació mèdica, gèneres discursius, cas clínic, català en les ciències de la salut, usos lingüístics, salut mental., Healthcare professionals have a genre at their disposal to narrate the clinical experiences of their patients for didactic or research purposes. This genre is the clinical case report (CCR), a type of highly specialized narrative with specific rhetorical features. Because they are not canonical research articles, CCRs had been relegated to a secondary role in traditional scientific journals. However, they are now acquiring a growing presence in online journals. In addition, they are widely used in the training of future healthcare professionals. Therefore, any language community that aspires to reverse language shift should ensure that it is also present in this genre. Based on the revision of a CCR corpus in the field of mental health, in this paper we discuss the characteristics of CCRs in Catalan and their vitality, and we make some suggestions for improving the contribution of this genre to the dissemination of the Catalan language in health sciences.Keywords: medical communication, discursive genres, clinical case report, Catalan in health sciences, language uses, mental health.

This volume is the first to address multilingual healthcare communication around the globe and focuses on institutional, social and linguistic challenges and resources of the healthcare industry. It comprises studies from Canada, Australia, South Africa, Greenland, Italy, Germany, Switzerland and Belgium, and aims to introduce new paths of communicative and methodological agendas, casting a critical view on current linguistic practices in healthcare, nursing and medical interactions. With increased personal mobility in a global society, the need for multilingual staff is on the rise in medical institutions and healthcare organisations, and communicative competencies and practices involving different languages pose challenges for medical doctors, healthcare staff and patients alike. Many studies have highlighted the crucial role played by interpreters and interpreting staff, but the diversity of language situations in different countries requires very different approaches and solutions. Additionally, it may not be possible to develop a single agenda of language services for different medical areas with different needs for counselling, with various forms of treatment that require explanation and the patient‘s informed consent and with varying approaches to the relationship between medical professionals and patients. How to best organise medical (digital) language services in countries as different as South Africa, Greenland, Germany, Belgium and Australia calls for a diversity of possible solutions. The current volume makes a variety of such solutions and practices available for medical staff and healthcare institutions faced with international patients and working with international medical staff. It makes the challenges palpable on an international scale in a way that comparisons may be drawn between different solutions as well as their socio-cultural and institutional implications. This volume is intended for policy makers, medical and healthcare practitioners, ins

Purpose – This paper aims to check whether the bodily self-perception factor plays any role in (female) migrants’ alleged underuse of health services. Out of the four main reasons identified by scholars, the “cultural specificity” factor is tackled here from an intersectional perspective that envisages gender, migration and totalitarianism. Design/methodology/approach – A survey was conducted on 20 Romanian women living in Spain. Two categories were analysed (body as image and body as discourse) to detect perceptions in consultations in Spain as compared to Romania. The assumption that their perceptions varied between the period prior and subsequent to the fall of the dictatorship was contrasted with the information provided by a sample of 25 Spanish women. Findings – The analysis revealed perceptions of a more relaxed medical relationship for Romanian patients in Spain, hence the possibility that migration (normally stressful) gave them a sense of freedom and empowerment. Originality/value – The intersectional perspective in health communication is original. This study opens a research avenue in health services’ underuse by migrants.

Purpose – This paper aims to check whether the bodily self-perception factor plays any role in (female) migrants’ alleged underuse of health services. Out of the four main reasons identified by scholars, the “cultural specificity” factor is tackled here from an intersectional perspective that envisages gender, migration and totalitarianism. Design/methodology/approach – A survey was conducted on 20 Romanian women living in Spain. Two categories were analysed (body as image and body as discourse) to detect perceptions in consultations in Spain as compared to Romania. The assumption that their perceptions varied between the period prior and subsequent to the fall of the dictatorship was contrasted with the information provided by a sample of 25 Spanish women. Findings – The analysis revealed perceptions of a more relaxed medical relationship for Romanian patients in Spain, hence the possibility that migration (normally stressful) gave them a sense of freedom and empowerment. Originality/value – The intersectional perspective in health communication is original. This study opens a research avenue in health services’ underuse by migrants.

Knee osteoarthritis, the most common form of arthritis, which results in stiffness, pain, and impaired movement, is a major cause of disability in elderly populations around the globe. In the course of treating this disease, patients have to endure enormous pains travel to hospitals to meet medical professionals. The motivation behind this project is to support those patients with limited physical mobility to travel fewer times to the hospital but still, communicate well with doctors and nurses. The goal is to build a VR clinic that simulates the real consultation room and facilities in the hospital. An ethnographic study was conducted at a local hospital in Delft to map the patient treatment journey from the first consultation meeting to the last meetings after surgery. The patient education part of the patient journey was chosen as the focus of this thesis since it involves most of the patient-nurse communications compared to other parts of the journey. Based on the results of the ethnographic study, a social VR clinic was designed and implemented to assist the nurse in explaining the treatment process, and to show the anatomy models and the surgery room to the patient. The main contribution of this thesis is the design and evaluation of a social VR clinic, based on the use case of knee pain treatment. Future research can expand the consultation to other diseaseses, explore the impact of using more realistic avatars on the VR clinal experience. Other perspectives can be probed into to describe user portraits on their attitude of having VR consultations., Design for Interaction

This thesis investigates the communicative work, organization and conduct of the participants in hospital bedside consultations occurring during daily ward round visits. Four research questions focusing on what happens during different phases of the bedside consultation and how these phases are organized as a whole, are the vehicle for the investigation. This structurally-based analysis shows how a distinctive set of constraints and imperatives are made relevant in the organization and conduct of the bedside consultation and distinguish it from other kinds of medical consultation. Videotaped data from 48 bedside consultations recorded at an Australian hospital is analyzed using a combination of Conversation Analysis (CA) - style qualitative analysis and basic quantification. The thesis finds that participants in this under-studied setting encounter distinctive communication challenges and that these challenges are reflected in correspondingly distinctive activities and practices not found in other types of medical consultation. These findings contribute to our understanding of medical communication and have implications for medical education and the provision of optimal care for a group of uniquely vulnerable patients.

Knee osteoarthritis, the most common form of arthritis, which results in stiffness, pain, and impaired movement, is a major cause of disability in elderly populations around the globe. In the course of treating this disease, patients have to endure enormous pains travel to hospitals to meet medical professionals. The motivation behind this project is to support those patients with limited physical mobility to travel fewer times to the hospital but still, communicate well with doctors and nurses. The goal is to build a VR clinic that simulates the real consultation room and facilities in the hospital. An ethnographic study was conducted at a local hospital in Delft to map the patient treatment journey from the first consultation meeting to the last meetings after surgery. The patient education part of the patient journey was chosen as the focus of this thesis since it involves most of the patient-nurse communications compared to other parts of the journey. Based on the results of the ethnographic study, a social VR clinic was designed and implemented to assist the nurse in explaining the treatment process, and to show the anatomy models and the surgery room to the patient. The main contribution of this thesis is the design and evaluation of a social VR clinic, based on the use case of knee pain treatment. Future research can expand the consultation to other diseaseses, explore the impact of using more realistic avatars on the VR clinal experience. Other perspectives can be probed into to describe user portraits on their attitude of having VR consultations., Design for Interaction

von Karoline Irschara, BA, Universität Innsbruck, Masterarbeit, 2018, (VLID)2403574

In the globalization and migration era, the paternalistic model in healthcare is affected by a new direction giving way to patient prominence and, therefore, activation. The diversity of patients in the Spanish medical consultations involves different communicative scenarios in which the medical interpreter and translator plays a crucial role as for example the delivery of documents addressed to the patient in the medical consultation with foreign patients. In this paper, we integrate research in informed consent from readability and comprehensibility. A qualitative and quantitative study on how professional dentists perceive the interpreters’ role is carried out. The needs of a sample of native and foreign patients as users are also covered., En esta era de globalización y migración, el modelo sanitario paternalista se ve afectado por un nuevo rumbo donde el paciente también adquiere protagonismo y, por ende, un papel activo. La diversidad de pacientes que acuden cada día a los centros sanitarios españoles comporta distintos escenarios comunicativos para los que la figura del traductor e intérprete médico ocupa un papel fundamental. Uno de estos escenarios es la entrega de documentos dirigidos a pacientes en la consulta médica con pacientes extranjeros. El presente trabajo revisa las líneas de investigación del consentimiento informado desde la legibilidad y la comprensibilidad. Se presenta un estudio cualitativo y cuantitativo sobre la percepción de los odontólogos profesionales del papel del intérprete y las necesidades de una muestra de pacientes autóctonos y extranjeros como receptores.

Ärztemangel führte in Deutschland und der Schweiz zu internationalen Rekrutierungen und Ärztemigration. Seit 2012 haben in der Schweiz jährlich mehr als 50% der neu akkreditierten Fachärzte ihr Diplom und ihre postgraduale Spezialisierung im Ausland erworben. Berichte über Kommunikationsprobleme (z. B. fremder Akzent, fehlender spezifischer Wortschatz, fehlende sprachliche Handlungsmuster) führten in der Schweiz u. a. zu politischen Massnahmen, um die Zahl der im Inland ausgebildeten Medizinerinnen und Mediziner zu erhöhen. Eine kritische Neubewertung auch der ethischen Aspekte von Ärztemigration steht noch am Anfang. Nicht beforscht wurde bislang, welche Auswirkungen sie auf das professionelle Selbstbild von Ärzten und Ärztinnen hat. Welche Rolle spielen Sprache und sprachliche Reflexion bei der Anpassung einer "mehrsprachigen beruflichen Identität"? Ärztinnen und Ärzte, Psychologen und Therapeutinnen, die in einem Land praktizieren, das nicht ihr Herkunftsland ist, in dem sie als „Ausländer“ oder als Mensch mit Migrationshintergrund angesehen werden, und die in der Arzt-Patienten-Kommunikation bzw. der Therapeuten-Klienten-Kommunikation entweder die Sprache des Patienten/ der Klientin als L2 oder eine gemeinsame Lingua Franca (z. B. Englisch) verwenden, können als ‚international doctors’ bezeichnet werden. Sie treten als ausgebildete medizinische Fachleute in eine neue Sprachgemeinschaft und Gesellschaft ein und haben fortan ein allophones oder mehrsprachiges Arbeitsumfeld, in dem eine andere Sprache als ihre L1 Arbeits- und Amtssprache ist. Da die Entwicklung einer "beruflichen Identität" als Teil des Ausbildungsprozesses zum Arzt angesehen wird, stellt sich die Frage, welche Veränderungen des ‚professional self’ diese grosse Gruppe von “international doctors” durch das Arbeiten in einer L2 erfährt. Die qualitative Studie basiert auf Interviews mit Ärztinnen und Ärzten, Psychologinnen und Therapeuten, die in Deutschland und der deutschsprachigen Schweiz mehrsprac

En esta era de globalización y migración, el modelo sanitario paternalista se ve afectado por un nuevo rumbo donde el paciente también adquiere protagonismo y, por ende, un papel activo. La diversidad de pacientes que acuden cada día a los centros sanitarios españoles comporta distintos escenarios comunicativos para los que la figura del traductor e intérprete médico ocupa un papel fundamental. Uno de estos escenarios es la entrega de documentos dirigidos a pacientes en la consulta médica con pacientes extranjeros. El presente trabajo revisa las líneas de investigación del consentimiento informado desde la legibilidad y la comprensibilidad. Se presenta un estudio cualitativo y cuantitativo sobre la percepción de los odontólogos profesionales del papel del intérprete y las necesidades de una muestra de pacientes autóctonos y extranjeros como receptores., In the globalization and migration era, the paternalistic model in healthcare is affected by a new direction giving way to patient prominence and, therefore, activation. The diversity of patients in the Spanish medical consultations involves different communicative scenarios in which the medical interpreter and translator plays a crucial role as for example the delivery of documents addressed to the patient in the medical consultation with foreign patients. In this paper, we integrate research in informed consent from readability and comprehensibility. A qualitative and quantitative study on how professional dentists perceive the interpreters’ role is carried out. The needs of a sample of native and foreign patients as users are also covered.

La comunicación en el ámbito médico-sanitario necesita una mayor revisión. Los resultados obtenidos a partir de distintos estudios realizados entre 2014 y 2016 contribuyen al desarrollo de herramientas para mejorar la competencia comunicativa y el trabajo en equipo entre profesionales sanitarios e intérpretes. Los ejes que vertebran los estudios están relacionados con aspectos lingüísticos, socioculturales y con las condiciones en las que tienen lugar los encuentros triádicos (médico-paciente-intérprete) puesto que son una fuente de conflictos. La hipótesis que se pretende verificar es la necesidad de una fase de contacto previa entre el intérprete y el profesional sanitario como primer paso para la resolución de conflictos, la mejora de los resultados de las consultas interpretadas y el aumento de la calidad asistencial. El estudio de estos componentes permite aumentar la legibilidad y comprensión de la información especializada., Communication in the medical-health field needs a wider review. The results obtained from the studies conducted during 2014 and 2016 contribute to the development of tools to improve the communicative competence and the cooperation between healthcare professionals and interpreters. The main axes of this piece of research are the linguistic and sociocultural aspects as well as conditions of the triadic encounters (doctor-patient-interpreter) understood as a source of conflict. The aim of these studies is to verify the thesis that a previous briefing session between the interpreter and the healthcare professional is needed as a first step to solve a conflict, improve the interpreting consultations and healthcare quality. The study of these factors may enhance readability and comprehension of specialized information.

In the globalization and migration era, the paternalistic model in healthcare is affected by a new direction giving way to patient prominence and, therefore, activation. The diversity of patients in the Spanish medical consultations involves different communicative scenarios in which the medical interpreter and translator plays a crucial role as for example the delivery of documents addressed to the patient in the medical consultation with foreign patients. In this paper, we integrate research in informed consent from readability and comprehensibility. A qualitative and quantitative study on how professional dentists perceive the interpreters’ role is carried out. The needs of a sample of native and foreign patients as users are also covered., En esta era de globalización y migración, el modelo sanitario paternalista se ve afectado por un nuevo rumbo donde el paciente también adquiere protagonismo y, por ende, un papel activo. La diversidad de pacientes que acuden cada día a los centros sanitarios españoles comporta distintos escenarios comunicativos para los que la figura del traductor e intérprete médico ocupa un papel fundamental. Uno de estos escenarios es la entrega de documentos dirigidos a pacientes en la consulta médica con pacientes extranjeros. El presente trabajo revisa las líneas de investigación del consentimiento informado desde la legibilidad y la comprensibilidad. Se presenta un estudio cualitativo y cuantitativo sobre la percepción de los odontólogos profesionales del papel del intérprete y las necesidades de una muestra de pacientes autóctonos y extranjeros como receptores.

En esta era de globalización y migración, el modelo sanitario paternalista se ve afectado por un nuevo rumbo donde el paciente también adquiere protagonismo y, por ende, un papel activo. La diversidad de pacientes que acuden cada día a los centros sanitarios españoles comporta distintos escenarios comunicativos para los que la figura del traductor e intérprete médico ocupa un papel fundamental. Uno de estos escenarios es la entrega de documentos dirigidos a pacientes en la consulta médica con pacientes extranjeros. El presente trabajo revisa las líneas de investigación del consentimiento informado desde la legibilidad y la comprensibilidad. Se presenta un estudio cualitativo y cuantitativo sobre la percepción de los odontólogos profesionales del papel del intérprete y las necesidades de una muestra de pacientes autóctonos y extranjeros como receptores., In the globalization and migration era, the paternalistic model in healthcare is affected by a new direction giving way to patient prominence and, therefore, activation. The diversity of patients in the Spanish medical consultations involves different communicative scenarios in which the medical interpreter and translator plays a crucial role as for example the delivery of documents addressed to the patient in the medical consultation with foreign patients. In this paper, we integrate research in informed consent from readability and comprehensibility. A qualitative and quantitative study on how professional dentists perceive the interpreters’ role is carried out. The needs of a sample of native and foreign patients as users are also covered.

La comunicación en el ámbito médico-sanitario necesita una mayor revisión. Los resultados obtenidos a partir de distintos estudios realizados entre 2014 y 2016 contribuyen al desarrollo de herramientas para mejorar la competencia comunicativa y el trabajo en equipo entre profesionales sanitarios e intérpretes. Los ejes que vertebran los estudios están relacionados con aspectos lingüísticos, socioculturales y con las condiciones en las que tienen lugar los encuentros triádicos (médico-paciente-intérprete) puesto que son una fuente de conflictos. La hipótesis que se pretende verificar es la necesidad de una fase de contacto previa entre el intérprete y el profesional sanitario como primer paso para la resolución de conflictos, la mejora de los resultados de las consultas interpretadas y el aumento de la calidad asistencial. El estudio de estos componentes permite aumentar la legibilidad y comprensión de la información especializada., Communication in the medical-health field needs a wider review. The results obtained from the studies conducted during 2014 and 2016 contribute to the development of tools to improve the communicative competence and the cooperation between healthcare professionals and interpreters. The main axes of this piece of research are the linguistic and sociocultural aspects as well as conditions of the triadic encounters (doctor-patient-interpreter) understood as a source of conflict. The aim of these studies is to verify the thesis that a previous briefing session between the interpreter and the healthcare professional is needed as a first step to solve a conflict, improve the interpreting consultations and healthcare quality. The study of these factors may enhance readability and comprehension of specialized information.

Ärztemangel führte in Deutschland und der Schweiz zu internationalen Rekrutierungen und Ärztemigration. Seit 2012 haben in der Schweiz jährlich mehr als 50% der neu akkreditierten Fachärzte ihr Diplom und ihre postgraduale Spezialisierung im Ausland erworben. Berichte über Kommunikationsprobleme (z. B. fremder Akzent, fehlender spezifischer Wortschatz, fehlende sprachliche Handlungsmuster) führten in der Schweiz u. a. zu politischen Massnahmen, um die Zahl der im Inland ausgebildeten Medizinerinnen und Mediziner zu erhöhen. Eine kritische Neubewertung auch der ethischen Aspekte von Ärztemigration steht noch am Anfang. Nicht beforscht wurde bislang, welche Auswirkungen sie auf das professionelle Selbstbild von Ärzten und Ärztinnen hat. Welche Rolle spielen Sprache und sprachliche Reflexion bei der Anpassung einer "mehrsprachigen beruflichen Identität"? Ärztinnen und Ärzte, Psychologen und Therapeutinnen, die in einem Land praktizieren, das nicht ihr Herkunftsland ist, in dem sie als „Ausländer“ oder als Mensch mit Migrationshintergrund angesehen werden, und die in der Arzt-Patienten-Kommunikation bzw. der Therapeuten-Klienten-Kommunikation entweder die Sprache des Patienten/ der Klientin als L2 oder eine gemeinsame Lingua Franca (z. B. Englisch) verwenden, können als ‚international doctors’ bezeichnet werden. Sie treten als ausgebildete medizinische Fachleute in eine neue Sprachgemeinschaft und Gesellschaft ein und haben fortan ein allophones oder mehrsprachiges Arbeitsumfeld, in dem eine andere Sprache als ihre L1 Arbeits- und Amtssprache ist. Da die Entwicklung einer "beruflichen Identität" als Teil des Ausbildungsprozesses zum Arzt angesehen wird, stellt sich die Frage, welche Veränderungen des ‚professional self’ diese grosse Gruppe von “international doctors” durch das Arbeiten in einer L2 erfährt. Die qualitative Studie basiert auf Interviews mit Ärztinnen und Ärzten, Psychologinnen und Therapeuten, die in Deutschland und der deutschsprachigen Schweiz mehrsprac

This paper describes a communication practice called "online commentary" that is in widespread use in primary care in the USA. Online commentary is talk by a clinician that describes what he or she is finding in the course of the physical examination of the patient. The paper reviews the primary features of online commentary, with a special focus on its role in forecasting the likely results of the physical examination during the examination itself. It also describes patient outcomes that are associated with this use. It then uses data from an emergency room in the western USA to extend the notion of online commentary from primary care to the emergency setting. It proposes that online commentary facilitates effective teamwork by forecasting next actions, allowing members of the emergency team to anticipate probable next steps in the investigation and treatment of patient injuries.

This paper describes a communication practice called "online commentary" that is in widespread use in primary care in the USA. Online commentary is talk by a clinician that describes what he or she is finding in the course of the physical examination of the patient. The paper reviews the primary features of online commentary, with a special focus on its role in forecasting the likely results of the physical examination during the examination itself. It also describes patient outcomes that are associated with this use. It then uses data from an emergency room in the western USA to extend the notion of online commentary from primary care to the emergency setting. It proposes that online commentary facilitates effective teamwork by forecasting next actions, allowing members of the emergency team to anticipate probable next steps in the investigation and treatment of patient injuries.

BACKGROUND AND OBJECTIVES: Handoff protocols are often developed by brainstorming and consensus, and few are directly compared. We hypothesized that a handoff protocol (Flex 11) developed using a rigorous methodology would be more favorable in terms of clinicians’ attitudes, behaviors, cognitions, or time-on-task when performing handoffs compared with a prevalent protocol (Situation Background Assessment Recommendation [SBAR]). METHODS: Using a between-groups, randomized control trial design (Flex 11 versus SBAR) during a pilot study in a simulated environment, 20 clinicians (13 attending physicians and 7 residents) received 3 patient handoffs from a standardized physician, managed the patients, and handed off the patients to the same standardized physician. Participants completed surveys assessing their attitudes and cognitions, and behaviors and handoff duration were assessed through observations. RESULTS: All data were analyzed using independent samples t tests. For attitudes, “ease of use” ratings were lower for SBAR participants than Flex 11 participants (P , .01), and “being helpful” ratings were lower for SBAR participants than Flex 11 participants (P 5 .02). For behaviors, results indicate no significant difference in the information acquired between the SBAR and Flex 11 protocols. However, SBAR participants gave significantly less information than Flex 11 participants (P , .01). For cognitions, SBAR and Flex 11 participants reported similar workload except for frustration. For handoff duration, there were no significant differences between the protocols (P 5 .36). CONCLUSIONS: The results suggest that Flex 11 is an efficient, beneficial tool in a simulated environment with pediatric clinicians. Future studies should evaluate this protocol in the inpatient setting.

Developmental delay (DD) has been estimated to affect 1 – 3% of the population and the underlying cause often remains unknown. For parents, receiving a diagnosis for their child’s DD can be a source of validation, and may impact upon their child’s prognosis, treatment and access to available supports. New genetic technologies, chromosomal microarrays (CMA), are now used across Australia to help end the ‘diagnostic odyssey’ families often experience. CMA tests have the capacity to identify genetic changes at much higher resolutions than was previously possible, but may increase the complexity and uncertainty of results. There is no research into the process of these consultations and the way in which this information is communicated to patients attending a genetics clinic. Using qualitative techniques and guided by the frameworks of symbolic interactionism and interactional sociolinguistics, this study provides a rich and nuanced analysis of paediatric genetic consultations. A multi-layered approach was used, enabling investigations of both the ‘front stage’ (consultations) and ‘backstage’ (interviews with parents and clinicians) to facilitate and further understand emerging patterns. Four data sources were used: (1) pre-consultation surveys with parents (n=32); (2) audio-recordings from consultations (n=32); (3) post-consultation telephone interviews with parents (n=32); and (4) post-consultation interviews with clinical geneticists (n=10). Overwhelmingly, parents were complimentary regarding consultations and described feeling reassured. Those who were disappointed were largely parents who were desperate for a diagnosis. The vast majority of parents reported a positive relationship with the clinician and felt that the genetic information had been explained in a very useful manner. Clinicians described consultations as varied and dependent on many factors including parents’ hopes and diagnostic expectations. They identified their primary role as a diagnostician but

International medical graduates moving to Australia are required to demonstrate satisfactory English language proficiency as part of the process to obtain professional registration. Concerns have been raised that language tests used for this purpose – including the Occupational English Test (OET), a specific-purpose language test for health professionals – are not sufficiently aligned to the communicative demands of the contexts in which the doctors will be working. To investigate the issue, this study sought to capture those aspects of performance in the doctor–patient consultation that the profession values by applying a thematic analysis to feedback commentary given by medical educators on trainee doctors. A model of what doctors value in the doctor–patient consultation was developed from the findings of the analysis. Consideration was then given to the extent to which the valued aspects apparent in the analysis were already reflected in the assessment criteria used in the OET Speaking sub-test and whether further aspects could be included in expanded assessment criteria. The study found that, in most cases, medical professionals focus on how the clinical task is achieved rather than on the language skills involved. Nevertheless, language is shown to be essential to an effective consultation, because the interactional tools used by doctors with their patients accomplish clinical work by linguistic means. This inseparability of content and language is at the core of specific-purpose language testing. From the study’s findings, it is proposed that the existing criteria used in the OET Speaking sub-test are supplemented with two new criteria, CLINICIAN ENGAGEMENT and MANAGEMENT OF INTERACTION, which consider the ability of the health professional – through the use of language – to demonstrate his/her awareness of the patient (patient-centredness) and to gather and give information efficiently. These elements are highly valued by participants in the study. This refoc

Effective communication between doctors and patients improves patient health outcomes (Hewett et al. 2009; Stewart 1995; Watson et al. 2012), and communication skills courses have become an integrated component of the medical curriculum. However, language-discordant contexts are not fully provided for yet, since “[l]anguage support guides (such as the Calgary- Cambridge guides; Silverman et al. 2005) generally target native speakers rather than language learners, and typically mention the use of a second or foreign language as just one of many issues in cross-cultural communication without providing any solutions or prescriptions to address ensuing communication problems” (Gasiorek and Van de Poel 2012:372). In a South African professional healthcare context, communication challenges are manifold because of the number of languages and cultures involved and because of the diverse views on the nature of a medical encounter. South African public healthcare is further hampered by a lack of doctors (KZN Department of Health 2013). Given the need for tailored communication materials, a new vocational training course in Afrikaans as a second language was introduced for first-year medical students at one South African university applying a blended learning approach (i.e. restricted contact teaching and autonomous online learning). To facilitate the development and implementation process, the European project Medics on the Move (MoM) was adapted and adopted as a communication tool. This paper addresses principles and practices underlying the MoM materials as part of the process of adapting the vocational training concept to the specific South African context, needs and learners. The development process is presented as an integral part of a comprehensive needs analysis (Brown 1995), at the end of which new questions and needs are identified. The results corroborate that MoM-SA is a dynamic and effective teaching/ learning tool which functions as a language support system that

Effective communication between doctors and patients improves patient health outcomes (Hewett et al. 2009; Stewart 1995; Watson et al. 2012), and communication skills courses have become an integrated component of the medical curriculum. However, language-discordant contexts are not fully provided for yet, since “[l]anguage support guides (such as the Calgary- Cambridge guides; Silverman et al. 2005) generally target native speakers rather than language learners, and typically mention the use of a second or foreign language as just one of many issues in cross-cultural communication without providing any solutions or prescriptions to address ensuing communication problems” (Gasiorek and Van de Poel 2012:372). In a South African professional healthcare context, communication challenges are manifold because of the number of languages and cultures involved and because of the diverse views on the nature of a medical encounter. South African public healthcare is further hampered by a lack of doctors (KZN Department of Health 2013). Given the need for tailored communication materials, a new vocational training course in Afrikaans as a second language was introduced for first-year medical students at one South African university applying a blended learning approach (i.e. restricted contact teaching and autonomous online learning). To facilitate the development and implementation process, the European project Medics on the Move (MoM) was adapted and adopted as a communication tool. This paper addresses principles and practices underlying the MoM materials as part of the process of adapting the vocational training concept to the specific South African context, needs and learners. The development process is presented as an integral part of a comprehensive needs analysis (Brown 1995), at the end of which new questions and needs are identified. The results corroborate that MoM-SA is a dynamic and effective teaching/ learning tool which functions as a language support system that

Four years old male. His mother reported that in July 2011, he was admitted in Neurosurgery service of a tertiary care hospital, with diagnosis of left-temporal arachnoid cyst; it was indicated drug treatment and the patient was discharged with an appointment to nuclear magnetic resonance (NMR), but symptoms persisted, so they went to a public pediatric hospital where a subdural peritoneal derivation system was applied to solve a subdural hematoma., Masculino de cuatro años de edad. Refirió la madre que en julio de 2011, fue ingresado a Neurocirugía de un hospital de tercer nivel de atención con el diagnóstico de quiste aracnoideo temporal izquierdo; se indicó tratamiento farmacológico y fue egresado con cita para resonancia magnética nuclear (RMN), pero ante la persistencia de los síntomas, acudió a un hospital pediátrico público donde se aplicó sistema de derivación subduroperitoneal por hematoma subdural.

International Medical Graduates (IMGs) play an important role in the Australian medical workforce and may face particular challenges due to their language, cultural background and clinical experience. Most studies of communication involving International Medical Graduates have focussed on doctor-patient encounters and there is a dearth of research into interactions with other medical colleagues. Intra-professional interactions frequently occur over the telephone and are central to managing patient-care issues. The central aims of this thesis are to identify the features of effective medical telephone consultations occurring in an intra-professional, intercultural context as well as to explore the nature of any communication difficulties in the calls. The study uses an integrated research design, drawing on qualitative analysis of feedback commentary from the participating senior doctor and genre analysis to examine the audio-recorded telephone consultations. The context is a patient safety training program in a simulation setting. Twelve telephone referrals made during the practice scenarios by a junior IMG to a more senior doctor were recorded and analysed using a genre approach informed by systemic functional linguistics. Feedback comments from the senior doctor were transcribed and analysed for recurring themes. Insights from the senior doctor highlight the many variables contributing to an effective call and the highly demanding nature of the telephone consultations. They also emphasise the similarities between IMGs and other junior doctors. Many of the calls were problematic and the findings point to the important role of professional knowledge in shaping the calls. Difficulties with the staging of the calls as well as with the interactional management of particular stages were identified. Effective calls could be understood as examples of collegial discourse whereas less effective calls typically contained instructional sequences. Problems with traditional lan

Four years old male. His mother reported that in July 2011, he was admitted in Neurosurgery service of a tertiary care hospital, with diagnosis of left-temporal arachnoid cyst; it was indicated drug treatment and the patient was discharged with an appointment to nuclear magnetic resonance (NMR), but symptoms persisted, so they went to a public pediatric hospital where a subdural peritoneal derivation system was applied to solve a subdural hematoma., Masculino de cuatro años de edad. Refirió la madre que en julio de 2011, fue ingresado a Neurocirugía de un hospital de tercer nivel de atención con el diagnóstico de quiste aracnoideo temporal izquierdo; se indicó tratamiento farmacológico y fue egresado con cita para resonancia magnética nuclear (RMN), pero ante la persistencia de los síntomas, acudió a un hospital pediátrico público donde se aplicó sistema de derivación subduroperitoneal por hematoma subdural.

Active listening in conversation is considered an important professional duty within nursing in general and in medical telephone advice service in particular. This can be accomplished in several ways, often by the use of minimal responses, such as in back channeling and short vocal feedback signals. The aim of this article is to explore the professional use of feedback signals in medical advice calls. Previous research has reported a variety of functions of feedback signals, both in professional contexts and in telephone calls, and such functions include continuers and empathic and channeling tokens. The results of my present study indicate that the feedback signals in telephone advice mainly belong to one of a number of information-oriented subtypes. Referential signals are the most frequent, but other commonly-used signals have regulatory, channeling, or phatic functions. Emotional- affective signals are also used, but to a less degree than in e.g. psychotherapy. The different functions can be distinguished and defined by prosodic features used in their production. Feedback signals usually appear at syntactic borders, except for empathic signals, which are uttered more freely. The signals seem to be part of a professional practice in which the nurse continuously and pedagogically adapts to the emergent situation and the caller. It is suggested that the form of feedback signals may be conventionalized to some degree, a finding that, however, needs to be further explored., Samtal i kris - sjukvårdsrådgivningens retorik och pragmatik

Active listening in conversation is considered an important professional duty within nursing in general and in medical telephone advice service in particular. This can be accomplished in several ways, often by the use of minimal responses, such as in back channeling and short vocal feedback signals. The aim of this article is to explore the professional use of feedback signals in medical advice calls. Previous research has reported a variety of functions of feedback signals, both in professional contexts and in telephone calls, and such functions include continuers and empathic and channeling tokens. The results of my present study indicate that the feedback signals in telephone advice mainly belong to one of a number of information-oriented subtypes. Referential signals are the most frequent, but other commonly-used signals have regulatory, channeling, or phatic functions. Emotional- affective signals are also used, but to a less degree than in e.g. psychotherapy. The different functions can be distinguished and defined by prosodic features used in their production. Feedback signals usually appear at syntactic borders, except for empathic signals, which are uttered more freely. The signals seem to be part of a professional practice in which the nurse continuously and pedagogically adapts to the emergent situation and the caller. It is suggested that the form of feedback signals may be conventionalized to some degree, a finding that, however, needs to be further explored., Samtal i kris - sjukvårdsrådgivningens retorik och pragmatik

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This study examines how professional identities are enacted in discourse; how clinicians convey their professional expertise and navigate the asymmetries that occur between expert and lay speakers in healthcare dyads. Utilising an innovative mixed-methods approach that combines corpus linguistics and discursive pragmatics with ethnography, two distinct healthcare corpora are analysed: The simulated consultations of a pedagogic training programme for general practice trainees, and the real-life consultations of primary care- based clinical pharmacists – a novel professional role that has not yet seen examination of its communicative practices. Analysis of the two datasets identifies that the GP trainees enact a performative certainty characterised by a disposition to state what ‘is’ within consultations, through realis moods, epistemic stances and commentary over contemporaneous states of affairs. Asymmetry is navigated by the trainees via recurrent strategies such as implicatures and wh-interrogative constructions previously identified as ‘invitations to input’ (Emerson et al. 2020). Examination of the clinical pharmacy data illustrates the clinical pharmacists’ utilisation of transactional irrealis constructions (characterised as ‘emphatic front staging’) to provide discursive evidence of work being concurrently undertaken, and to be undertaken in the future, for patient-centric purposes. The analysis argues that these formulations also operationalise a significant identity component, by dialogizing the remit of the new CP role and its alignment to the wider healthcare institution. Analysis of both datasets also considers how the meso-level, contextual detail apparent in each corpus effects the individual clinician’s identity performance. In line with the commitment to the collaborative, applied linguistics methodology taken, the thesis makes a number of recommendations for applied professional practice based upon the findings.