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Patient-engaging e-health is promoted as a means to improve care and change the social order of healthcare - most notably the roles of patients and healthcare professionals. Nevertheless, while researchers across various fields expect and praise such changes, these social aspects are rarely addressed rigorously in the literature on the effects of e-health. In this paper we review the scientific literature on patient-engaging e-health, with the purpose of articulating the different ways in which role is conceptualized in the various strands of literature and what explicit and implicit assumptions such conceptualizations entail. We identify three conceptualizations of the concept of role and exemplify the findings proposed by studies that apply each of these. We argue that the identified conceptual differences have implications for what is found to be at stake when using e-health to further the involvement of patients in their own care, and that a more rigorous and reflective approach to the use of concepts with rich intellectual histories, such as that of role, will improve both empirical research in e-health and discussions of implications for practice. [ABSTRACT FROM AUTHOR]

This paper argues that there are three separable but related dimensions that are important to the legal notion of consent. One is a consenting state of mind, the 'going along with' a plan of action, which may or may not be communicated or even reflected upon, but which certainly can be. A second is displaying behaviour which reveals or is an expression of consenting. Another is intentionally communicating consent. I illustrate how the communicative act is often vitally important as evidence of an underlying consenting state, but the underlying consenting state has to be postulated and brought to the fore since consensual actions (e.g. sexual intercourse) can, and more often than not do, take place without the communicative acts, and the communicative acts might for various reasons be made in the absence of the genuinely consenting state of mind. The arguments I put forward offer a reframing of cases in which an apparent intentional communication of consent was treated as consent, rather than as a piece of evidence which may or may not be indicative of a consenting state of mind. This paper emphasises that we must not allow the importance of something as evidential to eclipse the underlying phenomenon, which is itself, however hard to access otherwise, the thing of primary legal importance. [ABSTRACT FROM AUTHOR]

Nzema refers to both the language and the people who speak it. The language is spoken predominantly among the people who occupy the South-west part of the Western Region of Ghana as well as some parts of Côte d'Ivoire (Annan, 1980, 1994). Nzema forms part of the Niger-Congo Kwa language family. Many studies across languages have had their focus on the basic and extended usages of 'eat' and 'drink' (ingestion) verbs. Among such studies are Prins (1993), Newman (1997), Atintono and Adjei (2008), Aikhenvald (2009), Adjei (2013), Agyepong, Amfo and Osam (2017), and Otoo (2017). Several works, including Agyekum (2002, 2013, 2015a, 2015b, 2016) and Otoo (2018) have also examined the metaphorical extensions of human body parts and verbs of perception. In Nzema, however, studies on cultural schemas and conceptualisations are scanty. This paper, therefore, explores the basic and metaphorical interpretations of the disconnection verb, tu 'to uproot'/'to pull out' in Nzema communication. The paper relies on Conceptual Metaphor Theory (Lakoff and Johnson, 1980) with insights from 'Cultural Conceptual Metaphors' (Sharifian, 2011). Data were obtained from spontaneous natural speech contexts among the Nzema. Additional data were gathered by consulting other written sources like Nzema novels and drama books to extract some expressions involving the verb tu. Interviews with knowledgeable Indigenous speakers and my introspection as a native speaker were significantly brought to bear on this study. The paper finds that the basic sense of the verb is possibly projected to describe other abstract notions such as tu ahonle 'heart uproot' (to be afraid); tu ayε ne 'uproot witchcraft' (to drive a demon out of a person), tu belemgbunli 'uproot a chief' (to distool a chief), tu edwε kε sie (to postpone/adjourn a case), among others. The paper shows that the verb tu is 'polysemous', and can participate in causative/inchoative alternation. [ABSTRACT FROM AUTHOR]

Healthcare today increasingly involves patients using various devices to engage in different care activities and often doing so without the aid of trained healthcare professionals. This situation means patients must often use health and medical information (i.e., content) in various contexts with different dynamics. As a result, usability - or how effectively individuals can use items - becomes central to effective medical communication. Usability expectations affecting such communication dynamics are often guided by psychological processes reflecting prior healthcare experiences. Meeting these expectations involves identifying the cognitive factors influencing how individuals use materials. This conceptual paper examines how the psychological concept of 'cognitive scripts' can help address such situations. The paper also presents an approach for identifying the cognitive scripts affecting usability expectations and applying this information to create usable communication materials for healthcare contexts. [ABSTRACT FROM AUTHOR]

An editorial is presented which introduces a special issue of Communication and Medicine (C&M) that is a collection of written-up versions of presentations from the 19th COMET (Communication, Medicine, and Ethics) conference, highlighting various topics ranging from dental professionals' role perceptions to public and social media narratives about vaccination. It also discusses the longstanding relationship between the COMET conference and C&M journal.

Hospitals are facing a constantly changing context in which patients are becoming more demanding, public health education initiatives are regarded as increasingly important and hospital business models have to take account of constantly developing medical technologies. In order to better interact with internal and external stakeholders, hospitals try to reinforce their corporate communication strategies as well as their brand reputation by means that include using social media platforms. This literature review paper aims to better understand why health professionals have the potential to play a key role in hospitals' branding initiatives through social media. First, I report the findings from studies of concepts related to corporate communication, branding and the connection between social media and personal branding; and, second, I propose a communication model - what I call the PMA branding model - to help hospitals build a brand reputation based on health professionals' participation in corporate communication initiatives led by hospitals on social media. The paper concludes by showing that the PMA branding model consists of organisational tools based on a rigorous methodology that will help health professionals participate in branding initiatives led by the hospital through these platforms. [ABSTRACT FROM AUTHOR]

Effective teamwork is a critical feature of surgical practice and is based on shared expectations and understandings between team members. These shared understandings are intimately tied to a hierarchy of expertise pertaining to role, responsibility and participation status, and it has been suggested that this can sometimes negatively impact trainees' experience of intraoperative surgical training. Tis paper examines this issue, exploring how surgeons and their trainees collaboratively manage decision making amidst the hierarchy of expertise. Our data set consists of audio and video recordings of surgical procedures, which are examined using conversation analysis. Our findings indicate that implicit in the interactions between consultant surgeons and trainees is the expectation that the lead surgeon is the authoritative expert and will therefore direct decision making. Trainees actively acquiesce to that order. Notwithstanding this, the analysis underscores some of the interactional practices used by surgeons and trainees which preserve, and on rare occasions, challenge that hierarchical relation. The paper concludes by considering the implications of the findings within the broader context of patient safety. [ABSTRACT FROM AUTHOR]

This paper investigates the preference for Andalusian Spanish (second language, L2) over German (first language, L1) in bilinguals who have a lisp and do not encounter a feeling of belonging to their L1 society due to reactions such a divergent pronunciation provokes. This issue is novel due to its interdisciplinary nature within this unique language combination, and it draws particularly on the fields of speech (pathology), language preference, communication, bilingualism, phonetics, psycholinguistics and sociolinguistics. To test the hypothesis 'some bilinguals who have a lisp prefer to use Andalusian Spanish (their L2) over German (their L1) to avoid the noticeability of their speech divergence', within the boundaries of the present exploratory case study, interviews with participants were recorded. It was found that participants sacrifice the usage of their L1 in favour of their L2 in an attempt to vanish their phonetic divergence. Such a finding is important because in Andalusian Spanish the pronunciation of the/s/is significantly reduced during the conversation flow on account of many of the language's specific phonetic conventions. [ABSTRACT FROM AUTHOR]

In this paper, we compare two methodological approaches - Conversation Analysis (CA) and the Communication Deviance (CD) Scale - in detecting confusing family interaction, which is considered one of the risk factors for schizophrenia. CA is a method for identifying and describing actions in interaction, whereas the CD Scale presents the criteria for identifying communication defects in the field of schizophrenia research. Our aim is to determine whether the approaches resonate with and could complement each other in analysing the same interactional data - i.e., a total of 10.5 hours of audio-recorded Finnish family interaction in a psychological test in which the participants negotiate on mutual Rorschach inkblot interpretations. The data include 585 proposals by the family members. Here we focus on three types of proposal sequences (140 in all) where a proposal is not followed by an acceptance or a rejection. We have earlier shown that from the CA perspective, the family members orient to the discontinuity of these sequences by pursuing an explicit response to a proposal, but very rarely make the 'problematic' nature of the interaction visible to each other or the analyst. In the present paper, we will show that the CD Scale finds communication defects in the sequences under analysis but that the defects do not primarily involve the discontinuity of the sequence. Thus CA and the CD Scale look at interaction from different perspectives and disagree on what is considered an interactional problem. [ABSTRACT FROM AUTHOR]

When investigating intercultural communication in healthcare settings, interprofessional communication has received very little scholarly attention compared to doctor-patient interactions. Interactions among doctors, however, are an important locus for the organizational life of a hospital as the way these professionals communicate will promote (or hinder) professional effectiveness and efficiency. This paper presents the findings of a study that explores the perceptions concerning the degree and frequency of communicative conflict of 61 migrant doctors working in public healthcare institutions in the central region of El Maule in Chile. Drawing on data from a survey on communicative conflicts, the study analyses the perceptions of the migrant doctors in relation to one particular style of conflict management, namely, adaptability. Findings show that although communicative conflicts seem to occur only occasionally, moderate scores are reported for how such perceptions are believed to affect work performance. Also, the demands of communicative adaptability are perceived to be met largely by migrant doctors alone. The paper then offers considerations about the possible impact that these adaptability efforts could have on migrant doctors' integration processes. [ABSTRACT FROM AUTHOR]

Objective: To use a discourse analysis approach to identify salient features in the lived experiences of dental professionals in relation to explaining periodontal (gum) disease to patients. Methods: Interview data from 13 UK-trained and three internationally-trained dental professionals was examined using thematic discourse analysis. The first stage (discourse analysis) focused on the identification of language patterns in the interview data. This stage forms the focus of this paper. Findings: Six discourse categories (Clinician, Mentor, Educator, Collaborator, Rapport Builder, Professional) were identified that related to the participants’ perceived professional roles. The categories were associated with differing worldviews and language use patterns, but with some overlap. All interviewees used a variety of discourse categories in their accounts, but a few relied predominantly on one category, e.g., Clinician or Mentor. Conclusions: The local discourse categories identified in this study reflect broader discourses in healthcare relating to the roles of providers and patients, which have evolved through time. Practice implications: Practising dental professionals are faced with a diverse range of patients who have different communication preferences. A suite of discourse categories can act as a ‘toolbox’ that dental professionals can flexibly draw on when needing to adopt a role that could predispose a particular patient to positive oral health behaviour change. [ABSTRACT FROM AUTHOR]

The aim of this paper is to open a discussion about multimodal work in the area of gender, language and discourse, and propose the kinds of multimodal approaches that are most appropriate for this task. Multimodality, we claim, is a rather fragmented and unconsolidated field where many of the tools and concepts applied by different researchers are much less suitable than others. Our intention here is to raise critical questions about the affordances used by communicators in each context of usage and the ideological purposes they are meant to accomplish, so that meanings about gender and sexuality are uncovered. [ABSTRACT FROM AUTHOR]

To enhance the patient's involvement, clinical guidelines on rehabilitation require the patient's participation in the entire rehabilitation process, including discharge planning (DP). However, very little is known about how this institutional demand is actually dealt with in everyday clinical practice. Adopting a conversation analytic (CA) approach, our paper tackles the matter by looking at interdisciplinary entry meetings (IEMs) at a rehabilitation clinic in German-speaking Switzerland. Our study is based on audio-visual recordings of 11 IEMs, whose central aim is to formulate patients' rehabilitation goals and to plan their discharge. The paper offers a detailed analysis of the embodied practices through which healthcare professionals seek to involve patients in the IEMs, and also investigates patients' responses. Our analysis shows that, although carefully elaborated, the professionals' practices do not elicit more than reactive patient participation. The paper argues that this is due to (1) the practices' temporal positioning within the overall activity structure of the meeting - they are deployed when no important decision is at stake, projecting minimal patient participation on the phases in which decisions are taken - and (2) the actions the practices project on the next turn: confirmation, acknowledgement or ratification of what has previously been proposed by professionals. [ABSTRACT FROM AUTHOR]

The aim of this study is to describe the communicative strategies nurses and patients use on a micro level to ensure patient understanding during discharge discussions. The data of the study consist of 16 videotaped discharge encounters (total duration 1 h 40 mins) between nurses and patients in Finland, which were analyzed using conversation analysis. The findings reveal that patients express understanding or troubles in understanding by subtle means, such as response particles. Nurses monitor patients' reactions and adapt their subsequent actions to them, for instance by moving on to the next topic or by giving additional explanations. They also pursue expressions of understanding when needed, e.g., by prolonging the topic. This gives the patient time to react and more material to get a grip on the topic, thus facilitating displays of understanding. As a result, even if the discharge discussions consist mostly of information delivery that resembles a monological practice, the interaction is collaboratively constructed to secure patient understanding. A raised awareness of good practices already in use to secure understanding can contribute to further developing the guidelines for discharge education. [ABSTRACT FROM AUTHOR]

This paper addresses issues around the automatic repetition of particular memories in the narratives / blog accounts of individuals with Post Traumatic Stress Disorder (PTSD). Based on a long-term project that examines how people with various bodyrelated conditions and ailments write or speak about their bodies, the focus of this paper is on 80 blog accounts wherein individuals with PTSD write both about living with the condition and about their steps towards healing themselves. The paper pays special attention to how the act of repeated blogging counters the paralyzing repetition in their heads, leading them to re-cognize particular distressing life-events and thus creating alternate episodic structures (Gee 1992). In particular, the article addresses: What insights about repetition and memory are we able to glean from PTSD pathographies, and in what ways does current scholarship in narrative analysis, applied sociolinguistics, and psychology permit a more complex understanding of the condition?. [ABSTRACT FROM AUTHOR]

A setting which presents special challenges for interpreter- mediated communication is the speech pathology clinic, particularly when the encounter involves the assessment of aphasia. Drawing on a corpus of five interpreter-mediated assessments of aphasia in speakers of a range of languages (Cantonese, Greek, Tagalog and Vietnamese), this paper presents the findings of an interactive framing analysis of the corpus, focusing on illustrative extracts from two of the encounters. Analysis reveals that while the interpreters are frequently oriented towards issues of 'meaning' or 'content', the speech pathologists are generally oriented to issues of 'form'. This is evident from the fact that the speech pathologists frequently question the interpreters about the ways in which the speaker's language is abnormal. The interpreters, however, tend to respond to such questions with reference to their impressions of the person's intended meaning. It is argued that these differences in orientation can be explained by the different professional knowledge schemata of speech pathologists and interpreters and the fundamentally 'uninterpretable' nature of many of the speakers' utterances. This lack of shared understanding makes the interaction inefficient, and frequently results in a situation where the person with aphasia is put 'on hold'. The paper concludes with a discussion of some practical implications for the conduct of interpretermediated aphasia assessments. [ABSTRACT FROM AUTHOR]

This paper explores AVATAR therapy, an innovative therapeutic intervention for people experiencing auditory verbal hallucinations (AVH), where participants interact with their 'voice' in the form of a co-designed visual representation of their voice. Previous research has found AVATAR therapy to be successful in its aim to initiate change in the participant's relationship to and experience of their voice, but no study has explored the interactional practices employed as they unfold in this complex multiparty interaction between therapist, participant and avatar voiced by the therapist. We build on previous research and explore what it is about this interactional technique that might be contributing to the efficacy of this therapy. Using conversation analysis, we examine the therapist's use of 'hypothetical active voicing' (HAV), where the therapist formulates a proposed turn at talk in their interaction with the participant for the participant to reformulate in their next turn with the avatar. We show how, unlike in traditional dyadic therapeutic settings, participants are immediately able to enact the therapist-suggested dialogue. We find that as the therapist increases their assertiveness, control and precision in the delivery of HAV, so does the participant increase their assertiveness towards the avatar, thus contributing to the aims of the therapy. [ABSTRACT FROM AUTHOR]

New developments in cancer research provide opportunities to reduce the amount or intensity of chemotherapy for patients with early-stage breast cancer (EBC), with the goal of achieving recurrence-free survival rates equivalent to the current standard of care while reducing the short- and long-term toxicities that are associated with more aggressive chemotherapy regimens. Clinical trials are necessary to determine the lowest effective dosage of chemotherapy, and there is interest from patients and providers to enroll eligible patients in these trials. Currently, the word being used to describe these trials is 'de-escalation'. This paper considers the reactions of EBC patients and patient advocates to the word 'de-escalation' and how best to describe this approach and its anticipated benefits. Based on a patient survey and on interviews that were coded with the assistance of a content analysis program, we found that the participants tended to react negatively to 'de-escalation', with many associating this word with giving up in the war against cancer. Instead, the participants prefer positive, patient-centered language. This information will be useful to providers in considering how best to describe de-escalation clinical trials to eligible patients in ways that avoid therapeutic misconception and facilitate the shared decision-making process regarding treatment. [ABSTRACT FROM AUTHOR]

The aim of this paper is to study the 'translation process' (Fleischman 2001) from the patient's story into the doctor's report in interactive case reports from professional medical journals. Interactive case reports are a relatively new development in the genre, which has been postulated by, and adopted in, several publication outlets. The novelty of the variety is the possibility for readers to comment on a published case as well as the optional Patient's perspective section, in which the patient can share their experience of illness and treatment. In the present paper, a collection of interactive case reports derived from professional medical journals will be examined. The material under study can be seen as a contact situation between the lay discourse of a patient's narration and the professional discourse of medical description. The comparison and qualitative analysis of the two discourses referring to the same disease event will point to different communicative accents, different means and different effects. Drawing on the tradition of Rhetorical Genre Studies, the paper will also emphasise the many social practices in which the variety is, and can be, used. [ABSTRACT FROM AUTHOR]

Harvey Whitehouse offers a complex and stimulating theory of rituals that bind people together and propagate via affiliative imitation. The Ritual Animal argues that fundamental problems of group cooperation can be solved by causally opaque and goal-demoted behaviors which produce arbitrary cultural conventions, honest signals of membership, and collective fused identities. This amply evidenced and compelling account explains a broad variety of prominent examples, yet other key causal mechanisms emerge from the ethnographic literature and analytical reflection on affiliation and groups. Taking a glance at some widespread and unusual rituals, this paper highlights the importance of cultural transmission via pedagogy with or without copying, costly signaling and coordination without coalitional groups, and meta-representations of impenetrable ritual efficacy. Future research can explain how bonding rituals become central features of social interaction without relying upon a quite debatable adaptive function of ritual behavior for cooperation - or anything else. [ABSTRACT FROM AUTHOR]

This paper presents the responses of two "Spiritual Pastoral Therapists" (SPTs) at Porirua Hospital in Aotearoa New Zealand during COVID-19. The responses included the creation of local safe "bubbles," increased communication, maintaining chapel access, producing daily meditations for the employee newsletter, utilizing social media, writing letters, and using the labyrinth meditation walk. The authors record a variety of qualitative feedback from hospital staff affirming the contribution of SPT ministry in providing spiritual care services to nurture well-being among patients and hospital staff during the struggles caused by COVID-19. [ABSTRACT FROM AUTHOR]

Since the early 20th century reference has been made to the existence of a phatic or contact function in human communication, although only recently has it begun to be studied in depth. This function is realised through the use of various verbal and non-verbal resources with different ends: to ensure that the communication channel is open and working; to initiate, prolong or end communication; and to attract the interlocutor’s attention. With a view to understanding better how phatic resources work, what functions they perform in interaction, and how they are influenced by certain social (sex, age, education) and geolectal factors, we are currently engaged in a socio-pragmatic study which will enable us to document general and variable behaviour patterns. Focusing on the first of those subfunctions, this paper analyses the appearance of contact control question tags in the Colombian immigrant sub-corpus of the Dynamic Corpus of Immigrant Spanish (Corpus Dinámico del Español de la Inmigración –CORDIESIN). The results provide us with a first approximation to which verbal resources (question tags) are most commonly used by Colombians resident in Madrid and how they function. They also permit us to make some comparison with the corresponding state of affairs in the speech of Spanish Madrilenians, the upshot being that there is convergence with the host community. [ABSTRACT FROM AUTHOR]

The aim of this paper is to describe, analyse, and discuss the process of formulation in the specific context of mental health (MH). Formulation is a fundamental element of the work of psychiatrists and other MH clinicians that is expected to be mastered during training. The literature, however, shows that formulation is rarely explicitly addressed in the psychiatric curriculum; rather, it is implicitly developed through modelling, and/or clinical practice. This paper focuses on case formulation in one MH context in Australia. It tracks the iterative formulation of one patient in a hospital emergency department. The analysis uses resources from systemic functional linguistics (SFL) situated within a broader framework of discourse analysis. It highlights patterns of lexical relations and nominalisation as well as the range of conjunctions. These make explicit how the clinicians talk about the patient's illness and shape their developing understanding into a logical formulation. We see applications of this work for the training of mental health professionals. These data make explicit the ways in which the participating clinicians use language in the process of formulation. By bringing this process to the level of consciousness, it can be discussed and evaluated and become a pedagogic resource. [ABSTRACT FROM AUTHOR]

This paper considers the ways in which clinicians enact 'being a team', by analysing how they inform one another about critical patient information. The process where this information exchange happens is known as 'clinical handover'. The study that informs this paper spanned ten months of data collection in four hospitals, involving 150 clinicians and five patients. The analysis presented here draws on data collected at one of the hospital sites: an emergency department at a regional tertiary teaching hospital. Our analysis reveals how central clinical handover is to 'being a team' in health care, and how deficiencies in handover weaken clinical teams' ability to provide continuous and safe care for their patients. We further discuss how clinical practitioners' own responses to the footage foregrounded different issues compared to those revealed by formal analysis; namely, issues centring on relationships, and on practical steps to ensure these relationships could be improved. We reflect on the differences between our own formal analysis of the footage, and practitioners' 'lived response' to the footage, and the implications of these differences for how we as analysts conceptualise 'teamness' in organisations. [ABSTRACT FROM AUTHOR]

Central to teaching and assessing languages for specific purposes is collaboration between domain experts and applied linguists; yet, the complexity of the process has been little documented. A project involving collaboration between language testers, applied linguists and healthcare professionals in Australia provided an opportunity for exploration of this complexity. The project focused on interprofessional written communication about patient care, which forms the basis of a writing task in the Occupational English Test (OET), an English for Specific Purposes (ESP) test for health professionals. The project aimed to identify criteria indigenous to the work setting in order to inform the criteria used by language professionals in judging performance on the OET. This methodological paper examines the decisions involved in designing the collaboration and considers the possible effect of decisions on the validity of findings. The decisions include the choice of workplace writing tasks, of participants, of work settings and of written materials to be used as stimuli, the mode of eliciting responses to the stimuli from the domain experts and the coding and interpretation of data. The ways in which the research results are to be implemented in practice are examined, as well as the broader implications for the methodology of ESP research. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to investigate some of the challenges and prospects connected with interdisciplinary cooperation in the analysis of specialised discourse. In the last few decades, the literature on English for Special Purposes has often underlined the importance of this type of collaboration for a better understanding of how practitioners use language to achieve the objectives of their professions. The contribution that the applied linguist can provide may be very relevant, particularly in those cases in which hybridity and interdiscursivity can be detected in the discourses used by professional participants. In this paper, an example of this type of explanation is presented, drawn from the literature and my own direct experience relating to a specific interdisciplinary research project carried out by a joint group of arbitration experts/practitioners and applied linguists. The issues identified show that linguistic explanations can be of great help to disciplinary experts in attaining a more correct interpretation of the texts and practices in which they are commonly involved. [ABSTRACT FROM AUTHOR]

In this paper, we complement research into compassion in medical contexts with an analysis of the representation of patients in nursing handovers and the ways in which such practitioner-practitioner interaction can be said to demonstrate and evoke feelings of compassion towards patients. We label such representation as 'Compassion Talk' and suggest that potentially it can complement the information given as part of the standard format for handovers. The analysis is based on instances of non-scripted talk (NST) from three nursing handover meetings from a highly performing Medical Assessment Unit in the UK. In a data-led qualitative analysis, we find that within NST patients are represented in terms that not only make nurses' actions to alleviate their suffering seem possible and necessary, but that also highlight their shared humanity and position the patients as if they are members of the nurses' wider social group. We further demonstrate how NST can be successfully managed by experienced nursing staff and suggest, therefore, that handovers can function not only to pass on information accurately and concisely, but also as a space for nurses to regroup as a community of practice and to relate to their patients in human terms, as a defining principle of the profession. [ABSTRACT FROM AUTHOR]

Training for effective communication in high-stakes environments actively promotes targeted communicative strategies. One oft-recommended strategy is closed-loop communication (CLC), which emphasises three components to signal understanding: call-out, checkback and closing of the loop. Using CLC is suggested to improve clinical outcomes, but research indicates that medical practitioners do not always apply CLC in team communication. Our paper analyses a context in which speakers' linguistic choices are guided by explicit recommendations during training, namely out-of-hospital cardiac arrest (OHCA) resuscitation. We examined 20 real-life OHCA resuscitations to determine whether paramedics adopt CLC in the critical first five minutes after the arrival of the designated team leader (a paramedic specially trained in handling OHCA resuscitation), and what other related communication strategies may be used. The findings revealed that the standard form of CLC was not consistently present in any of the resuscitations despite opportunities to use it. Instead, we found evidence of non-standard forms of CLC and closed-ended communication (containing the first two components of standard CLC). These findings may be representative of what happens when medical practitioners communicate in time-critical, real-life contexts where responses to directives can be immediately observed, and suggest that CLC may not always be necessary for effective communication in these contexts. [ABSTRACT FROM AUTHOR]

This paper looks into the linguistic forces of persuasion of the woman judge in a Chinese civil trial. The judge was mediating the conflicts of the two parties in a local court. The two parties were in strong disagreement over compensation and the price for purchasing the bungalow of the plaintiff. She was successful in solving the con- flicts. This paper approaches the mediation of persuasion from the Systemic Functional model, and examines the generic features in the context of culture and register features in the context of situation. The analysis of genre finds that she uses the strategy of interference, elaboration and suggestion/proposal to fulfill her solution. The analysis of register finds that she employs proper linguistic tactics in the changing context of situation. Her proper tactics instantiates her strategy and the coupling of the two contribute to the successful mediation. One implication this paper draws is that one's attitude changes the others' attitude. [ABSTRACT FROM AUTHOR]

While studies of interpreted medical interactions are common, there is relatively little research on bilingual doctors who choose to consult in the first language of their migrant patients. This paper presents a case study of one such language-concordant consultation conducted in Italian in the outpatients' clinic of an Australian hospital, a triadic encounter where the patient was accompanied by her Italian-speaking daughter. In this consultation English medical terms were sometimes introduced but Italian was the main language of the consultation. The communication between all parties was notably very smooth and we reflect on reasons for this. These include the commitment of all parties to using Italian and the proactive role played by the patient's Italian-speaking daughter in supporting and occasionally challenging her mother's account of affairs. We conclude by reflecting on issues that bilingual doctors need to be aware of before undertaking to consult in more than one language. [ABSTRACT FROM AUTHOR]

The present paper examines interactions in psychiatric care consultation in selected hospital settings in three Akan-speaking communities in Ghana, based on 45 audio-recorded doctor/nurse--patient interactions. Using a discourse pragmatics approach, we note how language is used in the management of communication in psychiatric consultations, and how the dominance of healthcare practitioners is enacted. Specifically, we focus on some of the strategies used by the participants to manage the multilingual communicative settings, such as code-mixing. Our findings also suggest that the use of proverbs as a diagnostic tool in psychiatric consultations in Ghana needs to be reviewed. We propose that in order for patients to experience consultation sessions that are more interactive, with possible therapeutic benefits, health practitioners need to make considerable efforts to involve the patients in decisions regarding their health. [ABSTRACT FROM AUTHOR]

Effective doctor-patient communication has been widely endorsed as pivotal for optimal medical care and the building of a positive and lasting relationship between caregivers and patients. While the literature suggests that traditional Chinese medicine (TCM) doctors have better interpersonal skills than Western medicine (WM) doctors, and that the doctor-patient relationship in TCM is more lasting, a comparison of specific communication behaviors in both encounters has not yet been carried out. This paper examines the similarities and differences in communication behaviors between these two types of consultations in relation to doctor-elderly patient communication. Forty-five consultations were included for analysis using the Roter Interaction Analysis System (RIAS). Significant differences were found in communication behaviors at the level of lifestyle and psychosocial exchanges, type of questions, non-medical small talk, and emotional disclosure. The study's limitations and implications are discussed. [ABSTRACT FROM AUTHOR]

The study of metaphor in psychotherapy is undergoing a 'contextual turn', shifting emphasis from global mechanisms underlying metaphors and therapeutic change to their naturally occurring properties in therapist-patient interaction. While there have been rich qualitative and contextual descriptions of metaphors in psychotherapy, complementary quantitative accounts of metaphor usage patterns over larger amounts of talk have been less forthcoming. This paper reports metaphor usage patterns as associations between key contextual variables which characterize metaphors in a dataset of Chinese psychotherapy talk. A total of 2893 metaphor vehicle terms from 29.5 hours of talk were coded for SPEAKER, FUNCTION, TARGET, PHASE OF THERAPY, and DYAD. A loglinear analysis revealed significant higher order associations (DYAD*TARGET*FUNCTION*PHASE; DYAD *FUNCTION*PHASE * SPE AKE R ; TARGET*FUNCTION*SPEAKER), discussed as usage patterns which bear implications for the psychotherapeutic application of metaphor. Limitations and future research directions are discussed. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess differences in language complexity for physician and patient speech and describe differences in speech content and literacy for medical office visits related to contraception. In a cross-sectional, mixed-methods study, we invited clinic faculty, residents, and consecutive patients to participate in simulated clinical encounters. Two investigators independently transcribed the recordings of these encounters. We calculated Flesch-Kincaid Reading Level (FKRL) and Flesch Reading Ease (FRE) scores as proxy measures for language complexity related to physician and patient speech. We also performed content analysis of the office visit transcriptions. Thirty-one of 33 physicians and 51 of 61 patients participated in the study, yielding response rates of 94% and 84%, respectively. Student Independent t-tests revealed differences in language complexity for providers and patients. On average, physicians spoke at an Eighth-Grade (13 to 14 years old) reading level, while patients spoke at a Fourth-Grade (nine to ten years old) level. Physicians gave primary importance to physiologic mechanisms. Patients focused on efficacy and side effects. We interpret the findings from the theoretical perspective of language and culture as inseparable components of communication. Both language and culture communicate, but at different levels of analysis. We explore both dimensions of communication with the same data set. Although this paper is theoretically exploratory, we believe it broadens inquiry of language use in medicine for subsequent investigation. [ABSTRACT FROM AUTHOR]

This study examines modality in doctor-patient interactions during psychiatric interviews, using 23 video-recorded interviews conducted in Spanish involving patients who are members of a small community in rural California. Using the interpersonal metafunction (Halliday 1994; Eggins 2004) and approaches in pragmatics literature, this paper uses both qualitative and quantitative analysis to reveal the lexicogrammatical choices made by the patients and the doctor. Spanish modalization can be realized through modal operators (e.g. 'might'), mood adjuncts (e.g. 'possibly'), and the conditional and future tenses. In addition to these, oral contexts have alternative forms of expressing modalization such as using the preposition 'como' ('like') and tag questions (e.g. 'right?'), as described in the pragmatics literature. This work makes a methodological contribution by highlighting the analytical tools that alternative approaches to discourse analysis (pragmatics in this case) make available and how they complement the interpersonal metafunction. The results of this study reveal that patients use modalization at particular moments in the interview, for instance when discussing their symptoms and conditions, to deliver their information carefully and to recognize the social status of the doctor. The doctor also strategically uses modalization when he asks sensitive questions, in order to displace responsibility from the patients and avoid a face-threatening situation. [ABSTRACT FROM AUTHOR]

Effective communication skills are important in the healthcare setting to develop rapport and trust with patients, provide reassurance, assess patients effectively and provide education related to their health condition in a way that patients easily understand. However, with many nurses from culturally and linguistically diverse (CALD) backgrounds being recruited to fill the workforce shortfall in Australia, topics such as communication across cultures with increased potential for miscommunication and ensuing risks to patient safety have gained increasing focus in recent years. This paper reports on the first phase of a study that examines intercultural nurse-patient communication from the perspective of four Registered Nurses (RNs) from CALD backgrounds working in Australia. Five interrelating themes that were derived from thematic analysis of semi-structured interviews are discussed. The central theme of 'adjustment' was identified as fundamental to the experiences of the RNs and this theme interrelated with each of the other themes that emerged: (1) professional experiences with communication, (2) ways of showing respect, (3) displaying empathy, and (4) experiencing vulnerability. [ABSTRACT FROM AUTHOR]

Successful teamwork, constitutive of team talk, depends largely on shared responsibility in the coordination of tasks in a goal-oriented way. This paper examines how specific modes of talk or 'discourse types' are utilised by a healthcare team in simulated emergency care. The data corpus comprises six video-recorded simulation training sessions in an emergency department at a large Norwegian hospital. Our analysis focuses on the critical moment when the original healthcare team is joined by other specialists in an ad hoc manner, which necessitates the (re)distribution of expert responsibility in the management of the patient's condition. We examine the interactional trajectories and, in particular, the discourse types surrounding the critical moment which marks the incorporation of the new team members. The analysis centres on three discourse types (online commentary, offline commentary and metacommentary) that are utilised in accomplishing the multiple tasks in a collaborative and coordinated fashion. We suggest that team talk overlays and overlaps with distributed medical work in highly charged decision-making contexts such as emergency care. The findings have relevance for how healthcare professionals and students are trained in multidisciplinary team talk and teamwork. [ABSTRACT FROM AUTHOR]

This paper applies qualitative discourse analysis to 'shift-change handovers', events in which nurses hand over care for their patients to their colleagues. To improve patient safety, satisfaction and inclusion, hospitals increasingly require nursing staff to hand over at the patient's bedside, rather than in staff-only areas. However, bedside handover is for many a new and challenging communicative practice. To evaluate how effectively nurses achieve bedside handover, we observed, audio-recorded and transcribed nursing shift-change handovers in a short stay medical ward at an Australian public hospital. Drawing on discourse analysis influenced by systemic functional linguistics we identify four handover styles: exclusive vs inclusive and objectifying vs agentive. The styles capture interactional/interpersonal meaning choices associated with whether and how nurses include patients during handover, and informational/ideational meaning choices associated with whether or not nurses select and organise clinical information in ways that recognise patients' agency. We argue that the co-occurrence of inclusive with agentive and exclusive with objectifying styles demonstrates that how nurses talk about their patients is powerfully influenced by whether and how they also talk to them. In noting the continued dominance of exclusive objectifying styles in handover interactions, we suggest that institutional change needs to be supported by communication training. [ABSTRACT FROM AUTHOR]

The topic of this article is collaborative problem solving conducted as talk and social interaction in a particular team in the thoracic ward of a Norwegian hospital. The problems to be solved were complex and required a team consisting of participants from diverse medical specialties that met regularly to discuss examination procedures, formulate diagnoses, and decide forms of treatment. Data for the article come from field notes and audio recordings made while the author observed this meeting regularly over more than one year. The aim of the paper is to investigate how team discourse was regulated in ways that served the reproduction of institutional medical standards for problem solving, and also how the meeting had to deal with deviations from institutional standards and attempted to reproduce a certain form of normative orderliness and interaction order. [ABSTRACT FROM AUTHOR]

In this conceptual paper, I begin with a differentiation between generic 'competence' and professional 'expertise', the latter being manifest at the communicative level. I characterise professional expertise more broadly to include 'communicative expertise' as well as 'distributed expertise'. With regard to decision-making, expertise is no longer seen as an attribute of individuals deriving from scientific knowledge and practical experience. Instead, 'distributed expertise' in its mediated format underpins decisionmaking in many professional and institutional settings. I then extend the notion of 'distributed expertise' as constitutive of 'lay expertise' and 'expert systems'. Access to and use of 'expert systems' in optimal ways inevitably reconfigures the very conditions and consequences of professional expertise. I argue that 'communicative expertise' in professional practice comprises not only knowledge/skill about the mechanics of communication but also the channels through which the other types of knowledge/skill (including scientific, experiential, relational, technological, organisational, legal and ethical) are communicated in real-life settings. [ABSTRACT FROM AUTHOR]

A 1974 study of 'Doctor-Patient Communication Skills', led by Christopher Candlin, can tell us about the intellectual background of studies of professional communication and the ways theoretical frameworks are adapted to the actualities of collaboration with a funder and day-to-day work in an institutional environment. The funder was a healthcare foundation, and the aim of the study was to develop a syllabus for teaching communication to doctors coming from overseas. The study involved observation of more than 200 consultations in a casualty ward. Findings were framed in terms of a set of functions and the possible transitions between these functions, and these would guide the kinds of linguistic actions to be taught. But within this narrow and now dated framework, the team also raised a number of wider questions that are still relevant today: the idea of the consultation as a unit, networks of medical professionals, the use of frames, attention to multimodality as 'transmediation' and the crucial role of time constraints. [ABSTRACT FROM AUTHOR]

According to Raewyn Connell, 'being a man' involves actively positioning one's self in relation to culturally dominant images of masculinity. Yet, crucially, these images change depending on the social and historical context. In this paper, we examine contemporary discourses of masculinity as they are represented in the British press. In particular, we focus on the ways in which masculine representations are both racialised and classed, and how they are positioned in relation to one another within a broader ideological field of gender and power. Analyses are based on a quantitative and qualitative analysis of a large corpus (44.1 million words) of newspaper articles on masculinity that appeared in the UK between 2003 and 2011. Our findings underscore the importance of adopting an intersectional approach to the study of language and masculinity, and provide support for recent critical re-evaluations of the foundational concept of hegemonic masculinity. [ABSTRACT FROM AUTHOR]

Over the past two decades, queer has grown into an established critical approach to social science. Correspondingly, the term queer has emerged as a recognised brand in the language of academia. This paper examines the potential risks that such linguistic institutionalisation poses for queer as a critical and emancipatory endeavour. Building on Michael Billig's argument that the bias towards 'big nouns' in academic discourse tends to further entrench the power of academic elites, I draw a parallel between queer and CDA (critical discourse analysis) as two emerging academic brands in order to determine whether queer is one such big noun and how this may affect the very capacity of queer scholars to commit themselves to critique and self-critique. I conclude by outlining a modest proposal to ensure that the term queer remains available to be appropriated by whoever shares the premises and the aspirations underlying the queer project. [ABSTRACT FROM AUTHOR]

This study examined the participation patterns and effectiveness of two different instructional treatments: Treatment One consisted of a task-based activity; Treatment Two used a whole-class discussion approach (Q/A paradigm). The research investigated which instructional treatment was more relevant and effective. The quantity of information learners could remember immediately after instruction, one week later, and the information that emerged through the interactional formats were measured. Each treatment was carried out for approximately one hour and then participants were asked to write a summary. After a week, students were given a piece of paper to summarise what was carried out the week before to see how much information they could remember. All the interactions were transcribed. L2 learners' response towards the taskbased activity showed positive results and the task-based activity treatment was considered a better pedagogical approach. [ABSTRACT FROM AUTHOR]

There is a general assumption that, in the hospital setting, standard surgical masks, unlike transparent masks, prevent effective communication with the hearing-impaired. This study investigates the experience of healthcare professionals (HPs) and hearing-impaired patients using a transparent surgical mask vs. a standard surgical mask in an acute care hospital. Our study design used a cross sectional, mixed-methods survey of 25 adult hearing-impaired patients/visitors and 36 HPs caring for them while wearing a transparent mask. The results demonstrated that 89% of staff and 76% of patients said the mask improved communication. This improvement was due to better ability to interpret nonverbal cues, which led to less need for repetition or volume increase. It was found that 69% of staff said the mask was comfortable and 81% were satisfied; 64% of patients liked being able to see facial expressions of the person wearing the mask; 72% of patients felt more connected to, and 76% understood the speech of, the person using the mask; and 80% of patients and 78% of staff preferred the transparent mask. The findings suggest that hospital staff/providers should use a mask with a clear window around the mouth and face while caring for hearing-impaired patients. This may improve patient satisfaction and prevent errors that are due to miscommunication. [ABSTRACT FROM AUTHOR]

Previous research has identified that effective and high-quality communication between patients, families and professionals is a key contributing factor to end-of-life (EOL) care and recovery after bereavement. Increasingly, this communication work is being done by non-clinical staff in places such as homes and community settings. These additional care providers offer important pre- and post-bereavement support that can improve the quality of EOL care as well as promote healthy grieving for families, friends and communities. Despite this contribution, though, little is known about how these non-clinical workers use communication in their daily practices. This paper reports on the analysis of a set of nine in-depth interviews conducted in Hong Kong and in one region of Australia that examined in detail relational aspects of communication that shape interactions between non-clinical workers and service users. Data were collected during the COVID-19 health crisis, when the workers experienced exceptional restrictions on communication. The findings of this study highlight the fundamental importance of both verbal and non-verbal communication to the relationships established between non-clinical workers and service users. Specifically, greater support for the development of communication skills in non-clinical EOL workers will promote improvements in the quality of EOL care. [ABSTRACT FROM AUTHOR]

Narrative of personal experience, as a subjective interpretation of a set of events, constitutes a particularly fertile site for the construction of identity. It enables the teller to voice and (re-)organize disruptive phenomenological experiences, socialize emotions or forge interpersonal relations. Consequently, the narrator is able to access various facets of their identity and 'bring multiple, partial selves to life' (Ochs and Capps 1996: 19). Informed by the methods and insights of computer- mediated discourse analysis, conversation analysis and membership categorization analysis, and positioning narrative as a situated practice within social interaction, this paper scrutinizes publicly accessible data (15 forum threads) nested within a UK-based online Alzheimer's support group to demonstrate how Alzheimer's patients' family caregivers co-construct their sense of self when disclosing morally delicate aspects of their identities. The analysis demonstrates that the discursive space of the online support group encourages caregivers to disclose disruptions of predicates and activities associated with the 'family' membership categorization device. It also shows that the medium-afforded mode of engagement enables caregivers to gradually incorporate their unveiled aversive experiences into their autobiographical flow, with the help of other participants' responses which normalize these category disruptions. [ABSTRACT FROM AUTHOR]

This paper questions the nature of the communicative event that takes place in online contexts between doctors and web-users, showing computer-mediated linguistic norms and discussing the nature of the participants' roles. Based on an analysis of 1005 posts occurring between doctors and the users of health service websites, I analyse how doctor-patient communication is affected by the medium and how health professionals overcome issues concerning the virtual medical visit. Results suggest that (a) online medical answers offer a different service from that expected by users, as doctors cannot always fulfill patient requests, and (b) net consultations use aspects of traditional doctor-patient exchange and yet present a language and a style that are affected by the computer-mediated environment. Additionally, it seems that this new form leads to a different model of doctor-patient relationship. The findings are intended to provide new insights into web-based discourse in doctor-patient communication and to demonstrate the emergence of a new style in medical communication. [ABSTRACT FROM AUTHOR]

Empathy is believed to play a key function in clinical consultations. As online medical consultation (OMC) has become increasingly popular in the past decade, studies addressing empathic communication in the OMC context have started to attract research inter- est. However, previous studies have mainly addressed empathic communicative acts by online doctors. There is still a research gap as regards exploring online empathic communication from both doctors' and patients' perspectives, particularly in the context of China where there is a promising growth in OMC activities. The present study examines 150 text-based OMC cases that involve empathic interaction between doctors and patients/caregivers in the Chinese context. Adopting a theme-oriented discourse analysis approach, the paper aims to identify empathic communication sequences. Four types of sequence organization are identified, and these are discussed with relevant examples. The findings illustrate that OMC communication involves dynamic empathic sequential patterns, which can be optimally drawn upon by health professionals and medical students to practise their empathic communication skills. [ABSTRACT FROM AUTHOR]

This paper examines patient-physician communication, and in particular what each partner in this delicate relationship requests from the other, in the light of current research in cognitive studies relating to autobiographical memory and narrative. It explains that narratives are the result of a co-construction and sharing process between a storyteller and a listener - in this context, the patient and the physician, who work together on the story of the anamnesis. It further stresses the need for a robust and considered connection between patient-centred practices and theoretical constructs of narrative as it relates to the social development of autobiographical memory. Through an analysis of current evidence on doctor-patient communication and narratives of illness, a model of 'narrative-based medicine' (NBM) is proposed. [ABSTRACT FROM AUTHOR]