1887
  1. Home
  2. e-Journals
  3. Language and Dialogue
  4. Volume 6, Issue 3
  5. Article
Volume 6, Issue 3
  • ISSN 2210-4119
  • E-ISSN: 2210-4127
USD
Buy:$35.00 + Taxes

Abstract

Contemporary research on the communicative constitution of organization conceives organization as made up of multiple voices embodied in and enacted by the different actors inhabiting this social world. This paper illustrates the inner polyphony at play in the complex and sensitive workplace of an Intensive Care Unit. The study focuses on the diagnostic talk concerning infectious disease and on the communicative resources deployed by physicians to pursue or resist their often conflicting diagnostic trajectories and professional stances toward the use of antibiotics. Adopting a conversation analytical approach to video-recorded morning briefings, we will illustrate how polyphony characterises the team members’ conduct during this communicative event and the consequences this polyphony has on the decision-making process. As we will illustrate, in this as in most cases, the members of the community appear to be active users of their professional culture, yet are also — and unavoidably — its carriers.

© 2016 John Benjamins Publishing Company
Loading

Article metrics loading...

/content/journals/10.1075/ld.6.3.03car
2016-11-28
2025-04-27

  • From This Site

    /content/journals/10.1075/ld.6.3.03car
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Journal -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
Loading full text...

Full text loading...

References

  1. American Thoracic Society and Infectious Disease Society of America
    2005 “Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia.” American Journal of Respiratory and Critical Care Medicine171 (4): 388–416. doi: 10.1164/rccm.200405‑644ST
     https://doi.org/10.1164/rccm.200405-644ST [Google Scholar]
  2. Anspach, Renee R
    1993 Deciding Who Lives: Fateful Choices in the Intensive-care Nursery. Berkeley, CA: University of California Press.
     [Google Scholar]
  3. Ashcraft, Karen L. , Timothy R. Kuhn , and François Cooren
    2009 “Constitutional Amendments: ‘Materializing’ Organizational Communication.” Academy of Management Annals3 (1): 1–64. doi: 10.1080/19416520903047186
     https://doi.org/10.1080/19416520903047186 [Google Scholar]
  4. Atkinson, Paul
    1995 Medical Talk and Medical Work. The Liturgy of the Clinic. London: Sage.
     [Google Scholar]
  5. 1999 “Medical Discourse, Evidentiality and the Construction of Professional Responsibility.” InTalk, Work and Institutional Order. Discourse in Medical, Mediation and Management settings, ed. by Srikant Sarangi , and Celia Roberts , 75–108. Berlin/New York: Mouton de Gruyter. doi: 10.1515/9783110208375.2.75
     https://doi.org/10.1515/9783110208375.2.75 [Google Scholar]
  6. Bakhtin, Michael M
    1981 The Dialogic Imagination: Four Essays by M.M. Bakhtin. Austin, TX: University of Texas Press.
     [Google Scholar]
  7. 1984 Rabelais and his World. Bloomington, IN: Indiana University Press.
     [Google Scholar]
  8. Bazzanella, Carla
    1996 Repetition in Dialogue. Tubingen, DE: Niemeyer.
     [Google Scholar]
  9. Bencherki, Nicolas , and François Cooren
    2011 “Having to be: The possessive constitution of organization.” Human Relations, 64: 1579–1607. doi: 10.1177/0018726711424227
     https://doi.org/10.1177/0018726711424227 [Google Scholar]
  10. Bourdieu, Pierre
    1984 Distinction: A Social Critique of the Judgement of Taste. London: Routledge. Originally published in Pierre Bourdieu, La distinction. Critique sociale du jugement (Paris: Les Éditions de Minuit, 1979).
     [Google Scholar]
  11. 1990 The Logic of Practice. Stanford, CA: Stanford University Press. Originally published in Pierre Bourdieu, Le sens pratique (Paris: Les Éditions de Minuit, 1980).
     [Google Scholar]
  12. Byrne, Patrick S. , and Barrie E.L. Long
    1976 Doctors Talking to Patients: A Study of the Verbal Behaviours of Doctors in the Consultation. London, UK: HMSO.
     [Google Scholar]
  13. Caronia, Letizia
    2002 La socializzazione ai media. Contesti, interazioni e pratiche educative [Media Socialization. Contexts, Interactions and Educational Practices]. Milano, IT: Guerini.
     [Google Scholar]
  14. Caronia, Letizia , and Arturo Chieregato
    2015 “Assembling (Non)Treatable Cases: Physicians’ Epistemic and Interactive Resources to Pursue and Resist an “Off-label” Policy in an Intensive Care Unit.” Paper presented at theannual ICA International Conference, San Juan, Puerto Rico, May 21–25.
     [Google Scholar]
  15. Caronia, Letizia , and François Cooren
    2014 “Decentering Our Analytical Position: The Dialogicity of Things.” Discourse & Communication8 (1): 41–61. doi: 10.1177/1750481313503226
     https://doi.org/10.1177/1750481313503226 [Google Scholar]
  16. Caronia, Letizia , and Luigina Mortari
    2015 “The Agency of Things: How Spaces and Artefacts Organize the Moral Order of an Intensive Care Unit.” Social Semiotics25 (4): 401–22. doi: 10.1080/10350330.2015.1059576
     https://doi.org/10.1080/10350330.2015.1059576 [Google Scholar]
  17. Choo, Chun Wei
    2005 The Knowing Organization. How Organizations Use Information to Construct Meaning, Create Knowledge and Make Decision. Oxford, UK: Oxford University Press. doi: 10.1093/acprof:oso/9780195176780.001.0001
     https://doi.org/10.1093/acprof:oso/9780195176780.001.0001 [Google Scholar]
  18. Cicourel, Aaron V
    1986 “The Reproduction of Objective Knowledge: Commonsense Reasoning in Medical Decision Making.” InContemporary Perceptions of Language: Interdisciplinary Dimensions, ed. by Heidi Byrnes , 48–78. Georgetown, DC: Georgetown University Press.
     [Google Scholar]
  19. 1987 “Cognitive and Organizational Aspects of Medical Diagnostic Reasoning.” Discourse Processes10 (4): 346–367. doi: 10.1080/01638538709544682
     https://doi.org/10.1080/01638538709544682 [Google Scholar]
  20. 1992 “The Interpenetration of Communicative Contexts: Examples from Medical Encounters.” InRethinking Contexts: Language as an interactive phenomenon, ed. by Alessandro Duranti , and Charles Goodwin , 291–310. Cambridge, MA: Cambridge University Press.
     [Google Scholar]
  21. 1999 “The Interaction of Cognitive and Cultural Models in Health Care Delivery.” InTalk, Work and Institutional Order. Discourse in Medical, Mediation and Management settings, ed. by Srikant Sarangi , and Celia Roberts , 183–224. Berlin/New York: Mouton de Gruyter. doi: 10.1515/9783110208375.2.183
     https://doi.org/10.1515/9783110208375.2.183 [Google Scholar]
  22. Cooren, François
    2004 “Textual agency: How Texts Do Things in Organizational Settings.” Organization11 (3): 373–393. doi: 10.1177/1350508404041998
     https://doi.org/10.1177/1350508404041998 [Google Scholar]
  23. 2006 “The Organizational World as a Plenum of Agencies.” InCommunication as Organizing: Practical Approaches to Research into the Dynamic of Text and Conversation, ed. by François Cooren , James R. Taylor , and Elizabeth J. Van Every , 81–100. Mahwah, NJ: Lawrence Erlbaum.
     [Google Scholar]
  24. 2008 “The selection of agency as a rhetorical device: Opening up the scene of dialogue through ventriloquism.” InDialogue and rhetoric, ed. by Edda Weigand , 23–37. Amsterdam, NE: Benjamins. doi: 10.1075/ds.2.04coo
     https://doi.org/10.1075/ds.2.04coo [Google Scholar]
  25. 2010 Action and Agency in Dialogue: Passion, Incarnation, and Ventriloquism. Amsterdam, NE: John Benjamins. doi: 10.1075/ds.6
     https://doi.org/10.1075/ds.6 [Google Scholar]
  26. 2012 “Communication Theory at the Center: Ventriloquism and the Communicative Constitution of Reality.” Journal of Communication62 (1): 1–20. doi: 10.1111/j.1460‑2466.2011.01622.x
     https://doi.org/10.1111/j.1460-2466.2011.01622.x [Google Scholar]
  27. Cooren, François , Gail T. Fairhurst , and Romain Huët
    2012 “Why Matter Always Matters in (Organizational) Communication.” InMateriality and Organizing: Social Interaction in a Technological World, ed. by Paul M. Leonardi , Bonnie A. Nardi , and Jannis Kallinikos , 296–314. Oxford, UK: Oxford University Press. doi: 10.1093/acprof:oso/9780199664054.003.0015
     https://doi.org/10.1093/acprof:oso/9780199664054.003.0015 [Google Scholar]
  28. Cooren, François , and Sergeiy Sandler
    2014 “Polyphony, Ventriloquism, and Constitution: In Dialogue with Bakhtin.” Communication Theory24 (3): 225–244. doi: 10.1111/comt.12041
     https://doi.org/10.1111/comt.12041 [Google Scholar]
  29. Eggiman, Philippe , and Didier Pittet
    2001 “Infections Control in the ICU.” CHEST120 (6): 2059–2093. doi: 10.1378/chest.120.6.2059
     https://doi.org/10.1378/chest.120.6.2059 [Google Scholar]
  30. Erikson, Frederick
    1999 “Local Identities and Presentation of Self as a Fellow Physician: Aspects of a Discourse of Apprenticeship in Medicine.” InTalk, Work and Institutional Order. Discourse in Medical, Mediation and Management settings, ed. by Srikant Sarangi , and Celia Roberts , 109–143. Berlin/New York: Mouton de Gruyter. doi: 10.1515/9783110208375.2.109
     https://doi.org/10.1515/9783110208375.2.109 [Google Scholar]
  31. Fairhurst, Gail T
    2004 “Textuality and Agency in Interaction Analysis.” Organization11 (3): 335–353. doi: 10.1177/1350508404041996
     https://doi.org/10.1177/1350508404041996 [Google Scholar]
  32. Garfinkel, Harold
    2002 Ethnomethodology’s Program. Working out Durkheim’s Aphorism. Lanham, MD: Rowman & Littlefield.
     [Google Scholar]
  33. Goodwin, Charles
    1994 “Professional Vision.” American Anthropologist96 (3): 606–633. doi: 10.1525/aa.1994.96.3.02a00100
     https://doi.org/10.1525/aa.1994.96.3.02a00100 [Google Scholar]
  34. Heath, Christian
    1992 “The Delivery and Reception of Diagnosis and Assessment in General Practice Consultation.” InTalk at Work: Interaction in Institutional Settings, ed. byPaul Drew, and John Heritage , 235–267. Cambridge, MA: Cambridge University Press.
     [Google Scholar]
  35. Heritage, John
    1984 Garfinkel and Ethnomethodology. Cambridge, MA: Cambridge University Press.
     [Google Scholar]
  36. 1997 “Conversation Analysis and Institutional Talk: Analyzing Data.” InQualitative Research: Theory, Method and Practice, ed. by David Silverman , 221–245. London, UK: Sage.
     [Google Scholar]
  37. 2006 “Revisiting Authority in Physician-Patient Interaction.” InDiagnosis as Cultural Practice, ed. by Judith Felson Duchan , and Dana Kovarsky , 83–102. Berlin/New York: Mouton de Gruyter.
     [Google Scholar]
  38. 2012 “Epistemics in Action: Action Formation and Territories of Knowledge.” Research on Language & Social Interaction45 (1): 1–29. doi: 10.1080/08351813.2012.646684
     https://doi.org/10.1080/08351813.2012.646684 [Google Scholar]
  39. Heritage, John , and Douglas W. Maynard
    2006 Communication in Medical Care: Interaction between Primary Care Physicians and Patients. Cambridge, MA: Cambridge University Press. doi: 10.1017/CBO9780511607172
     https://doi.org/10.1017/CBO9780511607172 [Google Scholar]
  40. Heritage, John , and Geoffrey Raymond
    2005 “The terms of agreement: Indexing epistemic authority and subordination in talk-in- interaction.” Social Psychology Quarterly, 68: 15–38. doi: 10.1177/019027250506800103
     https://doi.org/10.1177/019027250506800103 [Google Scholar]
  41. Heritage, John , and Rod Watson
    1979 “Formulations as Conversational Objects.”InEveryday Language: Studies in Ethnometodology, ed. by George Psathas , 123–162. New York, NJ: Irvington Press.
     [Google Scholar]
  42. Husserl, Edmund G.A
    1954 The Crisis of European Sciences and Trascendental Philosophy. Evantson, IL: Northwestern University Press.
     [Google Scholar]
  43. Koschmann, Timothy , Curtis LeBaron , Charles Goodwin , and Paul Feltovich
    2011 “‘Can You See the Cystic Artery Yet?’ A Simple Matter of Trust.” Journal of Pragmatics43 (2): 521–541. doi: 10.1016/j.pragma.2009.09.009
     https://doi.org/10.1016/j.pragma.2009.09.009 [Google Scholar]
  44. Maynard, Douglas W
    1992 “On Clinicians’ Co-Implicating Recipients’ Perspective in the Delivery of Diagnostic News.” InTalk at Work: Interaction in Institutional Settings, ed. by Paul Drew , and John Heritage , 331–358. Cambridge, MA: Cambridge University Press.
     [Google Scholar]
  45. 2003 Bad News, Good News: Conversational Order in Everyday Talk and Clinical Settings. Chicago, IL: University of Chicago Press.
     [Google Scholar]
  46. Mishler, Elliot G
    1984 The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, NJ: Ablex.
     [Google Scholar]
  47. Moerman, Michael
    1988 Talking Culture: Ethnography and Conversation Analysis. Philadelphia, PA: University of Pennsylvania Press.
     [Google Scholar]
  48. Mondada, Lorenza
    2011 “The Organization of Concurrent Courses of Action in Surgical Demonstration.” InEmbodied Interaction: Language and Body in the Material World, ed. by Jürgen Streeck , Charles Goodwin , and Curtis LeBaron , 207–226. Cambridge, MA: Cambridge University Press.
     [Google Scholar]
  49. Nicolini, Davide
    2009 “Zooming in and out: Studying Practices by Switching Theoretical Lenses and Trailing Connections.” Organization Studies30 (12): 1391–1418. doi: 10.1177/0170840609349875
     https://doi.org/10.1177/0170840609349875 [Google Scholar]
  50. Niederman, Michael S
    2005 The clinical diagnosis of VAP. Respiratory Care50 (6): 788–796.
     [Google Scholar]
  51. Orlikowski, Wanda J
    2007 “Socio-material Practices: Exploring Technology at Work.” Organization Studies28 (9): 1435–1448. doi: 10.1177/0170840607081138
     https://doi.org/10.1177/0170840607081138 [Google Scholar]
  52. Sacks, Harvey , Emmanuel A. Schegloff , and Gail Jefferson
    1974 “A symplest systematics for the organization of turn-taking for conversation.”Language50(4): 696–735. doi: 10.1353/lan.1974.0010
     https://doi.org/10.1353/lan.1974.0010 [Google Scholar]
  53. Sanchez Svenssson, Marcus , Paul Luff , and Christian Heath
    2010 “Embedded Instruction in Practice: Contingency and Collaboration during Surgical Training.” Communication in healthcare settings. Policy, Participation and New Technologies, ed. by Alison Pilnick , John Hindmarsh , and Virginia Teas Gill , 99–116. Oxford, UK: Wiley-Blackwell. doi: 10.1002/9781444324020.ch7
     https://doi.org/10.1002/9781444324020.ch7 [Google Scholar]
  54. Schegloff, Emmanuel
    1987 “Between Micro and Macro. Context and other connections”. InThe micro-macro link, eds. by Jeffrey C. Alexander , Bernhard Giesen , Richard Munch , and Neil J. Smelser , 207–234. Berkeley, CA: University of California Press.
     [Google Scholar]
  55. 1992 “On talk and its institutional occasions”. InTalk at Work. Interaction in institutional settings, eds. by Paul Drew , and John Heritage , 101–134. Cambridge, MA: Cambridge University Press.
     [Google Scholar]
  56. Schütz, Alfred
    1962 Collected Papers I: The Problem of Social Reality. Dordrecht, NL: Martinus Nijhoff Publishers.
     [Google Scholar]
  57. Schütz, Alfred , and Thomas Luckmann
    1973 The Structure of the Life-world. Vol.1. Evanston, IL: Northwestern University Press.
     [Google Scholar]
  58. Silverman, David
    2005 Doing Qualitative Research. A Practical Handbook. London, UK: Sage.
     [Google Scholar]
  59. Stivers, Tania
    2002 “Participating in Decisions about Treatment: Overt Parent Pressure for Antibiotic Medication in Pediatric Encounters.” Social Science & Medicine54 (7): 1111–1130. doi: 10.1016/S0277‑9536(01)00085‑5
     https://doi.org/10.1016/S0277-9536(01)00085-5 [Google Scholar]
  60. 2005 “Non-antibiotic Treatment Recommendations: Delivery Formats and Implications for Parents Resistance.” Social Science & Medicine60 (5): 946–964. doi: 10.1016/j.socscimed.2004.06.040
     https://doi.org/10.1016/j.socscimed.2004.06.040 [Google Scholar]
  61. 2006 “Treatment decisions: negotiations between doctors and patients in acute care encounters.”InCommunication in Medical Care: Interaction between Primary Care Physicians and Patients, eds. by John Heritage , and Douglas Maynard , 279–312. Cambridge, MA: Cambridge University Press. doi: 10.1017/CBO9780511607172.012
     https://doi.org/10.1017/CBO9780511607172.012 [Google Scholar]
  62. 2007 Prescribing Under Pressure. Parents-Physician Conversations and Antibiotics. Oxford, UK: Oxford University Press. doi: 10.1093/acprof:oso/9780195311150.001.0001
     https://doi.org/10.1093/acprof:oso/9780195311150.001.0001 [Google Scholar]
  63. 2008 “Stance, Alignment, and Affiliation during Storytelling: When Nodding is a Token of Affiliation.” Research on Language & Social Interaction41 (1): 31–57. doi: 10.1080/08351810701691123
     https://doi.org/10.1080/08351810701691123 [Google Scholar]
  64. Taylor, James R. , and Elizabeth J. Van Every
    2011 The Situated Organization. London: Routledge.
     [Google Scholar]
  65. 2014 When Organizations Fail: Why Authority Matters. London/New York:Routledge.
     [Google Scholar]
  66. Timmermans, Stefan , and Alison Angell
    2001 “Evidence-based Medicine, Clinical Uncertainty, and Learning to Doctor.” Journal for Health and Social Behaviour42 (4): 342–359. doi: 10.2307/3090183
     https://doi.org/10.2307/3090183 [Google Scholar]
  67. Tracy, Sarah J
    2013 Qualitative Research Methods: Collecting Evidence, Crafting Analysis, Communicating Impact. Chichester/Oxford/Malden: Wiley-Blackwell.
     [Google Scholar]
  68. van Dijk, Teun A
    2006 “Discourse, Context and Cognition.” Discourse Studies8 (1): 159–177. doi: 10.1177/1461445606059565
     https://doi.org/10.1177/1461445606059565 [Google Scholar]
  69. Weathersbee, Elizabeth T. , and Douglas W. Maynard
    2010 “Dialling for Donations: Practices and Actions in the Telephone Solicitation of Human Tissues.” Sociology of Health & Illness31 (6): 803–816. doi: 10.1111/j.1467‑9566.2009.01189.x
     https://doi.org/10.1111/j.1467-9566.2009.01189.x [Google Scholar]
  70. Weigand, Edda
    2010 Dialogue: The Mixed Game. Amsterdam, NE: John Benjamins. doi: 10.1075/ds.10
     https://doi.org/10.1075/ds.10 [Google Scholar]
/content/journals/10.1075/ld.6.3.03car
Loading
  • Article Type: Research Article
Keyword(s): communicative constitution of organization (CCO); diagnosis; doctor-doctor interaction; Intensive Care Unit; medical decision-making; poliphony

Most Cited

This is a required field
Please enter a valid email address
Approval was successful
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error