Journal of Asian Pacific Communication - Volume 20, Issue 2, 2010

Data from multicultural contexts add more complexity to many findings regarding healthcare practices that have been reported in the literature. For example, patient participation has been reported to contribute to the enhancement of healthcare results (e.g. Candlin, 2006; Thompson, 2008). However, patient participation may be problematic when participants in the medical encounter face sociocultural and linguistic barriers. In this paper we focus on interactional difficulties that non-native speakers of English encounter in prenatal genetic counseling sessions. These difficulties, we argue, may place limitations on the extent of patient participation, when patient participation is narrowly defined in terms of verbal contributions. The data for the study come from a prenatal genetic counseling clinic in Hong Kong, and the participants of the interactions originate from various countries in the Asia region. Using a conversation analytic approach, we examine interactional difficulties in an attempt to capture the specific challenges faced by healthcare providers and patients in an increasingly diverse healthcare context. We also argue for an ethnographic perspective to examine patient participation in the multilingual context and to highlight dimensions of second language use and cultural diversities as observable evidence of patient participation.

Novices and experts alike must engage in the interactional complexities of clinical consultations as a form of institutional talk. This includes reconciling the demands of task completion with those of effective patient communication in order to achieve successful outcomes. This paper reports a study that identifies ‘giving reassurance’ as an area of relative communicative weakness for undergraduate student dentists (novices) and examines the mechanisms by which an experienced dentist (expert) interactionally accomplishes ‘reassurance’ during a single consultation in a multilingual Asian dental education clinic. Two stages of data gathering and analysis were adopted within a multivariate framework (Heritage and Maynard, 2006). First, 51 student dentists were rated using a 360° approach during a single clinical consultation. Interactants and observers rated each student’s communicative performance using an established scale in dentistry (Theaker, Kay, and Gill, 2000). Descriptive statistical analysis identified areas of relatively lower communication performance with ‘giving reassurance’ during the ‘examination’ stage consistently rated as the least accomplished skill. Second, an experienced dentists’ consultation was audio recorded and transcribed. Using conversational analysis (CA) as the method of analysis, strategies are identified in the process of an experienced dentist and a patient co-constructing ‘reassurance’ as a two-way process.

This study focuses on instructional talk during prenatal visits in Japan. In order to prepare an upcoming delivery, a midwife often engages in instructional talk about the patient’s self-care at home. Yet, giving instruction is an interactionally challenging task, even in the medical setting. For example, a recipient may not accept advice easily, since this may reveal a recipient’s lack of knowledge and incompetence. By using conversation analysis, I find some interactional steps through which a midwife establishes interactional relevance of instruction. These steps include (1) assuring readiness of a recipient, (2) unpacking instruction and (3) contextualizing the instruction to a recipient’s everyday life. In each step, a patient’s claim for her competency and concern is used as a resource for developing the instructions. For example, a midwife gives advice to a patient about self-care in order to address the patient concerns. Instead of simply teaching what is generally considered necessary to self-care for delivery, a midwife designs her advice according to what an individual patient has expressed as a concern and what can be anticipated for her situation given her social category. This allows a more individualized presentation manner, which may encourage a patient’s active participation in her self-care.

Sex and sex-related topics are rather sensitive in the Chinese culture, thus conversations about those topics prove to be a delicate issue. The present study uses Conversation Analysis as the research methodology to analyze the use of communicative strategies in doctor–patient communication about venereal disease. The data excerpt analyzed is from a radio phone-in program that offers medical advice for males’ sex-related diseases, solves problems that the listeners have about certain sexual behavior, and provides general sexual knowledge. In the telephone call selected for the present research, the caller is the mother of the young man who is infected with venereal disease and needs help from the medical expert who is on the program. The mother employs indirect compliment, direct compliment, insider claim, and sympathy seeking as communicative strategies to build solidarity with the doctor. The various communicative strategies used lead to a smooth sequential development of the communication, and illustrate how solidarity-building serves an important function in this specific healthcare context.

This paper examines the interactional accomplishment of information delivery in the context of prenatal genetic counselling (PGC) in Hong Kong. We argue that information delivery is structured as a joint activity between the healthcare provider and the patient, and the structure of the talk takes into account the patient’s experience and knowledge of medical issues. The healthcare provider ‘taps into’ the patient’s knowledge and experience by using what we call ‘initial inquiries’ as a means of introducing potentially new information. We define initial inquiries as a type of question-response sequence that initiates the speaker’s future action of information delivery. In this way, the information delivery is constructed as a joint activity and healthcare providers can also ‘tailor’ the information according to each individual patient. This study is part of a larger on-going interactional study of PGC based on video data recorded in a Prenatal Diagnostics and Counselling Department of one Hong Kong hospital between 2005 and 2008 and comprises more than 17 hours of recordings. We use a conversation analytic approach to examine the interactional organization of talk used in the accomplishment of information delivery.

This study analyses patient questions in prenatal genetic counselling (PGC) in a Hong Kong hospital. The focus is on the kinds of questions asked by the patients and the sequential environments in which the questions are asked. The ten patients in the study are pregnant women at or above 38 years of age, four local Cantonese-speaking Chinese, and six of Filipina or Thai origin. The PGC is conducted by a nurse who communicates with the Chinese patients in Cantonese and with the non-Chinese patients in English. Two broad types of questions, medical and administrative, in line with the purpose of PGC, are found in both groups. While both groups share a concern on the accuracy of the test, the Chinese group asks more questions on medical details beyond the issue of accuracy. With regard to sequential environments, questions may be either ‘occasioned’ by the nurse’s prior talk or ‘self-motivated’; both may occur in the positions for minimal responses in extended information delivery sequences. Self-motivated questions also occur as a second or later component in the patient’s extended turn. While the two groups of patients ask questions from either of the sequential positions, a qualitative difference lies in the turn design of the self-motivated questions.

Because preventive care is a critical step in promoting public health, medical professionals provide health education in order to inform the public how to avoid diseases. However, in a multilingual society such as Taiwan, where Western medical discourse is carried on mainly in Mandarin (the official language) and English (a foreign language and the lingua franca of Western medicine), the issue of how medical professionals communicate their knowledge to the lay public, especially to elderly patients who are monolingual in the local dialect of Southern Min, is a pressing concern. In this paper, I examine two osteoporosis education talks conducted by a male visiting physician at a teaching hospital in southern Taiwan. My analysis focuses on the speaker’s choice of language and lexical synonyms in conveying the two key concepts of ‘bone quality’ and ‘non-solid’, i.e., osteoporosis. By applying Ferguson’s high and low varieties (1972: 234) and Tsai’s four principles in quantifying lexical formality (2008), I observe that, due to the lack of an established writing system, Southern Min is hardly used in the written slides of the speaker’s presentation, and in fact occurs even less often than English does. Instead, Chinese characters representing Mandarin are the dominant language used in the written messages. While this form of presentation might cause comprehension problems for illiterate and monolingual speakers of Southern Min, this communication problem is offset by the speaker’s preference for Southern Min, the vernacular language, in the spoken form. Further discourse analysis leads to my arguments that (1) the speaker’s preference for linguistic expressions with less formality in the spoken discourse is a strategy in providing comprehensive and easy-to-access medical knowledge for the lay audience, (2) the de-formalization process of medical jargon moves from the higher codes to the lower ones in the discourse flow, and (3) the complementary distribution of higher codes on the written slides and lower codes in the spoken form facilitates the speaker’s task of delivering medical knowledge. The pedagogical implications of this research provide a practical guideline for medical professionals with regard to promoting the public’s medical literacy.