Introduction 28 sng an ec spel purposes M aie ‘Zwart (es), Reflections on language and one a ine jlese: studi recenti e prospettive ee ee Lelia ica Teorica e Applicata, 37 (1). PP- a) “Media Englishes «rescc nd Grego K.foeoming Mean & Keg (es), Pers EST nrc arty Bom cet mange Spain Duc, PtH 2% San Saget (i) 2006 a Mancha, ec ang Be een me cacian & rego (68) fh rgish Pome Monza ; en C eral, 2003, “Understanding commanicatin ns PENGST identification f edad Education, 37. pP-192-2 istes™, Medical Education, 37, pP-192-20 ‘of components of communica Some! $ & C. Roberts (24s) 1999, Ta, Work and Wnts Order: Discourse fork and Institutional ry (eds) t 7 . in Medical. rs, Mouton de Gruyter, Berlin jourse as professional iss sing, Perspectives on Medical “\ediation and Management Setins ‘Anna Loiacono, Giovanni lamartino and Kim 8. Grego (eds), Teaching Medical English: Methods and Models, 29-55 ©2011 Polimeirica Intemational Scientific Publisher Monzaltaly Insights into medical discourse in oral and written contexts! Maurizio Gotti (Universita di Bergamo) 1. Introduction Medicine, as it is practised nowadays, developed largely in the 17th, 18th and 19th centuries. Scientific medicine (so called in opposition to complementary/altemative medicine referred to as “unscientifi ‘or unorthodox) was based on testable and replicable results published in research papers, review articles and meta-analyses, Evidence- based medicine replaced the early medical traditions which were mainly based on the scholastic approach according te which the claims of prominent personalities were not to be discussed; they were, on the contrary, adopted as absolute truth (cf. Taavitsainen & Pahta 2004), Before the 17th century the doctrines of the ancient world dominated the theory and practice of Western medicine Galenism, for example, taught that diseases resulted from an imbalance in the ‘four humours’, and that treatment with bloodletting and purging would re-establish equilibrium. This period was very important for the development of English medical discourse, as these centuries marked a remarkable increase in the use of the vernacular for medical and scientiic writing, Indeed, at the beginning of this period Latin still had a dominant role. At the end of this period English prevailed, and the process of vernacularization can be described as largely completed by 1700, when we can find a full range of sophisticated university treatises on medicine in English where Latin played little or no role. Indeed, of the 238 medical books published in the years 1640-1660, 207 were in English (Webster 1974: 267). ' ‘The research on which this paper is based contributes to the National Research Programme “Tension and Change in Domain-specifie Genres” funded by the Italian Ministry of University (COFIN Grant No, 2007JCY9Y9),—EEEE | Maurizio Gott istemological and methodological developmen's place in that period, both in medicine and svar old schol Making began to be Feplaced by new patterns of thought and new rnathodologies based on observation and interpresticy of physical phenomena (cf. Vickers 1987; Hunter 1989; Jardine 1999; Shapiro B}00), These developments determined the need for corresponding zhanges both in the ways of communicating the net discoveries Mi adopting an ethnomethodological approach, conversation ims to show how the analysis of are mreraction can help to explain the organisation of the structures OF social institutions. By focusing on language Tt terms of social ysis uses naturally occurring data of verbal aed subjects it to close turn-by-turn examination, © ‘communi which no detail of the interaction is @ prior! regarded as insignificant The analysis is aimed to show that the different phases of an interaction tend to have different characterisct depending on its sequential development and itis for this rm that conversation defining the interaction within phases analysis studies concentrate on of talk, such as opening or closing sequences. he ature and structure of turn-aking can Pe investigated by means of a number of analytical tools. The first of these is the Mncept of the adiacency pair, which presvPpenr that in paired cterances (e-2, question-answer) the production of the second part is med by the first part. Consider the example, of @ quence of an encounter between a Pl (Dr. B) and a ~aughter (Die, in which the forme establishes the terminal ‘of the patient and thereby implies the furiity ‘of continued (2). De. E: [Phase 2 summary) {Whe dev! think she's ever going to 2 got better. We ean keep her body alive on 3 fhe machine for a very long period of time, bur 4 Dir: ==but she is going now. Soe phase 3 decision-making) And it sounds like th what she would want. _ history ofthe early development of conversation DS ey be found ory or sven studies are presented in Ten Have (199) For 3 thin recent years see Bowles (2006) in Heri ‘discussion ofthe main researc Insights into medical discourse in oral and ‘written contexts ar 6 Dir: No, 7 Dr. E: Everybody is in 1 Dr. Everybody i in grsrent with that and hts what Dr. 9 everybody said, her 10 to me, it sounds 11 Dir: No, As can be seen, ‘ , the daughter’s turns are doctor's opening moves: in Line 4 fe inion that the patient wis ing, ive i ns cat pt nn op a interpretations, such a ; acceptin, interpre 4 ig oF refusing when oF thanking when ove is given something. Another nother aie an interaction use t trouble or a problem in understanding. tue which is bec: is becomi intercultural medical discourse. ing increasingly researched in The use of v prodcet an corre samples in conversation analysis hé tle in the amount of attention paid tothe role of me lee in the organisation of medial talk, as (Modatt 2003), mayne lence (Ten Have 1991), body mover Macha tttssctiona have muy teen icles TCH 2002). a 1s have mainly been investi . ‘us on the analysis of their characteristic edad rl quent Ik, such as———— Maurizio Gs 8 & Heritage 2001). Various (Robinson & Stivers 2001; Stivers spects of is activity have been analysed, such the way doctors and patients interact in the di receive good! and bad news, negotiate prescr feat results or discuss taboo subjects such as Sexuality, Other aspects that have been investiga asymmetrical power relations. The analysis of some settings, interview or the psychiatric interview, from traditional tient interview, for example, has been shown 10 bs (Ribeiro & Pinto 2006), as the interactional process may be 10 often talk facilitated or inhibited by the participants themse|ves, whe Tadeed!, patients bring up idiosyncratic topics and Jpiatrists have to use their at cross-purposes, , often get ‘off the track’, In this case, psycl orerviewing competence (Shea 1998) to get back on t0P! their patients into less digression. bring up topic frequently ongoing conversation. They try to follow their i which implies their gathering patients’ inf diagnosis and establishing a course of act have different expectations as they see ‘opportunity to introduce personal illnesses. rAnother kind of activity which has relates to interactions taking place wi programme. One example is the study of surgical instruct Sperating theatre. As Zemel (2003) has shown, this complex as medi with a surgeon teaching ané Same time demonstrating surgical techniques t© ‘within the context of attending to the pal the staff present in the operating theatre, This {important in training terms, as it helps to poh phase, or deliver and jon requests, deal sed in the analysis of SPerews are the way participants take on specific wictform to particular identity traits or establish such as the psychotherapy has shown differentiations pey%ctional devices used in the organisation of the {interview patter. The psychiatric 1¢ a very complex activity fe interviewers themselves may jerrupting the al agenda, reaching & narratives unrelated to their tly been investigated iin a medical training ning is often simultaneous and multi-layered, my to medical students while at the trainee surgeons, all i being operated on and \d of study is very int out the key moments Insights into medical discourse in oral and ind written contexts 49 when the interact interaction between trainei ainer and. trai problematic. Moreover, in some educ: ation, Woes re is speech pathology, as as th effects of c effets of communication impaimment in a meaningful and rea manner, partculatly in the areas of aphasia and search. As regards the s)s convinced convers: is particular because it is able “to draw attention to the od soho ers’ conversation i strain eels the orgaisstional constraints a 1, straints of ‘A further area in which convers is convinced that has proved yhenomenon high rates which has become of imi cane In this context the study of oral medical di hepful for diagnosing, when interactional problems are tions. Indeed, consultations between doctors and patients are part of the chan, ee ee reality resulting from globalisation from range of ethic ang «backgrounds (Roberts 2006). a rogeneous eens a ea wit tems ote eed for ae rs and how they are used. The ity of such it ia is that patents do not come from a small number of linguistic grouy Ms Ips whose healt ly summarised and for whom interpreters ra Eversely 2000) and and each year the etht workers figeesandacyiumseekes enter ne sige Another aspect of intercultural communi the teams. ae wider contexts of the organisational processes of ‘new work order’ are reflected in their discourses and representEe _ 0 Mauizi Gott issue to be investigated if we want to develop & very interesting and discursive practices. deeper understanding of these social 4. Conclusions ‘As has been seen, medical discourse can be analyzed from maty perspectives: from a structural angi fan emphasis on the Goctor-patient relationship and on the social power re lationship; from from a gender fa cross-cultural/cross-linguistic standpoint perspective; from a cross-specialty viewpoints and from an ethical ingle in terms of how medicine serves the gosls of beneficence, ane'omy and justice. Ths richness of viewpoints is due (0 hs fact that in the past 30 years medical care in the Western world has ineteasingly emphasized ‘patient-centredness’ and patient ausonoly inpeision making which imply greater response t0 the concerns ‘ons of the patient, including shared-decision that the consultation arian, less bio-medical. Although physicians ed higher status and and have a public health measure, both advantages and dis categories of pati ‘occurred in the last 25 years as the c: third parties (insurance companies or government agencies) often ‘emand. a share of decision-making power, thus reducing the freedom of choice of both doctors and patients in many Ways. “This change of perspective is reflected in research on medical discourse, which has recently widened its focus taking inv iscotpation areas. which were once considered marginal, oF frrelevant, such as an interest in the talk of the patients themselves ap the’ analysis of interaction between patients involved. 1h Therapeutic sessions. Another recent area of study has Poet medical expertnon-expert talk with studies of such topics as. Tey diagnosis’ ind of talk, occurring between non-speci medicine’, is a growing area of medical disco Teflects the widening scope of health care research in. gene phenomenon which was bound to enlarge the Focus of applied Insights into medical discourse in ral and written cont texts si for health s : which needs to be ur estigated: par in the intercultural sphere. enty an wet 28 of terest and development for research cl discourse concern inary suis of bel studies of hea by the er ve eee ent developments of linguistic studies which have ad os ne Seonches and analytical tools of was isciplines other than linguistics such i reenie such and sociology, anthropology Eee eee the various branches of li : perspective concerns not ‘ones due to the intemation: linguistic backgrounds. Thus more and mere communication stils textbooks ate being produced for the tining Stor 5 Hingis iinguistic features of medical intera improved communication and the p ic interest in this speci approaches. developed for linguistic analys encount gacounters involving” multiple interactions and. pasties, and Participants, including different health ca 8. There are a number of reasons reasons ly to continue hanks to thei itrdcipliary nate, metotoloncalyMaurizio Gott Insights into medical discourse in oral and wit 2 f text, they ics and applicability to all forms o' adaptable chars Tep up with the continuous diversification of are vel eines a \d the Kind of discourse wi health care settings and practices anc they are likely to produce, References jon Analytic Perspective Reflections and Observations”, Si Research, | ingual Capital. The Languages of i. 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