Politeness and prosody in the co-construction of medical provider persona styles and patient relationships
DOI:
https://doi.org/10.1558/japl.24177Keywords:
bilingual Spanish-English medical consultation, communicative style, stance, prosody, powerAbstract
The purpose of this paper is to demonstrate how politeness and prosody work in the construction of medical provider communicative styles. Data are taken from a corpus of audio-recorded and transcribed bilingual Spanish-English medical consultations in a community clinic in the United States. Through discourse analysis and prosodic analysis, we demonstrate that particular linguistic features contribute to the construction of stances associated with two medical-provider particular communicative styles that we identify as an egalitarian communicative style and an authoritarian communicative style. We also indicate ways in which these communicative styles may impact patient health outcomes in the local clinical context. Implications include the need for further research that engages in fine-grained linguistic analysis to understand provider styles and their relationship to patient health outcomes.
References
Aguilar, L., De-la-Mota, C. and Prieto, P. (2009) Spanish ToBI Training Materials. Available online: http://prosodia.upf.edu/sp_tobi/
Ainsworth-Vaughn, N. (1994) Is that a rhetorical question? Ambiguity and power in medical discourse. Journal of Linguistic Anthropology 4 (2): 194–214. https://doi.org/10.1525/jlin.1994.4.2.194
Ainsworth-Vaughn, N. (1998) Claiming Power in Doctor-Patient Talk. Oxford: Oxford University Press.
Beach, W. A. and Dixson, C. (2001) Revealing moments: Formulating understandings of adverse experiences in a Health Appraisal interview. Social Science and Medicine 52 (1): 25–44. https://doi.org/10.1016/S0277-9536(00)00118-0
Beckman, M. and Hirschberg, J. (1994) The ToBI Annotation Conventions. Available online: https://www.ling.ohio-state.edu/~tobi/ame_tobi/annotation_conventions.html.
Bertakis, K. D., Callhan, E. J., Helms, J. L., Rahman, A., Robbins, J. A. and Miller, J. (1998) Physician practice styles and patient outcomes: Differences between family practice and general internal medicine. Medical Care 36 (6): 879–891. https://doi.org/10.1097/00005650-199806000-00011
Bertakis, K. D., Putnam, S. M. and Roter, D. (1991) The relationship of physician medical interview style to patient satisfaction. Journal of Family Practice 32 (2): 175–185.
Blanch, D. C., Hall, J. A., Roter, D. A. and Frankel, R. M. (2009) Is it good to express uncertainty to a patient? Correlates and consequences for medical students in a standardized patient visit. Patient Education and Counseling 76 (3): 300–306. https://doi.org/10.1016/j.pec.2009.06.002
Boersma, P. and Weenink, D. (2017) Praat: Doing phonetics by computer [Computer program]. Version 6.0.35. Available online: http://www.praat.org/
Brown, P. and Levinson, S. (1987). Politeness: Some Universals in Language Usage. Cambridge: Cambridge University Press.
Buller, M. K. and Buller, D. B. (1987) Physicians’ communication style and patient satisfaction. Journal of Health and Social Behavior 28 (4): 375–388. https://doi.org/10.2307/2136791
Burman W. J., Cohn D. L., Rietmeijer C. A., Judson, F. N., Sbarbaro, J. A. and Reves R. R. (1997) Noncompliance with directly observed therapy for tuberculosis: Epidemiology and effect on the outcome of treatment. Chest 111 (5): 1168–1173. https://doi.org/10.1378/chest.111.5.1168
Cegala, D. J. (1997) A study of doctors’ and patients’ communication during a primary care consultation: Implications for communication training. Journal of Health Communication 2 (3): 169–194. https://doi.org/10.1080/108107397127743
Collins, S., Britten, N., Ruusuvuori, J. and Thompson, A. (eds) (2007) Patient Participation in Health Care Consultations: Qualitative Perspectives. Maidenhead, UK: Open University Press.
Collins, S., Drew, P., Watt, I. and Entwistle, V. (2005) ‘Unilateral’ and ‘bilateral’ practitioner approaches in decision-making about treatment. Social Science & Medicine 61 (12): 2611–2617. https://doi.org/10.1016/j.socscimed.2005.04.047
Du Bois, J. (2005) Prosody in a delicacy hierarchy for discourse transcription. Paper presented at Transcribing Now: Means and Meanings in the Transcription of Spoken Interaction, University of California, Santa Barbara, 15 May.
Eckert, P. (2008) Variation and the indexical field. Journal of Sociolinguistics 12 (4): 453–476. https://doi.org/10.1111/j.1467-9841.2008.00374.x
Fraser, B. and Malamud-Makowski, M. (1996) English and Spanish contrastive discourse markers. Language Sciences 18 (3–4): 863–881. https://doi.org/10.1016/S0388-0001(96)00052-6
Hannawa, A. F. (2011) Shedding light on the dark side of doctor–patient interactions: Verbal and nonverbal messages physicians communicate during error disclosures. Patient Education and Counseling 84 (3): 344–351. https://doi.org/10.1016/j.pec.2011.04.030
Heath, C. (1992) The delivery and diagnosis in the general practice consultation. In P. Drew and J. Heritage (eds) Talk and Work: Interaction in Institutional Settings, 235–267. Cambridge: Cambridge University Press.
Ijäs-Kallio, T., Ruusuvuori, J. and Peräkylä, A. (2010) Patient involvement in problem presentation and diagnosis delivery in primary care. Communication & Medicine 7 (2): 131–141.
Kane, S., Huo, D. and Aikens, J. (2003) Medication nonadherence and the outcomes of patients with quiescent ulcerative colitis. American Journal of Medicine 114 (1): 39–43. https://doi.org/10.1016/S0002-9343(02)01383-9
Kaplan, S. H., Greenfield, S., Gandek, B., Rogers, W. H. and Ware, J. E. (1996) Characteristics of physicians with participatory decision-making styles. Annals of Internal Medicine 124 (4): 497–504. https://doi.org/10.7326/0003-4819-124-5-199603010-00007
Mast, M. S, Hall, J. A. and Roter, D. L. (2007) Disentangling physician sex and physician communication style: Their effects on patient satisfaction in a virtual medical visit. Patient Education and Counseling 68 (1): 16–22. https://doi.org/10.1016/j.pec.2007.03.020
McConnell-Ginet, S. (1983) Intonation in a man’s world. In B. Thorne, C. Kramarae, and N. Henley (eds) Language, Gender, and Society, 69–88. Boston, MA: Heinle & Heinle.
Mishler, E. G. (1984) The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, NJ: Ablex.
Peräkylä, A. (1998) Authority and accountability: The delivery of diagnosis in primary health care. Social Psychology Quarterly 61 (4): 301–320. https://doi.org/10.2307/2787032
Podesva, R. (2011) Salience and the social meaning of declarative contours: Three case studies of gay professionals. Journal of English Linguistics 38 (3): 233–264. https://doi.org/10.1177/0075424211405161
Pomerantz, A. (1986) Extreme case formulations: A way of legitimizing claims. Human Studies 9 (2): 219–230. https://doi.org/10.1007/BF00148128
Pomerantz, A. and Rintel, S. (2004) Practices for reporting and responding to test results during medical consultations: Enacting the roles of paternalism and independent expertise. Discourse Studies 6 (1): 9–26. https://doi.org/10.1177/1461445604039437
Robles-Puente, S. (2011) Looking for the Spanish imperative intonation: Combination of global and pitch-accent level strategies. In S. M. Alvord (ed.) Selected Proceedings of the 5th Conference on Laboratory Approaches to Romance Phonology, 153–164. Somerville, MA: Cascadilla Proceedings Project.
Rodero, E. (2011) Intonation and emotion: Influence of pitch levels and contour type on creating emotions. Journal of Voice 25 (1): 24–34. https://doi.org/10.1016/j.jvoice.2010.02.002
Roter, D. L., Putnam, S. M., Lipkin, M., Stiles, W. and Inui, T. S. (1997) Communication patterns of primary care physicians. Journal of the American Medical Association 277 (4): 350–356. https://doi.org/10.1001/jama.1997.03540280088045
Sarangi, S. (2010) Reconfiguring self/identity/status/role: The case of professional role performance in healthcare encounters. Journal of Applied Linguistics and Professional Practice 7 (1): 75–95. Also published 2010 in G. Garzone and J. Archibald (eds) Discourse, Identities and Roles in Specialized Communication, 33–57. Bern: Peter Lang.
Silverstein, M. (2003) Indexical order and the dialectics of sociolinguistic life. Language and Communication 23 (1): 193–229. https://doi.org/10.1016/S0271-5309(03)00013-2
Smith, D. L. (1989) Compliance packaging: A patient education tool. Journal of the American Pharmaceutical Association 42 (5): 49–53. https://doi.org/10.1016/S0160-3450(15)31856-0
Stivers, T. and Heritage, J. (2001) Breaking the sequential mold: Answering more than the question during comprehensive history taking. Text 21 (1–2): 151–185. https://doi.org/10.1515/text.1.21.1-2.151
Strasser, F., Palmer, J. L., Willey, J., Shen, L., Shin, K, Sivesind, D., Beale, E. and Bruera, E. (2005) Impact of physician sitting versus standing during inpatient oncology consultations: Patients’ preference and perception of compassion and duration. A randomized controlled trial. Journal of Pain Symptom Management 29 (5): 489–497. https://doi.org/10.1016/j.jpainsymman.2004.08.011
Tannen, D. (1991) Talking Voices: Repetition, Dialogue, and Imagery in Conversation. Cambridge: Cambridge University Press.
Vickers, C., Deckert. S. and Goble, R. (2014) Constructing language normativity through the animation of stance in Spanish-language medical consultations. Health Communication 29 (7): 707–716. https://doi.org/10.1080/10410236.2013.778224
Ainsworth-Vaughn, N. (1994) Is that a rhetorical question? Ambiguity and power in medical discourse. Journal of Linguistic Anthropology 4 (2): 194–214. https://doi.org/10.1525/jlin.1994.4.2.194
Ainsworth-Vaughn, N. (1998) Claiming Power in Doctor-Patient Talk. Oxford: Oxford University Press.
Beach, W. A. and Dixson, C. (2001) Revealing moments: Formulating understandings of adverse experiences in a Health Appraisal interview. Social Science and Medicine 52 (1): 25–44. https://doi.org/10.1016/S0277-9536(00)00118-0
Beckman, M. and Hirschberg, J. (1994) The ToBI Annotation Conventions. Available online: https://www.ling.ohio-state.edu/~tobi/ame_tobi/annotation_conventions.html.
Bertakis, K. D., Callhan, E. J., Helms, J. L., Rahman, A., Robbins, J. A. and Miller, J. (1998) Physician practice styles and patient outcomes: Differences between family practice and general internal medicine. Medical Care 36 (6): 879–891. https://doi.org/10.1097/00005650-199806000-00011
Bertakis, K. D., Putnam, S. M. and Roter, D. (1991) The relationship of physician medical interview style to patient satisfaction. Journal of Family Practice 32 (2): 175–185.
Blanch, D. C., Hall, J. A., Roter, D. A. and Frankel, R. M. (2009) Is it good to express uncertainty to a patient? Correlates and consequences for medical students in a standardized patient visit. Patient Education and Counseling 76 (3): 300–306. https://doi.org/10.1016/j.pec.2009.06.002
Boersma, P. and Weenink, D. (2017) Praat: Doing phonetics by computer [Computer program]. Version 6.0.35. Available online: http://www.praat.org/
Brown, P. and Levinson, S. (1987). Politeness: Some Universals in Language Usage. Cambridge: Cambridge University Press.
Buller, M. K. and Buller, D. B. (1987) Physicians’ communication style and patient satisfaction. Journal of Health and Social Behavior 28 (4): 375–388. https://doi.org/10.2307/2136791
Burman W. J., Cohn D. L., Rietmeijer C. A., Judson, F. N., Sbarbaro, J. A. and Reves R. R. (1997) Noncompliance with directly observed therapy for tuberculosis: Epidemiology and effect on the outcome of treatment. Chest 111 (5): 1168–1173. https://doi.org/10.1378/chest.111.5.1168
Cegala, D. J. (1997) A study of doctors’ and patients’ communication during a primary care consultation: Implications for communication training. Journal of Health Communication 2 (3): 169–194. https://doi.org/10.1080/108107397127743
Collins, S., Britten, N., Ruusuvuori, J. and Thompson, A. (eds) (2007) Patient Participation in Health Care Consultations: Qualitative Perspectives. Maidenhead, UK: Open University Press.
Collins, S., Drew, P., Watt, I. and Entwistle, V. (2005) ‘Unilateral’ and ‘bilateral’ practitioner approaches in decision-making about treatment. Social Science & Medicine 61 (12): 2611–2617. https://doi.org/10.1016/j.socscimed.2005.04.047
Du Bois, J. (2005) Prosody in a delicacy hierarchy for discourse transcription. Paper presented at Transcribing Now: Means and Meanings in the Transcription of Spoken Interaction, University of California, Santa Barbara, 15 May.
Eckert, P. (2008) Variation and the indexical field. Journal of Sociolinguistics 12 (4): 453–476. https://doi.org/10.1111/j.1467-9841.2008.00374.x
Fraser, B. and Malamud-Makowski, M. (1996) English and Spanish contrastive discourse markers. Language Sciences 18 (3–4): 863–881. https://doi.org/10.1016/S0388-0001(96)00052-6
Hannawa, A. F. (2011) Shedding light on the dark side of doctor–patient interactions: Verbal and nonverbal messages physicians communicate during error disclosures. Patient Education and Counseling 84 (3): 344–351. https://doi.org/10.1016/j.pec.2011.04.030
Heath, C. (1992) The delivery and diagnosis in the general practice consultation. In P. Drew and J. Heritage (eds) Talk and Work: Interaction in Institutional Settings, 235–267. Cambridge: Cambridge University Press.
Ijäs-Kallio, T., Ruusuvuori, J. and Peräkylä, A. (2010) Patient involvement in problem presentation and diagnosis delivery in primary care. Communication & Medicine 7 (2): 131–141.
Kane, S., Huo, D. and Aikens, J. (2003) Medication nonadherence and the outcomes of patients with quiescent ulcerative colitis. American Journal of Medicine 114 (1): 39–43. https://doi.org/10.1016/S0002-9343(02)01383-9
Kaplan, S. H., Greenfield, S., Gandek, B., Rogers, W. H. and Ware, J. E. (1996) Characteristics of physicians with participatory decision-making styles. Annals of Internal Medicine 124 (4): 497–504. https://doi.org/10.7326/0003-4819-124-5-199603010-00007
Mast, M. S, Hall, J. A. and Roter, D. L. (2007) Disentangling physician sex and physician communication style: Their effects on patient satisfaction in a virtual medical visit. Patient Education and Counseling 68 (1): 16–22. https://doi.org/10.1016/j.pec.2007.03.020
McConnell-Ginet, S. (1983) Intonation in a man’s world. In B. Thorne, C. Kramarae, and N. Henley (eds) Language, Gender, and Society, 69–88. Boston, MA: Heinle & Heinle.
Mishler, E. G. (1984) The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, NJ: Ablex.
Peräkylä, A. (1998) Authority and accountability: The delivery of diagnosis in primary health care. Social Psychology Quarterly 61 (4): 301–320. https://doi.org/10.2307/2787032
Podesva, R. (2011) Salience and the social meaning of declarative contours: Three case studies of gay professionals. Journal of English Linguistics 38 (3): 233–264. https://doi.org/10.1177/0075424211405161
Pomerantz, A. (1986) Extreme case formulations: A way of legitimizing claims. Human Studies 9 (2): 219–230. https://doi.org/10.1007/BF00148128
Pomerantz, A. and Rintel, S. (2004) Practices for reporting and responding to test results during medical consultations: Enacting the roles of paternalism and independent expertise. Discourse Studies 6 (1): 9–26. https://doi.org/10.1177/1461445604039437
Robles-Puente, S. (2011) Looking for the Spanish imperative intonation: Combination of global and pitch-accent level strategies. In S. M. Alvord (ed.) Selected Proceedings of the 5th Conference on Laboratory Approaches to Romance Phonology, 153–164. Somerville, MA: Cascadilla Proceedings Project.
Rodero, E. (2011) Intonation and emotion: Influence of pitch levels and contour type on creating emotions. Journal of Voice 25 (1): 24–34. https://doi.org/10.1016/j.jvoice.2010.02.002
Roter, D. L., Putnam, S. M., Lipkin, M., Stiles, W. and Inui, T. S. (1997) Communication patterns of primary care physicians. Journal of the American Medical Association 277 (4): 350–356. https://doi.org/10.1001/jama.1997.03540280088045
Sarangi, S. (2010) Reconfiguring self/identity/status/role: The case of professional role performance in healthcare encounters. Journal of Applied Linguistics and Professional Practice 7 (1): 75–95. Also published 2010 in G. Garzone and J. Archibald (eds) Discourse, Identities and Roles in Specialized Communication, 33–57. Bern: Peter Lang.
Silverstein, M. (2003) Indexical order and the dialectics of sociolinguistic life. Language and Communication 23 (1): 193–229. https://doi.org/10.1016/S0271-5309(03)00013-2
Smith, D. L. (1989) Compliance packaging: A patient education tool. Journal of the American Pharmaceutical Association 42 (5): 49–53. https://doi.org/10.1016/S0160-3450(15)31856-0
Stivers, T. and Heritage, J. (2001) Breaking the sequential mold: Answering more than the question during comprehensive history taking. Text 21 (1–2): 151–185. https://doi.org/10.1515/text.1.21.1-2.151
Strasser, F., Palmer, J. L., Willey, J., Shen, L., Shin, K, Sivesind, D., Beale, E. and Bruera, E. (2005) Impact of physician sitting versus standing during inpatient oncology consultations: Patients’ preference and perception of compassion and duration. A randomized controlled trial. Journal of Pain Symptom Management 29 (5): 489–497. https://doi.org/10.1016/j.jpainsymman.2004.08.011
Tannen, D. (1991) Talking Voices: Repetition, Dialogue, and Imagery in Conversation. Cambridge: Cambridge University Press.
Vickers, C., Deckert. S. and Goble, R. (2014) Constructing language normativity through the animation of stance in Spanish-language medical consultations. Health Communication 29 (7): 707–716. https://doi.org/10.1080/10410236.2013.778224
Published
2018-07-11
Issue
Section
Articles
License
Equinox Publishing Ltd.
How to Cite
Vickers, C. H., & Goble, R. (2018). Politeness and prosody in the co-construction of medical provider persona styles and patient relationships. Journal of Applied Linguistics and Professional Practice, 11(2), 202-226. https://doi.org/10.1558/japl.24177
