Seeking Narrative Coherence: Doctors' Elicitations and Patients' Narratives in Medical Encounters

<p>This thesis presents research on how doctors and patients negotiate meaning through interaction, focusing on the role of narrative in the medical encounter. Within sociolinguistics, most previous studies using discourse analysis to analyze patients’ narratives have adopted the canonical (Labovian) framework. This thesis adds more recent approaches to narrative analysis, within an interactional sociolinguistics (IS) framework in order to examine the relationship between doctor elicitations and patient narratives. The analysis also explores the clinical approach of Narrative Medicine (NM), which offers patients “space” in which to construct their narratives, to create an interdisciplinary lens for exploring data. The data comprised 69 videotaped medical interviews, amounting to 18 hours of naturally occurring medical interactions, plus evaluative feedback from questionnaires and interviews with 12 doctors. All interactions were initially analyzed for canonical narrative components. Twelve interactions were then selected for more detailed analysis on the basis of the frequency of doctors’ elicitations, which represent medical interview approaches. The analysis of these interactions demonstrates how and to what extent participant roles and identities frame the co-construction of patient narratives. Evaluations of three of the interactions by 12 doctors provided information on how aspects of patient narratives are perceived by clinicians, particularly with respect to the types and amounts of patient information considered necessary for making diagnostic decisions. Key findings demonstrate that both patients and doctors seek to construct narrative coherence. The analysis shows how the frame of developing narrative coherence offers insights on the interactional narratives as they are co-constructed by participants. Patients living with chronic illness may have difficulty constructing coherent narratives, and thus, strategies for developing narrative coherence are important for both patients and doctors when managing patients’ chronic illnesses. Additionally, in constructing narrative coherence, patients present important aspects of their identities potentially offering important information related to their illness and intervention. Evaluating doctors’ also engaged in using this frame which offers insight into one way doctors develop their professional identities and perhaps indicates the strength of the role of narrative in our lives. This research represents a first attempt to use both interactional sociolinguistics and NM to contribute to the understanding of doctor-patient interaction. Overall, the research indicates that narrative plays an important part in constructing relevant meanings in medical interactions between doctor and patient. Patients strive to create a coherent narrative as they present their medical problem to their doctor. Although this analysis provides further evidence of the relevance of the power asymmetry in medical interviews, it also suggests ways in which patients can shape their narratives to construct themselves as active agents to their benefit in medical interactions.</p>

Seeking Narrative Coherence: Doctors' Elicitations and Patients' Narratives in Medical Encounters

<p>This thesis presents research on how doctors and patients negotiate meaning through interaction, focusing on the role of narrative in the medical encounter. Within sociolinguistics, most previous studies using discourse analysis to analyze patients’ narratives have adopted the canonical (Labovian) framework. This thesis adds more recent approaches to narrative analysis, within an interactional sociolinguistics (IS) framework in order to examine the relationship between doctor elicitations and patient narratives. The analysis also explores the clinical approach of Narrative Medicine (NM), which offers patients “space” in which to construct their narratives, to create an interdisciplinary lens for exploring data. The data comprised 69 videotaped medical interviews, amounting to 18 hours of naturally occurring medical interactions, plus evaluative feedback from questionnaires and interviews with 12 doctors. All interactions were initially analyzed for canonical narrative components. Twelve interactions were then selected for more detailed analysis on the basis of the frequency of doctors’ elicitations, which represent medical interview approaches. The analysis of these interactions demonstrates how and to what extent participant roles and identities frame the co-construction of patient narratives. Evaluations of three of the interactions by 12 doctors provided information on how aspects of patient narratives are perceived by clinicians, particularly with respect to the types and amounts of patient information considered necessary for making diagnostic decisions. Key findings demonstrate that both patients and doctors seek to construct narrative coherence. The analysis shows how the frame of developing narrative coherence offers insights on the interactional narratives as they are co-constructed by participants. Patients living with chronic illness may have difficulty constructing coherent narratives, and thus, strategies for developing narrative coherence are important for both patients and doctors when managing patients’ chronic illnesses. Additionally, in constructing narrative coherence, patients present important aspects of their identities potentially offering important information related to their illness and intervention. Evaluating doctors’ also engaged in using this frame which offers insight into one way doctors develop their professional identities and perhaps indicates the strength of the role of narrative in our lives. This research represents a first attempt to use both interactional sociolinguistics and NM to contribute to the understanding of doctor-patient interaction. Overall, the research indicates that narrative plays an important part in constructing relevant meanings in medical interactions between doctor and patient. Patients strive to create a coherent narrative as they present their medical problem to their doctor. Although this analysis provides further evidence of the relevance of the power asymmetry in medical interviews, it also suggests ways in which patients can shape their narratives to construct themselves as active agents to their benefit in medical interactions.</p>

INTERACTIONAL SOCIOLINGUISTICS IN CASUAL CONVERSATION OF GRADUATE STUDENT IN EFL CONTEXT: A PRAGMATICS STUDY

Communicating to others towards text which is as the result of discourse is everyone need. In producing text, there are some factors affected. Context which is one important influential factor needs to be analyzed. On the other hand, conversation as a media of exchanging meaning among the speakers are done in order to fulfill speaker aim. Pragmatics that learns meaning is seen as the best media to learn meaning produced by both speakers related to the context. By using interactional sociolinguistics, as a part of conversation analysis in pragmatics, this approach takes pragmatic and sociolinguistics aspects of interaction, as well as adjacency pairs, turn-taking and sequences, giving importance to the way that language is situated in particular circumstances in social life. Based on the analysis done, it maps out that interactional talk claiming common ground with vague reference as a marker of both speaker friendship. Key words: Interactional Sociolinguitics, Casual Conversation, EFL

The Effect of Social Class on the Linguistic Behavior of Saudi Female Employees at Al-Imam Muhammed Ibn Saud Islamic University

This study aimed to investigate how the linguistic behaviors of Saudi female employees at Al-Imam Muhammad Ibn Saud Islamic University index their social class identity. The study used a holistic case with embedded units design. The researchers carried out interviews to collect the data. The interview questions were validated by eight EFL university professors. Besides, the discourse analysis was discussed based on the ethnography of communicative approach and the interactional sociolinguistics approach. The data analysis revealed that the linguistic behavior of the Saudi female employees yielded variant extents of indexation to their social class identity in terms of self-esteem, prestige, and power. The results proved that the linguistic behavior of the professors indexed their high-class identity in terms of their high level of self-esteem, high level of prestigious state, and high level of possessing power emotions. In addition, the linguistic behavior of the security employees indexed only two phases of their middle-class identity which were unsuccessful attempts to be prestigious speakers and their moderate sense of power. Finally, the indexation of the workers’ identity as low-class speakers was manifested in their linguistic behavior in terms of the low level of self-esteem and lack of power possession emotions.

Three decades in the field of gender and language

This essay provides an account of one scholar’s thirty-five-year immersion in language and gender research. I included a chapter on conversations between women and men in That’s Not What I Meant!, my first book for general audiences, as part of an overview of interactional sociolinguistics. Disproportionate interest in that chapter led me to write You Just Don’t Understand, which I assumed would be my last word on the topic. Then insights into gendered patterns turned out to be crucial in all my subsequent books, each of which grew out of the one before. Writing about gendered patterns in conversational interaction raised my own consciousness, illuminating aspects of a previous study that I had overlooked. It also brought me face to face with agonistic conventions in academic discourse, and the distortions and misrepresentations that result from them.

FRAME ANALYSIS OF MICROTEACHING IN A COMMUNITY OF PRACTICE OF TEACHERS OF ENGLISH AS AN ADDITIONAL LANGUAGE IN SOUTHERN BRAZIL

The purpose of this study is to discuss the discourse practice of microteaching in a teaching community consisting mainly of students pursuing the teacher certification in English as an Additional Language in southern Brazil. The study relies on qualitative methods of data generation and analysis as well as on the framework of interactional sociolinguistics. Results suggest microteaching is a highly complex practice, with a recurring pattern. Additionally, they suggest that students who are considered successful in a microteaching session are those who produce such pattern in their micro-classes. We conclude by suggesting that informing participants about the expectations regarding the structure of microteaching before they engage in it is desirable.