ABSTRACT
There are many lessons that the discourse analyst can abstract from the study of a wide variety of types of medical encounter, from diagnosis and prescription to counseling, which would be of benefit to those training to become medical professionals. According to Mishler (1984, p. 11), “Since the discovered illness is … partly a function of the talk between a patient and a physician, the study of this talk is central to our understanding.” Of particular importance, with the advent of the AIDS epidemic, is a balance between the clinical, problem-oriented approach adopted by most doctors, and needed in the treatment of specific, identifiable medical problems, and the relationship-centered approach preferred by counselors, and needed in helping patients come to terms psychologically with their condition (cf. Robinson, 1982, p. 24). There is likely to be a greater shift toward the latter, an approach that was hitherto largely limited to psychiatry and clinical psychology, and generally unusual in other types of medical discourse. Issues of learning to live positively with an incurable and probably fatal illness, as well as facing up to an early and harrowing death, confronted many fewer people in the past. Furthermore, though some could trace their problem to a specific behavior, such as smoking in the case of lung cancer, many could be seen as innocent victims of circumstances beyond their control. Now, faced with AIDS, many more medical professionals have to deal with their own feelings about and attitudes to certain sexual behaviors, rather than simply avoid them: “AIDS, more than any other illness, challenges our most basic beliefs about health, infection, death and dying; dependency, disability and disfigurement; sexual behaviour and orientation” (George, 1989, p. 69). AIDS is also challenging the medical profession to take on new roles as “social, cultural, and linguistic translators, [which roles] are vital to ensure accurate and motivational communication” (Gayle, 1989, p. 249). Practice 57:
Record, on audio- or, if possible, videocassette, one medical interview on a case that interests you, using a consent form similar to the one here. If you cannot find anyone willing to serve as a subject, then the next time you go to see the doctor for a not-too-serious reason ask to record the interview.
Transcribe a 10-minute segment of the interview, giving as much detail as possible of use of gestures and facial expressions, and noting prosody and body language. Also ask the patient and the doctor for permission to read the medical file. Use these materials to compare with the medical interview data to be discussed.
The University of _________
Consent to Act as Human Subject
Subject’s name: _______________
Date: _______________
This study examines, for research and educational purposes, how doctors or counselors and patients communicate.
I hereby authorize (YOUR NAME) to gather information in the following ways:
to audiotape, videotape, and observe interactions between me and my doctor or counselor;
to review my medical records;
to conduct interviews with my attending doctor and/or counselor.
I hereby authorize (YOUR NAME) to use these tapes and this information to teach student doctors and counselors about communication skills.
I understand that the information-gathering techniques described in Paragraphs I and II hold the potential to enhance doctors’ or counselors’ and patients’ abilities to communicate with each other.
I understand that my confidentiality will be protected by removing my name and all other personally identifying information from all teaching and research materials obtained by audiotaping, videotaping, and observing the interactions between me and my doctor and/or counselor.
I understand that (YOUR NAME) will answer any inquiries I may have at any time concerning the information-gathering techniques.
I understand that my participation in the study is voluntary and that I may terminate it at any time with no risk to my doctor/counselor-patient relationship or to the quality of care I am receiving.
Subject’s Signature: __________________
Witness: _______________
(Adapted from Burgess, 1986, p. 77. Reprinted with permission.)
