Clinical communication

Question 1

What is pragmatics

Answer 1

“the study of the use of context to make inferences about meaning”
(Fasold, 1990: 119)

• How people use context and other information in order to understand language

Question 2

Discuss health care complexities

Answer 2

• Participants - doctors and patients have different goals, often misaligned, leading to miscommunication
• Setting
• Interactional goals/expectations
• Socio-cultural environment
• Policy/Political climate
• Intra/cross-cultural differences

Question 3

Discuss impression management

Answer 3

Relational Work:
- Negotiating relationships and getting ‘things done’ by means of language
- Pragmatics: Use context and other information to understand language
- Impression Management: How people see you and how they interact with you

Definition:
“Impression management is … a bipartite process whereby speakers project, on the basis of their impression managing style, impressions of themselves through their discourse, and hearers interpret this discourse and create certain impressions of speakers, impressions that may or may not be at odds with the impressions speakers think they are projecting”
(Goffman (1959), Bilbow, 1997, p.465)

-difference in presentation: front vs backstage

Managing Impressions through Language
- Projection and Attribution (Bilbow, 1996):
- Projection: The way in which an individual performs, e.g., rude, polite
- Attribution: The way in which the audience reacts, e.g., angry, insincere

Resonant and Discordant Impression Management
- Resonant: Succeed in creating the intended impression
- Discordant: Audience forms a different impression than intended

Question 4

How do clinicians speak in a way that is patient-centred?

Answer 4

• Reduce power-distance?
  
  • Come across as friendly and approachable?
  • Show empathy and reassurance?
  • Establish rapport?

Sociopragmatic:
- Understanding expectations

Pragmalinguistic:
- Display intended impression accurately

Question 5

Describe how to be approachable when engaging with patients (vs not)?

Answer 5

Non-verbal Engagement:
- Open posture
- Attentive listening
- Greetings
- Smiling
- Appropriate responding
- Introductions
- Eye contact
- Eliciting patient views
- Small talk
- True bedside location
- Mirroring
- Humour
- Shared topic choice/control
- Familiar patient naming
- Interrupting to collaborate
- Balanced focus between patient lifeworld and clinical task

Lexical Choices:
- Informal or everyday language
- Jargon avoided or explained
- Framing

Approachable Discourse:
- Create positive, social atmosphere
- Reduce social, power distance
- Build/maintain rapport, relationship
- Signal solidarity, common ground, respect
- Support patient participation

Not Approachable Discourse Features

Non-verbal Engagement:
- No greetings
- No or token introductions
- No or discomfort in small talk
- No humour
- Ignoring patients’ questions/contribution
- Closed posture
- Inappropriate response
- No smiling
- Patient views not elicited
- Missed empathic opportunities
- No eye contact
- Corridor, doorway, or behind curtain
- No patient names
- Third person pronouns
- Labelling patients
- Terms of endearment
- Nurse controls topics in interaction
- Interrupting to gain power
- Labelling behaviours
- Strict clinical focus
- Unexplained jargon
- Strict task orientation

Lexical Choices:
- Framing

Not Approachable Discourse:
- Create unfriendly, controlled atmosphere
- Reduce rapport, relationship
- Signal lack of caring, commitment
- Create distancing effect
- Discourage patient participation

Question 6

Explain why impression management isimportant

Answer 6

• Patient empowerment
• Shared decision making
• Trust
• Adherence
• Vaccine hesitancy
• COVID denial
• Advance care directives
• Mental health service users