The Structural Features Of Medical Interviews English Language Essay

Much of the research done in doctor-patient interaction has focused on the assorted ways by which dissymmetry is achieved ( Ainsworth-Vaughn, 1998 ) . Numerous lingual surveies have identified structural characteristics ( breaks, alterations of subject, oppugning and replies ) of the medical interview that allow physicians to command the construction and content of the audience. Research done by Mishler ( 1984 ) identified forms within the interaction which he believes allowed physicians to command the content and construction of the audience. Shuy ( 1983, in Todd & A ; Fisher, 1993 ) identified breaks as one means for patients to defy control. However, he found that whenever coincident address occurred, it was the dominant talker who “ prevailed ” ; in other words, the physician ‘s breaks were ever successful, while the patient ‘s ever failed.

Surveies on inquiries in medical brushs ( e.g. , West, 1984 ; Hein & A ; Wodak, 1987 ; Weijts, 1993 ) have revealed that, more frequently than non, it is the physicians who ask the inquiries. In West ‘s survey in 1984, she studied inquiries in 21 brushs in a clinic whose population was chiefly drawn from lower socioeconomic strata. She found 773 inquiries, of which 91 % ( 705 ) were asked by doctors. Merely 9 % of the inquiries were asked by patients. West ‘s informations suggest that medical brushs between occupants and hapless patients in a clinic bash in fact belong to the “ interview ” genre with the physicians inquiring inquiries and the patients ‘ function being mostly limited to replying. Incidentally, West found that an self-asserting patient, who repeated inquiries when they were non answered, received less replies than other patients. Harmonizing to her, “ the really legitimacy of the doctor ‘s authorization may be threatened by patients ‘ curiousness ” ( West, p. 153 ) . Based on the findings of this survey, it can be assumed that there is a certain dispreference for patient initiated inquiries by physicians. However, other surveies have shown grounds that such dispreference is reciprocally produced by both the physician and the patient. West ( 1994, p.152 ) found that patients frequently stammer when inquiring inquiries and other research has shown that patients frequently do non inquire inquiries, even when given the chance ( Heath in Drew & A ; Heritage, 1992, p. 241 ) .

Surveies on break have shown that its happening in interaction constrains the patient ‘s bend at talk and can be a merchandise of an asymmetric relationship ( Jin, 1999 ) . Although physicians may disrupt to acquire more information, these breaks may halt them from acquiring pertinent information from the patient ( West, 1984 ) .

While it is true that physicians have the inclination to rule the interaction, it is of import to observe that physicians do hold a demand to exert control in medical interviews since discourse in institutional scenes are about ever goal-oriented and are highly-ritualized ( Ainsworth Vaughn, 1998 ) . Bryne and Long ( 1976 ) suggest six stages present in the medical interview: “ Phase 1, associating to the patient ; II, detecting the ground for the attending ; III, carry oning verbal or physical scrutiny ; and IV, consideration of the patient ‘s status ; V, detailing intervention or farther probe ; and VI, ending. ‘ If one is to detect, most of the stages mentioned are descriptions of doctor ‘s activity instead than joint activity.

However, colloquial discourse co-occurs with ritualized discourse in medical brushs ( Ainsworth-Vaughn, 1998 ) . Ten Have ( 1989 ) speaks of medical brushs as organized into an “ ideal sequence ” of six stages: gap, ailment, scrutiny or trial, diagnosing, intervention or advice, and shutting. The sequence is called “ ideal ” since divergences do be in these sequences ( Ten Have, 1989, p.118 ) . Shuy ‘s ( 1983 ) information seem to hold with this impression since findings in his survey suggest the possibility that medical brushs can be colloquial to a grade. The deduction of this is that facets of conversations may take the focal point off from what the physician originally intended to prosecute. All these findings seem to connote that although physicians conduct the medical interview with a specific format in head, they are besides faced with the undertaking of airting the interview back to its original stage as convergences, breaks, and sudden subject displacements arise during the interview. Additionally, the functions both physicians and patients occupy in the medical interview are non limited to expert-novice and interview-interviewee as what surveies in dissymmetry seem to suggest.

While the surveies mentioned have explored assorted structural characteristics of the text to account for dissymmetry, this survey would wish to research the assorted bordering schemes physicians utilize to derive control of the medical interview as colloquial facets of the interview arise. It seeks to analyse how terms between physicians and patients lead to mutual and one-sided subject passages. The survey will take the constructs of frames, terms and alliance as originally proposed by Goffman ( 1974 ) and subsequently modified by Tannen and Wallat ( 1987 ) in the analysis of the principal.

Additionally, this survey would wish to research the possibility of taking speech Acts of the Apostless as frames. Dijk ( 1977 ) mentioned that on the surface degree speech Acts of the Apostless may non look as a frame ( e.g. , express joying or hitting ) since “ the lone forming rule involved is that associating certain intents, purposes and certain behaviors ( vocalizations with certain belongingss ) to contextual provinces and events. ” ( p. 5 ) However, he besides points out that there are besides speech act sequences of which the construction has a more or less conventional or ritual character, such as giving talks, sermon, doing mundane conversation, or composing love letters. In such instances there are a figure of different ( address ) acts that may “ aˆ¦serve a map in the public presentation of an episode: gap, introducing, giving statements, supporting, shutting, etc. “ ( p.5 ) In such instances middlemans may use different schemes for to the full carry throughing ends in the same manner bordering schemes allow physicians to command the flow of talk in the medical interview.

Theoretical Model

2.1 Frames and terms

Harmonizing to Gumperz ( 1982 ) , engagement in a conversation requires each participant to portion lingual and socio-cultural cognition. Peoples draw upon this cognition to construe what is traveling on in the interaction. This procedure of tapping one ‘s scheme in order to get at a sensed reading of what is traveling on is what Goffman has termed as “ bordering ” ( 1974 ) . Broad general thoughts about what is traveling on or what actions participants are involved in are called interpretive frames. However, in every bit far as interpretive frames are concerned one can state that they are culturally predisposed. If one would be in a state of affairs whose civilization does non co-occur with another so calculating out what people are making or what is traveling on can turn out to be a challenging and demanding undertaking.

Additionally, within these wide interpretative frames lie smaller frames called synergistic frames. Harmonizing to Tannen and Wallat ( 1987 ) , these are sets of outlooks about what certain activities are like and how they should be carried out, including what sort of thoughts should be said and done by whom, when, why and how ( p. 207 ) . In their survey of a clinical audience affecting a physician, a kid and its female parent, they demonstrated how a mismatch in frames and knowledge scheme can ensue in a shifting of frames. Such displacements were marked by the different lingual registries that have been identified during the audience. All in all, they were able to place three distinguishable registries, each of which is dependent on the middleman being addressed. They are: ( a ) tease registry ( used when turn toing the kid ) , ( B ) conversational ( used when turn toing the female parent ) , and ( degree Celsius ) coverage ( used when turn toing an fanciful audience ) ( Tannen & A ; Wallat, 1987 ) .

Although looking at registries is one manner of recognizing displacements in frames, it is non the lone manner ( Tannen & A ; Wallat, 1987 ) . The physician in Tannen and Wallat ‘s ( 1987 ) survey was besides noted to hold changed functions for each audience. So non merely did the physician adjust her registries with regard to the audience concerned but she besides dealt with each audience otherwise depending on which frame she was involved in. For illustration, in the societal brush, this frame required her to entertain the kid, set up resonance with the female parent, and disregard the picture camera. In the scrutiny frame she ignored the female parent, made sure the crew was on cue and ignored them subsequently, examined the kid, and explained what she was making for the imagined “ future audience ” comprised of paediatric occupants. The audience frame, on the other manus, required that she speak to the female parent and disregard the crew and the kid. The ability to cover with different audiences in different ways and the changing of functions imposed upon herself and to the other members of the audience in relation to the presenting frame is what is known as terms.

.

Footing refers to the place or alliance set, stance, position, or projected ego of an person, through which participants indicate how their vocalizations should be taken ( Goffman, 1981 ) . It allows analysts to “ aˆ¦ . research the nature of engagement and engagement in societal interaction ” ( Clayman, 1992, pp. 165 ) . Goffman saw engagement in interaction non merely as a state of affairs wherein one party speaks while the other one listens. For him, changing signifiers and grades of engagement exist and the functions of speech production and hearing can be broken down analytically into more specific interactive termss ( Clayman 1992, p. 165 ) . In other words, talkers may take up assorted termss in relation to their ain comments. This is made possible by using “ production formats ” ( Goffman, 1981, p.145 ) that would let them to convey differentiations between the ( a ) energizer, ( B ) writer, and ( degree Celsius ) principal of what is said. The energizer is the individual who presently utters a sequence of words. The 1 who expressed the beliefs and sentiments, and possibly the 1 who besides composed the words through which they are expressed, is the “ writer. ” Finally, the “ chief ” is the individual whose point of view or place is presently being expressed in and through the vocalization ( Goffman, 1981, p. 145 ) .

Footing is normally conveyed through subject, pick of vocabulary, tone of voice, and other discourse constructions. Shifts in picking take topographic point when talkers change their function ( s ) in an interaction ( Goffman, 1981 ) . These shifts map as cues or signals to the listener as to the class the talk is traveling and the form it is taking. These may happen at any clip including within the talker ‘s same bend and are normally signaled through contextualization cues ; characteristics of lingual signifier which signal what the context is — what things are presupposed about the content, ends, way, and impact of the conversation. Other characteristics that can move as cues and can impact terms are ( a ) ticket inquiries ( e.g. , you know? ) , ( B ) backchannel cues ( e.g. , uh-huh, mmm hectometer, nodding caput, perchance, like, sort-of ) , ( degree Celsius ) hedges ( e.g. , possibly ) , and ( vitamin D ) subject displacement.

In a survey by Ainsworth-Vaughn ( 1992 ) , she examined similar cues as a agency by which physicians and patients manage topic displacements. She coined the term minimum links to depict discourse markers that exist between mutual and one-sided subject passage activities. Additionally, these links showed different grades of recognition of the old talker and lesser or greater shows of power or dissymmetry in topic passage.

Findingss suggest that physicians realize far greater interactive power than patients and that male physicians play a more dominant function in the interview than their female opposite numbers. The ratio of mutual to one-sided subject passages for patients is 54:4, or approximately 13.5 to 1. Physicians had a ratio of 83:33, or approximately 2.5 to 1. From this grounds, physicians are “ much more likely to exert power one-sidedly than patients ” ( p. 423 ) .

So, all in all, these theories imply that middlemans are capable of taking assorted functions in ongoing discourse as termss and alliances are presented in the class of the median interview. Additionally, passages from one frame to the following can be achieved as a concerted act or may be straight imposed by either the physician or the patient. It is possible, nevertheless, that physicians have more control of subject alterations than patients, and this, consequences in one-sided passages within the medical brush.

Frames and address Acts of the Apostless

There has been a argument over the possibility of utilizing speech act theory in

the analysis of conversation ( Moeshcler, 1995 ) . The suggestion is based on the thought that speech Acts of the Apostless are non stray moves in conversation ; instead, they appear in more planetary units of communicating, defined as discourses or conversations ( Vanderveken, 1994 ) . In this instance, linguistic communication usage is seen as a societal signifier of lingual behaviour that consists of general, ordered sequences of vocalizations made by several talkers who tend, through their verbal interactions, to accomplish common dianoetic ends such as discoursing a inquiry, make up one’s minding together how to respond to a certain state of affairs, negociating, confer withing or more merely interchanging salutations and talk ( Vanderveken, 1994 ) .

Another statement was made by new wave Dijk ( 1977 ) which pointed out that speech Acts of the Apostless can be interpreted on the footing of “ frame-like universe cognition because they are parts of such frames. ” ( p. 216 ) Since address Acts of the Apostless frequently pertain to past or future activity of the talker or the listener, they are basically working in ways in which such activities are planned, controlled, commented upon or they are intended with the intent of supplying information for such actions. So when a talker congratulates person, the talker assumes that something pleasant occurred to that individual.

Furthermore, van Dijk ( 1977 ) mentioned how frames can modulate the type of the act performed. For him, societal contexts ( private, public, institutional/formal, informal scenes ) are organized by certain constructions of societal frames. An illustration he cited was the institutional context of the tribunal which consists of several chronological frames, viz. : charge-frame, the defense-frame, and the judgments/conviction frame. Each of these frames includes members who are assigned specific functions/positions, belongingss and dealingss which more of less predict the address act to be performed.

These thoughts reinforce the premise that address acts together with registries and discourse markers, may function as a cue in recognizing frames in a given text. Furthermore, it gives a clear image of the hierarchal relationship between frames and the lexicogrammatical characteristics of the text.

3. Conceptual Model

The analysis of doctor-patient interaction in this survey can be farther understood through the usage of a paradigm which hopes to farther stress the expected interaction among variables in relation to the theoretical model merely presented.

Footing

A· mutual A· minimum links

A· links A· sudden subject displacement

Doctor

Patient

Frame

A· address Acts of the Apostless A· discourse markers

A· registries A· codification shift

Figure 1. Conventional Diagram of the Expected Interaction

of Variables in the survey

Based on the model, as participants ( in this instance, physicians and patients ) engage themselves in interaction, they draw upon past life experiences, their cognition scheme, outlooks or frame in order to construe and pass on significance about the state of affairs at manus. As an middleman presents his/her terms, this serves as a signal to both middlemans as to the functions they are about to busy within the frame. When the undertaking is already accomplished within that peculiar frame, they may signal the other of the following activity ( following frame ) by doing usage of either address acts, or signals ( discourse markers, alteration in registries ) . It is of import to observe though, that it is possible for the same frame ( e.g. , interview frame ) to happen more than one time in the medical interview, particularly if that peculiar frame accomplishes assorted undertakings as the interview progresses.

Puting things in concrete footings, when the physician controls the terms and displacements in frames, he/she promotes asymmetry. If he/she makes a gradual subject alteration, through minimum links ( Ainsworth-Vaughn, 1992 ) , he/she promotes less dissymmetry than when he/she makes an disconnected subject alteration. On the other manus, when the patient takes control of the subject and subject alteration, the patient promotes symmetricalness. During the class of frame or subject displacements, both the physician and patient usage breaks, which are one-sided subject alterations, to switch to another subject towards their ain docket.

Reciprocal activities can happen as a shuting down of activity by each talker ; a sum-up or appraisal ; or an agreement to alter subject with an understanding about subject alteration by the following talker ( Ainsworth-Vaughn, 1998 ) takes topographic point.

4. Statement of the Problem

The survey will look into the construct of frames every bit good as the impression of terms and alliance in order to explicate the agencies by which physicians and patients manage their places in the interaction and how they are made cognizant of and co-construct these places. With these in head, the research worker hopes to happen replies to the undermentioned inquiries:

What frames are observed in doctor-patient interaction in public and private infirmaries?

How are frames sequenced?

How is each frame in doctor-patient interaction realized in footings of:

address Acts of the Apostless

registries

discourse markers

code-switching?

4. ) What picking schemes are used in each frame?

5. Significance of the Study

This survey which explores the kineticss affecting doctor-patient interaction among public and private infirmaries in Manila derives its importance from the fact that the consequences can:

a. ) set up a principal for the farther apprehension and lingual probe

of the kineticss affecting doctor-patient interaction in the Philippines.

B. ) validate consequences of surveies conducted in other surveies.

c. ) provide an empirical footing that will explicate the lingual

features or qualities of this specific type of medical discourse.

d. ) provide teaching method with constructs on the manner lingual characteristics of

verbal interaction allow middlemans to carry through undertakings and

topical coherency in ongoing discourse

6. Scope and Restrictions

The survey will non try to do any correlativity between the consequences and patients ‘ conformity with intervention or satisfaction with patient-doctor conversation.

Although gender is a much-explored variable in the survey of medical brushs, it is non a variable that the survey will research. In add-on, holding the audiences videotaped is non an option sing that there are privateness issues, which concern both patients and physicians. This has hence made it impossible to detect contextualization cues as a agency with which termss are signaled. However, audio-taped conversations would let the survey to capture lingual elements of the interaction which can take to the presence of frames every bit good as the functions which picking impose upon the participants and the alliances.

7. Definition of Footings

Discourse markers. Refer to lingual devices which both physician and patient employ in seeking to present new subjects, or termss in the medical interview.

Doctor-patient interaction. This refers to the on-going talk between physician and patient during the class of a medical audience.

Footing. Refers to the alliance which talkers take up to themselves and to

others as evidenced by the manner they handle the production and response of

vocalizations ( Goffman, 1981, p. 128 ) . Changes in terms may affect different

response, roles or different production functions or both ( Goffman 1981, p 226 ;

Levinson, 1988 ) they are normally understood to be signaled inter alia

by prosodic cues and code-switching, which contextualize the peculiar

terms or participant model presently relevant ( Gumperz 1982, Tannen,

1993 ) .

illustration

Frames. The construct of frame has been borrowed from Goffman ( 1974 ) . For the interactants, frame is a resource. Harmonizing to Drew and Heritage ( 1992 ) , Frame refers to “ the current societal activity-to what is traveling on, what the state of affairs is, and the functions which the interactants follow within it ” ( p. 8 ) . This survey will besides follow Tannen ‘s definition of frame as a individual ‘s constructions of outlooks ( 1979 ) or sets of associations based on anterior experience ( Tannen & A ; Wallat, 1987 ) .

illustration

Interpretative frames. These are strategic resources in conversation and are frequently signaled by contextualization cues ( alterations in voice quality, modulation, position, gesture, etc. ) ( Goffman, 1974 ) . This survey, nevertheless, will non be looking into contextualization cues as a agency of recognizing frames in the principal but will be looking into the lexigogrammatical characteristics alternatively.

Synergistic frames. These are the smaller frames within larger ‘interpretative frames ‘ ( or ‘primary models ‘ ) . They represent the discrete activities that people perform ( like joking, flirtation, reasoning, discoursing, chew the fating, etc. ) ( Goffman, 1974 )

Private infirmaries. These are secondary wellness attention suppliers ( primary being the community wellness centres ) that are non funded by the authorities. In Philippine context, the patronage of these establishments belong to the upper category and the in-between category of society. Examples of these would be Makati Medical Center, St. Lukes Hospital.

Public infirmaries. This refers to secondary wellness attention suppliers that are

funded by the authorities. These establishments cater largely to people of low

income but they are non needfully limited to such patronages. Hospitals like the

Philippine General Hospital, Ospital ng Maynila and San Lazaro Medical

Center are illustrations of such.

Registers This refers to a scope of vocabularies which talkers may use in

interaction to accommodate the individual spoken to or the subject. The survey expects to detect medical slangs which may signal frames related to the field of medical specialty.

Schema. This is an organized organic structure of cognition which people tap in order to construe what is traveling on in an interaction ( Gumperz, 1982 )

Chapter 2

REVIEW OF RELATED LITERATURE

2.1 The Structure of Ordinary Conversation V. Institutionalized Ones

In a survey by Sacks, Schegloff and Jefferson in 1974, they introduced a set of regulations which they believe conversationists utilize in forming their bends of talk in conversation. Their findings suggest that in any conversation ( whether face-to-face or telephone ) , merely one talker speaks at a clip, talker alteration recurs, passages between bends are finely coordinated, and overlapping talk is avoided.

To account for this, the basic unit of analysis used by Sacks. Schegloff and Jefferson in detecting this turn-taking organisation were based on the logic with which bends are organized by participants in conversation. . The units are: turn-construction unit ( TCU ) , and passage relevancy topographic point ( TRP ) . One turn-construction unit, or TCU, consists of a sequence of talk which is grammatically and pragmatically complete and is produced as one entity

A repeating subject in the survey of doctor-patient interaction is the dissymmetry that is said to qualify such interaction. This has been described as the state of affairs when physicians take control over on-going medical audience by originating the sequence of conversation, subject alterations every bit good as puting the parametric quantities of patients ‘ bend in talk ( Beckman & A ; Frankel, 1984 ; Mishler, 1984 ) .

2.2 Studies on the function of inquiries in the medical interview

A popular attack in detecting dissymmetry in doctor-patient interaction is placing indexs of control, such as breaks and inquiries, and analyze their happening in each participant ‘s talk throughout the audience. Beckman and Frankel in 1984 investigated the gaps of 74 everyday medical brushs at an internal medical clinic. The written texts were subjected to analysis whether the patient ‘s statement was completed or interrupted ( either by a physician break of the address watercourse or by a doctor following a patient statement of concern with a narrowly focussed, close-ended inquiry ) . Results showed that in 69 % of the visits, the patient ‘s statement of concerns was interrupted and that there was merely one case in the interrupted statements the patient raised extra concerns at the very terminal of the visit. Harmonizing to Frankel ( 2000 ) , one of the deductions of such determination is that breaks discourage patients from voicing out extra concerns at the beginning of their visit.

Recent sociolinguistic surveies have shown similar findings in which doctors have been observed to “ rule and command the doctor-patient conversation by inquiring inquiries, commanding subjects and subject development, interrupting, and ignoring patients ‘ attempts to lend something new ” ( Hyden & A ; Mishler, 1999, p.177 ) . In add-on, physicians ‘ usage of other colloquial moves, such as informal reference footings, medical nomenclature, and directives, farther underscore physicians ‘ control within the interaction. Therefore, dissymmetry is one of the trademarks of medical conversation.

A cardinal issue in the survey of inquiries is the frequences by which physicians and patients ask inquiries during audience ( Ainsworth-Vaugh, 1998 ) . Surveies by West ( 1984 ) , Hein and Wodak ( 1987 ) , every bit good as Weijts ( 1993 ) have shown that medical brushs normally consist of physicians inquiring inquiries and patients replying. An account for this is that the medical brush is an “ interview ” genre which is extremely asymmetrical, with merely one individual holding the right to inquiry. In 1984 West investigated inquiries in 21 brushs in a clinic whose population was drawn from lower socioeconomic strata. She found 773 inquiries, of which 91 per centum ( 705 ) were asked by doctors. In contrast, merely 9 per centum of the inquiries were asked by patients. West ‘s informations may propose that interaction between occupants and hapless patients in a clinic bash in fact belong to the “ interview ” genre, with physicians inquiring inquiries and the patients ‘ function being mostly limited to replying.

On the other manus, Aisworth-Vaughn ( 1998 ) pointed out that “ true ” inquiries are directives that exert control over others through taking the following talker, the following subject, what will go on next, and what information must be provided. She found that 40 % of the clip, patients ask true inquiries and she proposes that many surveies that find patients inquiring fewer inquiries are influenced by the manner the inquiries are defined. Furthermore, she asserts that syntactic, referential discourse, and other characteristics must be taken into history in order to find whether a given address act is a inquiry ( 1998, p. 82 ) .

It has besides been proposed that the context and content of the inquiry be considered in order to to the full understand the sum of power it claims. For illustration, oppugning by the physician is more frequently than non a basic process in order to place or name the job presented by the patient. However, excessively much oppugning inhibits other information which may be contributed by the patient in the brush. Many surveies have focused on the fact that physicians often use closed-ordered ( yes-no type ) oppugning versus open-ended inquiries ( how? why? ) , thereby curtailing the patients ‘ responses ( Roter & A ; Hall, 1992 ; Boder, 1986 ) .

A survey by Frankel ( 1979 ) investigated 10 audiotapes of ambulatory attention visits. Consequences showed that less than one per centum of the entire figure of inquiries asked by doctors and patients were “ patient-initiated ” . In order to be “ initiated ” by the patients, the inquiry had to be the first vocalization in the bend and besides had to present new information. In add-on, Frankel excluded “ normal ” problems such as petitions for elucidation, information, etc ( 1979 ) .

2.2 Surveies on placement and alliances in the medical interview

Framing, together with inquiries, has been a favourite in the analysis of doctor-patient interaction. A frame is defined as the address activity underway ( Tannen, 1993 ) . Theories of frames and scheme suggest that by proffering a frame, a talker attempts to represent the ego. In bordering medical brushs ( doctor-patient interaction ) participants are constituted as physicians, patients, nurses, etc. But as frames are offered or invoked, the functions of the participants alteration. In this procedure, favourable or unfavourable properties are added to one ‘s cognitive scheme which s/he can mention to during the future fundamental law of their ain and others ‘ societal individualities ( Ainsworth-Vaughn, 1998 ) .

Coupland et Al. ( 1994 ) found bordering in doctors ‘ smalll talk at the first of medical brushs in a little infirmary in England. There were salutations and welcomings, apologies, regards, annoyers and other talk that “ represent a preponderantly societal frame for audience gaps ‘ ( p. 102 ) . Furthermore, physicians ‘ willingness to prosecute non-medical subjects was strikingly at odds with the findings of most old surveies ( p. 104 ) . Coupland et. Al. see these bordering gestures in a positive visible radiation.

Although bordering moves are typically proffered at the first brush, they can happen anyplace within it. Tannen and Wallat ( 1987 ) studied a baby doctor who was videotaped for the intent of learning medical pupils, and spoke to the female parent, traveling back and Forth among frames. Consequences of the survey have shown that medical discourse may affect the coexistence of multiple frames.

Ten Have ( 1989 ) pertained to border when he said that “ different interactive formats ” can happen in medical audiences ( 1989, p. 115 ) . Unlike Tannen and Wallat, who found multiple frames in peaceable coexistence, Ten Have was interested in difficulties- ” activity taint ” – that might originate from the saliency of multiple frames.

The assorted functions or individualities that participants occupy in the medical interview have besides been studied as they occur in the assorted stages or consecutive constructions of the medical interview. It has been observed that as the medical interview progresses from one sequence to the following, physicians and patients do non merely occupy the functions of expert-novice, interviewer-interviewee. Harmonizing to Ten Have ”.the individualities, implied in the assorted formats, can be seen to be re-negotiated clip and once more. ” This is best exemplified by Tannen & A ; Wallat ‘s ( 1987 ) survey, which shows the onerous undertaking on the portion of the physician, in analyzing a kid in the female parent ‘s presence while describing to an “ fanciful ” audience.

Chapter 3

Methodology

This subdivision discusses the informations assemblage process, the principal of the survey, the principle for the selected unit of analysis which is the utterance unit, and the model for analysis.

3.1 Procedure for the Selected Corpus

A sum of 10 audiences with 10 General Practitioners ( three audiences per

General Practitioner ) from ten public and private infirmaries in Metro Manila, viz. , Philippine General Hospital, Ospital nanogram Maynila, Manila Doctor ‘s Hospital and Manila Medical Center, will be taped. The 10 physicians will be informed of the survey through informal paths by utilizing personal contacts. A missive informing the physicians of the survey every bit good as an affiliated consent signifier will be provided to them hebdomads prior to the existent informations assemblage session. Patients, on the other manus, will be asked for their written consent before holding their audience with the physician. Merely those who will hold to take part in the survey shall hold their audience included in the survey. After each audience, the patients will be asked to finish a questionnaire which will include information for demographic profiling.

Consultations will be transcribed utilizing all notations on Jefferson ‘s ( 1974 ) written text convention. Two interraters will be asked to look into for the truth of the written texts. Aspects of address bringing which will tag contextualization cues will non be included in the written text.

3.2 Unit of Analysis

The survey will do usage of the vocalization to account for the different

lingual characteristics that may take to the realisation of frames in the principal. The vocalization

unit was chosen to capture most of the verbal interaction taking topographic point between

physician and patient. Harmonizing to Crookes, ( 1990 ) , an “ vocalization is defined as a watercourse of

address with at least one of the undermentioned features: ( a ) under one modulation

contour, ( B ) bounded by intermissions, and ( degree Celsius ) representing a individual semantic unit. ”

Although this definition did non include the length of clip a intermission would be declarative of

an vocalization boundary, Scollon ( 1974 ) pointed out that a intermission of less than 0.6 seconds

does non bespeak an vocalization boundary and that one between 1 and 8 seconds does. Due

to the restriction of the informations assemblage method to be employed, modulation contour will non

be considered in placing utterance units within the principal. Merely sentence and

semantic signifiers of the principal will be utilized as the unit for analysis. An illustration is

given below.

Identifying Utterance units in the Corpus

Excerpt 1

Dr: Sooner state, so Emily Fatah Revolutionary Council? ( .02 ) Reyes?

Emily: Oho.

Dr: So ilang taon Ka na Emily?

Emily: Thirty-one

Taking talkers ‘ bend in the interaction, this peculiar extract shows a sum of four vocalization units. The intermission between “ Fatah Revolutionary Council ” and “ Reyes ” , holding a.02 spread does non do the vocabulary “ Reyes ” another vocalization unit. In add-on to this, “ Reyes ” does non even number as a individual semantic unit.

3.3 Coding of the Data

Following are the schemes that will be used in coding the vocalizations. Transcriptions of audiences from private and public infirmaries shall be coded individually.

3.3.1 Means of placing frames

Discourse markers like “ good ” , “ O.K. ” , “ sige ” and “ alright ” which may signal the start or the terminal of each stage ( interview, scrutiny, audience ) of the medical interview will be taken as an indicant of a frame. The extract below illustrates the point.

FRAME 1 ( Interview frame )

L01 Dr: Okay, so Emily ano? ( .02 ) Reyes?

L02 Emily: Oho.

L03 Dr: So ilang taon Ka na Emily?

L04 Emily: Thirty-one

L05 Dr: ( . ) anong trabaho minute?

L06 Emily: homemaker

L07 Dr: ( ( sigh ) ) so walang income, no?

L08 Emily: wala

L09 Dr: O.K. ,

FRAME TWO ( Gynecologic frame )

L10 Dr: so ngayon anon a tayo National Aeronautics and Space Administration ( .03 ) /papunta na tayo sa nine-

months mo, no?

L11 Dr: kaya ito yung pakikiramdaman minute ngayon, yung paninigas,

HILAB, contraction

L12 Dr: pareho lang ibig sabihin

L13 Dr: kaya kanina diba nararamdaman minute yung paninigas

L14 Dr: pagka yung mild lang paninigas pwedeng parang ( . ) um ( . )

mabigat lang naii-stretch Air National Guard tegument, ganun.

Similarly, any registries distinct to the activity that is traveling on will besides be taken

as a signal for the presence of a frame. Frame two is an illustration of this. Every frame that will be identified shall be labeled as Pub1, Pub2, etc. or Pri1, Pri2, etc. , in order to distinguish vocalizations from public and private infirmaries. Frequencies will so be transformed to per centums.

3.3.2 Speech Acts of the Apostless that physicians and patients display in synergistic frames

To account for address Acts of the Apostless within each frame, the survey will be following Searle ‘s ( 1969 ) taxonomy of address Acts of the Apostless, viz. :

* Assertives

The act bounds the talker to accommodate himself/herself to what has been stated.

* Directives

The act tries to do the listener do something.

* Commissives

The act tries to jump the listener to make something in the hereafter.

* Expressives

The act tries to convey an attitude towards something.

* Declarations

The act of turning a suggestion into world.

Frequencies of address shall be taken as they occur within each frame. It is

possible that speech Acts of the Apostless may signal frames every bit good.

3.3.3 Framing schemes that physicians and patients employ to carry through mutual and one-sided subject passage

To account for the framing schemes that will be utilized by physicians and patients, the shuttings of the frames shall be placed into Ainsworth-Vaughn ‘s ( 1992 ) classs of subject passages. The classs are: mutual activities ( sequences in which two talkers both contribute a move ) , links ( a participant ‘s effort to mention explicitly to the content of the old bend before altering a subject ) , minimum links ( Okay, M-hm, or Alright followed instantly by a alteration in subject by the same talker ) , and sudden subject passage. Frequencies shall be divided as to those initiated by the physician and by the patient. Examples of these are given below.

Reciprocal activities

Calciferol: I think you ‘ve got all of this.

Phosphorus: I ‘ve got all of that.

Calciferol: Alright

Phosphorus: Yeah.

Calciferol: O.k. .

Phosphorus: Um.

Calciferol: Alright.a†’ And this piss is sloping proteinaˆ¦ .

[ Ainsworth-Vaughn, N. ( 1992 ) , p. 419 ]

Linkss

Calciferol: Okay, I ‘m merely traveling to take your gown here.

Phosphorus: I ever think it ‘s in the dorsum.

Calciferol: Yeah we put them on backwards here. Okay now bring your weaponries over

your caput, good and down onto your hips and force them in existent tight,

great merely loosen up

[ Ainsworth-Vaughn, N. ( 1992 ) , p. 419 ]

Minimal Linkss

Phosphorus: Dr. M had suggested perchance waiting a month. And so, there ‘s times in

which I have really ( good remainder ) and so there are times when I ca n’t acquire

any remainder because I ‘m excessively sore. I have to put on my dorsum in which I ‘m non

comfy lying on my dorsum. I like to put on my side.

Calciferol: Okay, a†’ when are we traveling to make another CT scan?

[ Ainsworth-Vaughn, N. ( 1992 ) , p. 419 ]

Sudden subject alterations

Calciferol: And if we ‘re traveling to ( handle? ) your cholesterin if you decide that you want

to make that ahhh together with me, so like I said there ‘s non a whole batch of

other options in footings of medicines for your cholesterin.

Phosphorus: Yeah, so you prolong your life for what, your know?

Calciferol: ( 3 sec intermission ) a†’ Do you hold a, do you hold an assignment to see a

healer shortly?

Analysis of Datas

After holding the interraters check the written texts for truth ( non

all notations will be adopted by the survey as antecedently mentioned ) , frequences of vocalizations in all audiences shall be transformed into per centums.

Each frame shall so be categorized into two: those that were signaled by distinguished registries ( medical slangs ) , and those that were realized by discourse markers. The frames will once more be analyzed to place dominant address Acts of the Apostless which may depict or qualify the specific frame. It should be mentioned that it is rather possible for a frame to incarnate all three characteristics. Should this occur, another class will be added.

To account for bordering schemes that realize mutual and one-sided subject passages, the gap and shutting of each frame shall be analyzed so that they could be categorized harmonizing to the standards suggested by Ainsworth-Vaughn ( 1992 ) .

Consequences from the principal of audiences in public and private infirmaries shall be compared and contrasted for similarities and differences in:

per centums and agencies of vocalization units

frequences accounting for devices signaling frames

per centums and agencies for address Acts of the Apostless that dominate the frames

frequences and per centums of bordering devices utilized by physicians and patients in accomplishing subject passages

The Pilot Study

The research worker conducted a pilot survey in order to find the viability of the variables that the survey would wish to look into.

A gynaecological audience at a clinic in Chinese General Hospital was recorded

for this survey. Prior to the recording of the audience, a missive was given to the physician which detailed the intent every bit good as the method for informations assemblage. Attached to this missive was a signifier which the patient and physician had to make full out for their demographic profiles. The physician was informed that no portion of the interview would be included in the survey should she or the patients have reserves in including it in the survey.

Due to struggles in agenda, the research worker was unable to enter the session herself. However, instructions were given to the physician on how to travel about the recording of the session.

The audio-tape was subsequently transcribed utilizing Jefferson ‘s written text convention. While transcribing, it became evident to the research worker that the physician took the demographic profile of the patient during the audience itself. This may hold somewhat but non significantly affected the genuineness of the interview.

The audience lasted for merely 1 minute and 58 seconds. On a surface degree, the physician evidently had full control of the interview as evidenced by the entire figure of her utterance units. All in all, the physician had 35 utterance units ( 81.4 % ) while the patient merely had 8 ( 18.6 % ) . Similarly, three frames were identified in the whole continuance of the interview, viz. : interviewing, gynecologic and instructional. Although based on theory, registries accounted for frame displacements, the sorts of registries being little indexs of such displacements. The written text is provided below.

Doctor: Ok so, Emily Fatah Revolutionary Council? Reyes?

Emily: Oho

Doctor: Oklahoma

Doctor: So ilan taon Ka sodium, Emily?

Emily: thirty-one

Doctor: — anong trabaho minute?

Emily: homemaker

Doctor: ( ( sigh ) ) so walang income no?

Emily: =wala

________________________________________________________________________

________________________________________________________________________

Doctor: so ngayon Fatah Revolutionary Council na tayo National Aeronautics and Space Administration

Doctor: ( .03 ) papunta na tayo sa nine months, mo no?

Doctor: Kaya mas madalas na yung paninigas, HILAB, contraction,

Doctor: pareho lang ang ibig sabihin

Doctor: kaya kanina diba naramdaman minute yung paninigas?

Doctor: pagka yung mild lang paninigas pwedeng parang..um..mabigat lang naii-

stretch Air National Guard tegument, ganun.

Doctor: Pero kung matindi yung paninigas puwedeng masakit, as in matindi sodium

( ( xxx ) ) tinigas, pero hin: : : di ang pinapakiramdaman doon, Hindi yung tuwing

masakit pero tuwing paninigas

Doctor: Mga ilang segundo lang ito, pinakamatagal na yung isang minuto yung

Paninigas

Doctor: Then, after that lalambot na ang tiyan minute,

Emily: aˆ¦ahummmaˆ¦

Doctor: so titigas sya uli. Kaya yun ang isang mark ng labour no

Emily: aˆ¦uhmmmaˆ¦

Doctor: o kaya may dugong lumabas SA iyo O kaya pumutok Air National Guard panubigan minute

Doctor: yung tubig Hindi Ka naman umiihi pero panay Air National Guard agos ng tubig hanggang

paanan minute ibig sabihin pumutok na Air National Guard panubigan

________________________________________________________________________

Doctor: So isa lang SA tatlong ito, either paninigas ng tyan O kaya dugo o tubig isa

SA talong yan, PUMASOK ka sodium.

Doctor: Diretson ka sa bringing room.

Doctor: Pagdating minute SAs loob may isang doktorang e-eksamin

Doctor: Pagka-examine..uh..tatawagan nila ako

Doctor: yun SA pag/sa assessment namin nagle-labor Ka, so ia-advice KO na ipa-

admit Kas na

Doctor: Pero kung Hindu naman -so pauwiin Ka rin namin

Doctor: Ganun lang yun, no

However, this still verifies that frames can be signaled through the different registries employed to accommodate both audience and scene. In this instance, cognizing for a fact that the patient was a homemaker, the physician refrained from doing usage of medical slangs which would do it hard for the patient to follow what she was depicting ( which was really important for the patient to cognize in order for her to find if her contractions are declarative of impending labour ) . There was one case though were the physician made usage of “ aˆ¦.naka left-lateralaˆ¦ ” which she failed to lucubrate or explicate in simpler footings to the female parent.

Doctor: Kaya kailangan lang pakiramdaman minute

Doctor: Then, pero? Huwag minute dad pealing kalimutan yung/pakiramdaman

minute dad rin galaw

Emily: galaw ngaˆ¦uhuh

Doctor: ng babe yung naka-left sidelong

Emily: aˆ¦uhumm

Doctor: yun

Doctor: Then uminom ng maraming tubig

This was besides observed in the survey of Tannen and Wallat ( 1982 ) where the physician addressed the kid by stating “ aˆ¦No. There ‘s nil in at that place. Is your spleen tangible over there? ” and the kid surprisingly said no ( p.210 ) . On the other manus, the patient in this pilot survey ne’er made any move at all to clear up what the physician meant by left-lateral.

In footings of displacements in frames, topical alterations significantly signaled the frame displacements compared with registries. The observations made in this pilot survey have shown that the happening of all the frames in the principal ( questioning, gynecologic, and directing frames ) were doctor-initiated.

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