LINGUIST List 34.687
Mon Feb 27 2023
Review: Applied Linguistics, Sociolinguistics: Kondo (2022)
Editor for this issue: Maria Lucero Guillen Puon <luceroguillenlinguistlist.org>
Date: 27-Oct-2022
From: Yufei Ren <ryffei
163.com>
Subject: Patient-centred Communication
E-mail this message to a friend Discuss this message Book announced at
https://linguistlist.org/issues/33/33-2516.html
AUTHOR: Kayo Kondo
TITLE: Patient-centred Communication
SUBTITLE: Discourse of In-home Medical Consultations for Older Adults
SERIES TITLE: Language at Work
PUBLISHER: Multilingual Matters
YEAR: 2022
REVIEWER: Yufei Ren, Tsinghua University
SUMMARY
Chapter 1 (Introduction to Patient-centred Communication) is a leading chapter that introduces readers to the key concept of patient-centred communication and its cultural differences. Patient-centred communication is expected to be an interaction in which clinicians fully take care of patients from factors listed in its multidimensional frameworks (see a systematic review by Scholl et al., 2014), an important framework being the Calgary-Cambridge Guide (Silverman et al., 2013). However, its realisation is quite different among cultures, in that Asian countries seem more hierarchical and paternalistic than the US. Thus, it is necessary to assess the PCC concepts and theories in practical contexts among various cultures.
Chapter 2 (Face and Linguistic Politeness) continues to explore interpersonal concerns in medical consultation contexts. It sets out from the pragmatic linguistic concept of face and linguistic politeness (Brown and Levinson, 1987) to discuss its utilisation in healthcare studies within different cultures. This chapter presents key concepts and terms involved in face and linguistic politeness. Terms in this theory, such as positive face and negative face, are examined through critiques considering cultural/contextual variances such as individualism versus collectivism, high-/low-context, and honorifics. The author concludes that despite its limitations, the classical work of Brown and Levinson’s politeness theory offers an efficient tool for the conceptualisation of the patient’s face.
Moving from face and politeness theories to fieldwork observation, Chapter 3 (Fieldwork and Data) presents the specific details of the author’s ethnographic fieldwork experience in in-home authentic consultations. The overall procedure of the consultations is illustrated in detail in the healthcare system in Japan; this procedure includes the preparation stage (e.g., data collection method, methodological positions, data sample), the consultation recording stage, and the translation and coding stage according to the Calgary-Cambridge Guide (Silverman et al., 2013) as well as the concepts of face/politeness theory (Brown and Levinson, 1987).
Chapter 4 (Listening to Patients and Identifying Issues) explores PCC communicative acts emerged from the analysis of the consultations in which physician questioning and listening techniques could bring about more from patients. Extracts from the analysed consultations present the linguistic instantiations of the represented Face-PCC categories. Techniques mentioned include ‘initial general remarks’, ‘gradually moves from open to closed questions’, and ‘repetition, paraphrasing and interpretation’, in comparison to non-PCC facts, illustrated with extracts from the transcripts of the consultations.
Chapter 5 (Empathy and Acceptance) looks into empathy, a core of clinical PCC, understood as the doctor’s engagement with patients’ experiences and perspectives. Prominent features of empathy and acceptance are discussed through an authentic consultation corpus, in which ‘understanding and appreciation of the patient’s feelings’, ‘expressions of positive regard’ and ‘silence as empathic anticipation’ are crucial for doctors, in comparison to ‘being judgmental’ as a potential non-PCC aspect. These approaches to the patients’ feelings address patients' positive face; but in fact, the combinations of positive and negative face shown in some examples do not only overtly express empathy but give patients spaces to think.
Chapter 6 (Work Towards Shared Decision-making) addresses another crucial component in PCC, shared decision-making. Its involvement in a greater use of negative politeness strategies shows the importance of understanding and respecting patients' problems and desires in decision-making. ‘Sharing understanding’, ‘sharing thinking’ and ‘offering suggestions’ are key aspects of a shared decision-making while ‘no shared discussion’ is considered as a potential non-PCC aspect. However, cultural differences may play a role, as a patient's involvement varies according to different contexts, which might be a challenge for young doctors.
Chapter 7 (Leave Space for the Patient and Respecting the Patient’s Freedom) concerns physicians' responses that leave space for patients and show respect for their freedom. Key aspects concerning patients’ space involve ‘open questions that occur throughout the session’, ‘checking for understanding’ and ‘linguistic deference’, while potential non-PCC aspects such as ‘directives’ and ‘touching without asking’ seem intrusive. Cultural variations here occur with regard to ‘physical touch’ and ‘proximity – closeness/distance’.
The final chapter (Chapter 8 “Transferring into Future Training”) concludes the primary factors considered throughout the consultation, contexts (home consultation and family member involved or not), empathy and politeness strategies, as stated in the Calgary-Cambridge Guide, only with cultural differences as seen in Japan. As for future direction, the author points out the significance of linguistic politeness as an educational and analytical tool in medical consultation, as well as the contributions and limitations of this study for further investigations. Appendices are listed in Chapter 9.
EVALUATION
This book functions as a practical guidance to physicians and to students in medical school. Through the authentic consultation data, readers could get a hint of the importance of communication skills such as politeness and face-protecting during conversations. As noted by the author in her interview with physicians, they emphatically reported the lack of communication skills in medical education. PCC skills training for young professionals and medical and nursing students would become a tool to encourage them to apply their human skills in their interactions with patients and help to reduce the negative effects from physical impairment and anxieties in their patients (Kondo, 2022, p148).
As for its theoretical significance, the combination of face theory with PCC elements in authentic consultations examines the theory in practice and offers potential future directions. Among which, cultural differences play a crucial role in face theory and PCC. Just as the author has mentioned, western concepts, terms such as patient/person-centred care and communication, have been disseminated worldwide and are now being embedded into real-life practice in health and social care. However, different countries exhibit various cultures, which may influence their language preference, way of communication, and even everyday lifestyle, not to mention their inter-relationship between patients and doctors. Eastern countries like Japan prioritize collectivism instead of individualism. People from collectivistic cultures emphasise the values of group orientation, collaboration, and conformity. The way of perceiving the concept of ‘self’ in society could reflect the differentiation between individualistic and collectivistic cultures. This might influence the overall background where face theory and politeness theory are built upon, thus, leaving space for modifications in related theories. People who are interested in linguistics, especially in pragmatics (the study of language in use/contexts), may find this book fascinating in its quite novel perspective looking into face theory in PCC. The multiple qualitative methods of integrating the findings of literature review with empirical investigation in a culturally specific context shows both its practical and theoretical significance.
Though the concept of PCC in consultation seems to be demanding in the first place, the story-telling style in this book using first person narrative is reader friendly. In Chapter 3, the author mentioned gatekeepers who allowed her to gain access to the medical teams and their patients. Her experience and interaction with them provide a more comprehensive picture of her fieldwork. The reflection part among chapters, such as a diary of a young doctor reflecting on his experience in shared decision-making in Chapter 6, is also first-person narrative. To some extent, discourse comprehension is the interaction between readers and the texts (Alptekin & Ercetin, 2011). This first-narrative style can bring about a connectedness and closeness between the readers and the text, possibly eliciting empathy among readers.
The structure of the book basically follows the time sequence, in presenting the theoretical background stage, preparation stage, consultation recording stage, and interpretation of the PCC transcription. During the authentic consultation stage, some specific aspects from politeness and face theory are chosen by the author as a lens to PCC with evidence of extracts from the consultation data. The data is analysed in its concern or neglect of PCC. This comparison between PCC and potential non-PCC made the discussed component more easily understood with regard to its relationship to PCC. However, this overall time-line structure is not explicitly stated in the book as the division of chapters is mainly based on different aspects of PCC methods. With a more clearly stated structure, the reading might be smoothly paved for readers in a more general sense.
REFERENCES
Alptekin, C., & Erçetin, G. (2011). Effects of Working Memory Capacity and Content Familiarity on Literal and Inferential Comprehension in L2 Reading. TESOL Quarterly, 45(2), 235–266.
https://doi.org/10.5054/tq.2011.247705Brown, P. and Levinson, S.C. (1987) Politeness: Some Universals in Language Usage. Cambridge: Cambridge University Press.
Kondo Kayo (2022). Patient-centred Communication: Discourse of In-home Medical Consultations for Older Adults. Multilingual Matters. Bristol.
Silverman, J., Kurtz, S. and Draper, J. (2013) Skills for Communicating with Patients (3rd edn). London: Radcliffe Publishing.
Scholl, I., Zill, J.M., Harter, M. and Dirmaier, J. (2014) An integrative model of patient-centeredness – A systematic review and concept analysis. PLOS One 9 (9), e107828.
ABOUT THE REVIEWER
Yufei Ren: PhD student, Tsinghua University. Research interests: neurolinguistics, psycholinguistics, psychiatry
Page Updated: 27-Feb-2023