Latest Issue: Vol 11, No 1 (2014) RSS2 logo

Communication & Medicine

Editor Srikant Sarangi Aalborg University, Denmark

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Since its inception in 2004, Communication & Medicine has been consistently interrogating the `black box’ of what is routinely characterised as `the communicative turn’ in healthcare practice in clinical and public health domains. It is now firmly established as a leading forum for these critical debates.

Aims and Scope
Communication & Medicine continues to abide by the following distinctive aims:

• To consolidate different traditions of discourse and communication research in its commitment to an understanding of psychosocial, cultural and ethical aspects of healthcare in contemporary societies.

• To cover the different specialities within medicine and allied healthcare studies.

• To underscore the significance of specific areas and themes by bringing out special issues from time to time.

• To be fully committed to publishing evidence-based, data-driven original studies with practical application and relevance as key guiding principles.

• To be targeted at an interdisciplinary audience, which will include healthcare professionals and researchers and students in the medical, social and human sciences.

• To promote a reader-friendly style and format, including engagements with debates and dialogues on crosscutting themes of topical significance.

The editor is supported by an internationally acclaimed, interdisciplinary advisory board, selectively drawn to represent the well-established traditions of the medical, social and human sciences.

Indexing and Abstracting
Bibliography of Linguistic Literature / Bibliographie Linguistischer Literature (BLL)
ComAbstracts
ComIndex
EBSCO Communication and Mass Media Index
EBSCO Current Abstracts
EMBASE
IBZ International Bibliography of Periodical Literature in the Humanities and Social Sciences
IBR International Bilbiography of Book Reviews of Scholarly Literature in the Humanities and Social Sciences
Linguistics and Language Behaviour Abstracts
OCLC Electronic Collections Online
Proquest Academic Research Library
Proquest Central
Proquest Health & Medical Complete
Proquest Health Management
ProQuest Medical Library
ProQuest Nursing & Allied Health Source
Pubmed
Scopus
European Reference Index (ERIH Plus)

Publication and Frequency: 3 issues per year from 2011 (volume 8)
ISSN: 1612-1783 (print)
ISSN: 1613-3625 (online)


Professor Srikant Sarangi
Faculty of Humanities
Aalborg University
Kroghstræde 3
DK-9220 Aalborg Ø
DENMARK

Notice Regarding Volumes 1-4
For print copies of Volumes 1-4 as well as online access for those issues please contact the former publisher, Mouton De Gruyter.



Most Recent Articles

 

Treating without diagnosis: Psychoanalysis in medical settings in Argentina

This article is part of a larger research project the aim of which is to understand the discursive conditions of access and adherence to an outpatient mental health service at a public hospital in Buenos Aires, Argentina. The focus is on the historical conflict between medical discourse and psychoanalytical discourse as it emerges in the negotiation of treatment and diagnostic sequences at first consultations. This allows us to observe, on the one hand, patients who, socialized in medical discourse, and even in psychiatric discourse, expect the usual organization which first offers a diagnosis, however transitory, and then a treatment recommendation. On the other hand, however, psychoanalysts tend to reject diagnostic labels and offer treatment without further justification. This has an impact on the adherence of patients, and allows us to argue for the need of negotiating with medical discourse in order to guarantee engagement and continuity in treatment.
Posted: 2015-01-08More...
 

Back to the future: Can conversation analysis be used to judge physicians’ malpractice history?

In its monograph Crossing the Quality Chasm, the Institute of Medicine asserted that 44,000 to 98,000 lives are lost every year due to avoidable medical errors, more than 80% of which involved breakdowns in communication. Medical malpractice claims also involve errors that cause harm, including death. Reasons for malpractice claims have been investigated using variables such as age, race, country of origin, and gender, none of which are predictive. One promising area that has not systematically been studied is the role of face-to-face communication in malpractice claims. To better understand this phenomenon, we tape-recorded 125 doctors (divided equally between surgeons and primary care practitioners), each with 10 consecutive patients. Half of these doctors had been sued at least twice, while the rest had never been sued. We then did a qualitative analysis based on a single taped encounter per doctor using conversation analysis (CA), in order to try to identify which doctors had claims or no-claims histories. While we were able to identify two out of every three no-claims primary care doctors, we were much less successful in identifying those with claims. Surprisingly, in the surgeon group, predictions based on CA were worse than by chance probability. We discuss the implications of our findings for the field of outcome-based communication analysis.
Posted: 2014-12-17More...
 

‘If it didn't work the first time, we can try it again’: Conditionals as a grounding device in a genre of illness discourse

This article explores the occurrence and some special patterns of conditional usage in medical discourse produced by doctors and patients. Findings are based on the Journal of the American Medical Association with its section Clinical Crossroads, which was founded to further the cooperation of patients with medical professionals. The analysis centers upon the concept of prediction, which is considered both a semantic concept governing verb patterns as well as a communicative act prominent in medical encounters. It is found that, in the discourse context investigated here, patients are more concerned with prediction than doctors, but that they also produce at times unusual patterns in which they mirror their doctors’ voices. The mapping of mental spaces, inherent in the conditional construction, then takes the form of a mapping of voices as institutionalized by the genre. Such uses of conditionals suggest that a classification based on content, or ‘logic’, from which only pragmatic types of conditionals depart, turns out to be inadequate, since the construction operates on two simultaneous levels; these are grounded in the discourse situation provided by the genre. For medical communication, this illustrates that patients engage in their own predictions but also strive for an alignment with their doctors.
Posted: 2014-12-17More...
 

Drowning in negativism, self-hate, doubt, madness: Linguistic insights into Sylvia Plath’s experience of depression

This paper demonstrates how a range of linguistic methods can be harnessed in pursuit of a deeper understanding of the ‘lived experience’ of psychological disorders. It argues that such methods should be applied more in medical contexts, especially in medical humanities. Key extracts from The Unabridged Journals of Sylvia Plath are examined, as a case study of the experience of depression. Combinations of qualitative and quantitative linguistic methods, and inter- and intra-textual comparisons are used to consider distinctive patterns in the use of metaphor, personal pronouns and (the semantics of) verbs, as well as other relevant aspects of language. Qualitative techniques provide in-depth insights, while quantitative corpus methods make the analyses more robust and ensure the breadth necessary to gain insights into the individual experience. Depression emerges as a highly complex and sometimes potentially contradictory experience for Plath, involving both a sense of apathy and inner turmoil. It involves a sense of a split self, trapped in a state that one cannot overcome, and intense self-focus, a turning in on oneself and a view of the world that is both more negative and more polarized than the norm. It is argued that a linguistic approach is useful beyond this specific case.
Posted: 2014-10-30More...
 

Accounts of consent: Orienting to self-other relations regarding motivations to participate in cancer bio-banking

The motivations of those who give consent to bio-banking research have received a great deal of attention in recent years. Previous work draws upon the notion of altruism, though the self and/or family have been proposed as significant factors. Drawing on 11 interviews with staff responsible for seeking consent to cancer bio-banking and 13 observations of staff asking people to consent in routine clinical encounters, we investigate how potential participants are oriented to, and constructed as oriented to, self and other related concerns (Author 2007). We adopt a rhetorical discourse analytic approach to the data and our perspective can be labelled as ‘ethics-in-interaction’.

Using analytic concepts such as repetition, extreme case formulation, typical case formulation and contrast structure, our observations are three-fold. Firstly, we demonstrate that orientation to ‘general others’ in altruistic accounts and to ‘self’ in minimising burden are foregrounded in constructions of motivation to participate in cancer bio-banking across the data corpus. Secondly, we identify complex relational accounts which involve the self as being more prominent in the consent encounter data where the staff have a nursing background whereas ‘general others’ feature more when the staff have a scientific background. Finally, we suggest implications based on the disparities between how participants are oriented in interviews and consent encounters which may have relevance for developing staff’s reflective practice.
Posted: 2014-10-30More...
 

Most Viewed Articles

 

The use of abbreviations in medical records in a multidisciplinary world -- an imminent disaster

Abbreviations are commonly used in the medical world to save time and space whilst writing in the patients’ medical records. As various specialties have evolved, each has developed a collection of commonly used abbreviations within its practice, which may not be recognizable to those not working within the same field. The purpose of this study was to assess whether we, the multidisciplinary team members, correctly interpret the abbreviations used in the medical records. We analysed one week of orthopaedic surgical medical records for the use of abbreviations and assessed their appreciation by other members of the multidisciplinary team by means of a standardized questionnaire. We found great variability in the understanding of these abbreviations by different groups of health care professionals. As expected, the orthopaedic surgeons produced significantly more right answers when compared to the other groups, but even they could correctly interpret just over half (57.24 per cent) of the abbreviations. There were many misinterpretations of the abbreviations across the specialties posing imminent clinical risk. Whilst abbreviations may indeed save time, the observed inter-group variation in correct interpretation of these abbreviations is unacceptable. We recommend that the abbreviations have no place in the multidisciplinary world and their continued use will only lead to eventual clinical error.
Posted: 2008-11-25More...
 

Laughter, communication problems and dementia

This article investigates how the elderly with dementia and their professional caregivers use laughter as a device to deal with problems related to language production and comprehension. The data consist of two game-playing situations, used to engage the elderly people in memory work. The article shows how the elderly patients recurrently laugh to acknowledge communication difficulties and to show awareness of their potential non-competency. The professional caregivers are shown to use slightly different strategies for responding to laughter segments initiated by the patients, either making the shortcomings part of the conversation or avoiding referring to the lapse explicitly. The laughter strategies used by the patients are compared to those reported in the CA-literature on laughter. It is well known that laughter is used in sequences of trouble and delicacy in both ordinary and institutional contexts, but my study shows that speakers with dementia laugh when they encounter problems related to language production and comprehension. This functional expansion in relation to premorbid occurrence is evidence that laughter fits the definition of compensatory behaviour utilized to overcome communication barriers. Certain conversational skills are preserved in individuals with dementia, but due to their cognitive impairment these resources are utilized in a slightly different way than by healthy speakers.
Posted: 2008-11-25More...
 

The negotiation of the problem statement in Cognitive Behavioural Therapy

Cognitive behavioural therapy (CBT) is a form of psychotherapy which is characterized by being highly structured, outcomes focused and time limited. The literature concerning CBT is extensive but it has primarily focused on the outcomes of therapy with limited qualitative studies investigating the process of CBT. In this present study we investigate how the CBT model is implemented in therapeutic interaction through a focus on the conversion of the client’s problem into CBT terms and its ultimate articulation as the problem statement. The problem statement is an integral part of the form of CBT studied from which the subsequent therapy is derived. Drawing on theme-oriented discourse analysis we examine the first two sessions of the treatment of one client using a number of tools derived from discourse and conversation analysis. This case study was drawn from a larger corpus of the CBT treatment of ten clients. The expertise of the therapist in applying the generic CBT model of therapy to the client’s particular problem is a focus of this study.
Posted: 2010-10-22More...
 

Moral accounts and membership categorization in primary care medical interviews

Although the link between health and morality has been well established, few studies have examined how issues of morality emerge and are addressed in primary care medical encounters. This paper addresses the need to examine morality as it is (re)constructed in everyday health care interactions. A Membership Categorisation Analysis of 96 medical interviews reveals how patients orient to particular membership categories and distance themselves from others as a means of accounting (Buttny 1993; Scott and Lyman 1968) for morally questionable health behaviours. More specifically, this paper examines how patients use membership categorisations in order to achieve specific social identity(ies) (Schubert et al. 2009) through two primary strategies: defensive detailing and prioritizing alternative membership categories. Thus, this analysis tracks the emergence of cultural and moral knowledge about social life as it takes place in primary care medical encounters.
Posted: 2012-02-24More...
 

Establishing mutual understanding in interaction: An analysis of conversational repair in psychiatric consultations

The therapeutic relationship is the greatest predictor of treatment outcome, yet its relationship to communication is largely unevaluated. This study explored how psychiatrists and people with a diagnosis of schizophrenia establish mutual understanding in naturalistic communication, and associations with the therapeutic relationship, patient satisfaction and symptoms. In conversation analysis, the concept of repair focuses on how participants in interaction create mutual understanding and address misunderstanding. A standardized protocol measuring the frequency of repair was applied to 15 outpatient consultations. Correlations between repair and the therapeutic relationship, patients’ experience of the consultation and symptoms were explored. Patients made most effort to make their contribution understandable, whereas psychiatrists made most effort to repair misunderstandings. The more positively psychiatrists rated the relationship, the more effort they made to understand patients. Although psychiatrists’ efforts were not associated with patients’ overall view of the relationship, patients felt better emotionally, despite, feeling less understood. Psychiatrists used fewer repairs when patients were more symptomatic. Both parties prioritized understanding similar topics but psychiatrists focused more on medication and patients on voices. Quantifying repair offers a new way of analyzing how mutual understanding is established in interaction, and links communication processes with treatment outcomes.
Posted: 2010-01-16More...
 

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