Latest Issue: Vol 10, No 2 (2013) RSS2 logo

Communication & Medicine

Editor Srikant Sarangi Cardiff University, UK

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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.

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.

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.

Contents of Next Issues
Volume 10 Issue 3

To be announced shortly...

Indexing and Abstracting
Bibliography of Linguistic Literature/Bibliographie Linguistischer Literature (BLL)
EBSCO Communicatioin and Mass Media Index
EBSCO Current Abstracts
IBZ International Bibliography of Periodical Literature in the Humanities and Social Sciences
IBR International Bilbiography of Book Reviews of Scholary 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

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

Professor Srikant Sarangi
Health Communication Research Centre
Cardiff University
Humanities Building
Colum Drive
Cardiff CF10 3EU (UK)

Most Recent Articles


Assumptions about culture in discourse on ethnic minority health

This paper is interested in the way the concept of culture is deployed in documents aimed at investigating, informing on and promoting aspects of ethnic minority health. Within a health-political discourse focusing increasingly on individual lifestyles, ethnic minority health became subject to increased political and professional interest in the last decades of the twentieth and the first decade of the twenty-first century. Analysis of the discourse on ethnic minority health emerging in five texts addressing health professionals shows that the culture of ethnic minority citizens is primarily seen as contributing to low levels of knowledge about health and to adverse health behavior. Thus, the texts present cultural beliefs and practices as contributing to the high prevalence of lifestyle diseases among ethnic minority population groups. The analysis, however, demonstrates that a more nuanced discourse is evolving, taking the complexity of the culture concept into account. In accordance with Danish health-political priorities, the most recent text analyzed in this study promotes an individualistic approach to both ethnic minority and Danish ethnic majority citizens.
Posted: 2014-01-02More...

Communicating moral reasoning in medicine as an expression of respect for patients and integrity among professionals

The communication of moral reasoning in medicine can be understood as a means of showing respect for patients and colleagues through the giving of moral reasons for actions. This communication is especially important when disagreements arise. While moral reasoning should strive for impartiality, it also needs to acknowledge the individual moral beliefs and values that distinguish each person (moral particularity) and give rise to the challenge of contrasting moral frameworks (moral pluralism). Efforts to communicate moral reasoning should move beyond common approaches to principles-based reasoning in medical ethics by addressing the underlying beliefs and values that define our moral frameworks and guide our interpretations and applications of principles. Communicating about underlying beliefs and values requires a willingness to grapple with challenges of accessibility (the degree to which particular beliefs and values are intelligible between persons) and translatability (the degree to which particular beliefs and values can be transposed from one moral framework to another) as words and concepts are used to communicate beliefs and values. Moral dialogues between professionals and patients and among professionals themselves need to be handled carefully, and sometimes these dialogues invite reference to underlying beliefs and values. When professionals choose to articulate such beliefs and values, they can do so as an expression of respectful patient care and collaboration and as a means of promoting their own moral integrity by signalling the need for consistency between their own beliefs, words and actions.
Posted: 2013-12-10More...

Improving patient information leaflets: Developing and applying an evaluative model of patient centeredness for text

The purpose of this paper is to present an evaluative model of patient-centredness for text and to illustrate how this can be applied to patient information leaflets (PILs) that accompany medication in the European Union. Patients have criticized PILs for sidelining their experiences, knowledge and affective needs, and denying their individuality. The health communication paradigm of patient-centredness provides valuable purchase on these issues, taking its starting point in the dignity and integrity of the patient as a person. Employing this evaluative model involves two stages. First, a Foucauldian Discourse Analysis is performed of sender and receiver and of the main discourses in PILs. These aspects are then evaluated using the perspectives of patient-centredness theory relating to the medical practitioner, patient and content. The evaluative model is illustrated via a PIL for medication for depression and panic attacks. Evaluation reveals a preponderance of biomedical statements, with a cluster of patient-centred statements primarily relating to the construction of the patient. The paper contributes a new method and evaluative approach to PIL and qualitative health research, as well as outlining a method that facilitates the investigation of interdiscursivity, a recent focus of critical genre analysis.
Posted: 2013-12-10More...

Movie dialogues as discourse data in the study of forecasting mechanisms in the delivery of medical bad news

Understanding the communication skills for delivering bad news, an important daily task for medical professionals, presents a challenge for most discourse researchers due to methodological and ethical dilemmas. Movie dialogues, in which difficult communication of life-and-death issues are fundamental ingredients in creating dramatic effects, are often adopted in medical education and thus potential data for study. By applying the concept of ‘forecasting mechanism’ in bad news delivery (Schegloff 1988 and Maynard 2003), this study examines bad news delivery events depicted in three movie clips. My analysis demonstrates (1) how forecasting, as a ‘macro conversation mechanism,’ is observed in both natural and artificial discourses; (2) what two subtypes of forecasting are identified in movie dialogues: forecasting that directs the interaction to a ‘recipient-leading-the-telling’ pattern, and forecasting that constructs the delivery as one with shared agency; and (3) how the two subtypes may facilitate the deliverers’ task by minimizing the conflicting perspectives with the recipients, ensuring the recipients’ orientation to the bad news, and freeing the deliverers from the pressure of being blamed. These findings implicate the possibility of applying movie clips in discourse research and medical education in regarding to conversational strategies for difficult communication.
Posted: 2013-12-10More...

Experience of suicidal thoughts: A discourse analytic study.

In the paper we explore the relationship between current psychiatric thinking on suicide and service users’ accounts of suicidal ideation and suicide attempts. The data comes from recordings of psychiatric interviews collected in three psychiatric hospitals in Poland. Assuming a constructionist view of discourse we argue that the literature on suicide ignores and simplifies the experience of those who think about suicide and attempt to commit it and constructs their experiences as a homogeneous group of ‘thoughts’ only with content (without form).
We also offer a preliminary insight into the complexity of ‘suicide thoughts, as narrated by those reporting them. We demonstrate that they are marginalised and made relatively irrelevant in the accounts of attempted suicide. Additionally, we demonstrate that while women construct suicide attempts (whether actually attempted in the end or not) as at least potentially beyond their control, men’s narratives very show them in control of the attempt, as if choosing an available option. We conclude by exploring possibilities of further qualitative discourse analytic research which builds on the findings we present here.
Posted: 2013-12-10More...

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...

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...

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...

Expressing the unexpressed: self-disclosure as interactional achievement in the psychotherapy session

Self-disclosure is endemic to psychotherapy. Though clients themselves disclose their experiences and emotionala states during the course of a psychotherapya session, they typically do so with extensive prodding on the part of their therapists. Thus, the therapist’s interactional role is an agentive one, facilitating a client’s verbalization of therapeutically-relevant material. In this article we will discuss how the therapist
manages such facilitation locally when the client (unexpectedly) ceases his/her self-disclosure, often at potentially therapeutically relevant moments. As a locally managed interactional practice, the therapist’s intervention resumes the client’s self-disclosure. Since such intervention emerges amidst ongoing, emotionally-loaded revelations on the part of the client, they should be interactionally aligned with the client’s contribution.

This paper describes how the psychotherapist enables the client to verbalize significant aspects of self, aspects that may never before have been verbalized or, if verbalized, failed to elicit any empathetic response from an interested listener. This paper presents how specific communicative strategies and language forms take on therapeutic value in the discussed context, underlining that the communicative function is not pre-ordained but rather remains to be actively constructed in discourse. Data taken from a corpus of audio recordings of actual therapy sessions conducted in August and October, 2004, document the practical application of a Relational Psychotherapy approach based on such categories of methods as, among others, inquiry, attunement, and involvement (Erskine et al. 1999).
Posted: 2008-11-25More...



Twelfth Interdisciplinary Conference: Communication, Medicine & Ethics

Twelfth Interdisciplinary Conference: Communication, Medicine & Ethics (COMET)
26-28 June 2014, University of Lugano, Switzerland.
Posted: 2013-04-01 More...
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