Karin Birkner, Alexandra Groß, Polina Marenchik
From the 4th to the 5th of October, the international conference Comparative Perspectives on Doctor-Patient Interactions (CDPI) was hosted at the University of Bayreuth in hybrid mode, bringing together researchers who take a comparative perspective on doctor/patient interactions across different languages and medical settings. It finalized the group linkage project Interactive Dynamics and Contexts of Nigerian and German Doctor-Patient-Encounters (Karin Birkner & Akin Odebunmi), funded by the Alexander von Humboldt Foundation.
The conference started with a plenary talk by Ana Cristina Ostermann (Federal University of Rio Grande do Sul / Brazil) on Recommendations in medical interactions in Brazil as compared to practices in the UK and the US. Based on her research on women’s limited agency in Brazilian doctor-patient encounters, Osterman showed different practices of patient resistance in response to doctor’s contraceptive recommendations during gynecological consultations. Against the historical background of the health care system in Brazil, which is connected to lower income and low educational background of the patients, she raised the question of why female patients would resist doctors’ recommendations despite consulting them as medical experts. Ostermann aimed to discuss how active resistance to recommendations might illuminate our understanding of patient agency in women’s health in Brazil, where unintended pregnancies constitute a serious public health concern, e.g. illegal abortion and increased maternal mortality.
Ostermann focused on doctors’ practices of giving recommendations and patients’ responses to these recommendations in Brazil in contrast to those found in the US and UK. She also explored the trajectory of patient resistance in the Brazilian context. Identifying practices of women’s agency and resistance Ostermann presented the distribution of physicians’ recommendation action types and patients’ responses. The interactional trajectories of active resistance to recommendations lead to the suspension of the decision and further investigations. Patients account for the resistance to therapy recommendation on three grounds: 1) problematic assumptions about the patients’ (sexual) lives; 2) the recommendations turned out to be problematic in the past or 3) the recommendations may be problematic in the future.
The presentations during the conference were the following:
Anja Weiß (University of Duisburg-Essen / Germany) & Benjamin Quasinowski (University of Bremen / Germany) – Studying biomedical professional encounters through transnational comparison.
Weiß and Quasinowski focused on the interactional manifestation of medical professional knowledge in transnational comparison, emphasizing the relevance of parallel existing global medical knowledge based on natural sciences as well as of local medical knowledge based on different educational and health care systems. The presenters discussed the need to include incorporated knowledge as collective abilities to solve socio-material problems, amongst others. Seventy-one simulated video recordings of consultations were analyzed at four university clinics in Ankara, Beijing, Groningen, and Würzburg. Their quasi-experimental design involves doctors treating a simulated patient detailing symptoms of heart failure. The presenters reported on fundamental similarities across national contexts, such as questions during history taking, conversational organization, and conversational style (medical lexis, metaphors, and gestures). For example, despite different countries and languages they found a similar set of “medical” gestures, indicating a priority of global medical knowledge in the conversational activities in a genuinely somatic and acute medical context.
Kifayat Gambari Olufadi (University of Ilorin / Nigeria) – A comparative evaluation of accommodation strategies in Doctor/Patient-Interaction in the Nupe and Yoruba setting.
Gambari Olufadi presented her work on Nigerian doctor-patient interactions in Yoruba and Nupe speaking communities, two distinct cultures in north-central Nigeria. The consultations were collected at the teaching hospital of Kwarta State. Applying The Communicative Accommodation Theory (Dragojevic, Gasiorek, and Giles, 2016), the analysis focuses on conversational moves leading to convergence or divergence between interlocutors.
Cultural practices in the Yoruba and Nupe cultures become relevant in shaping medical consultations, e.g. when first encounters are treated by patients as the foundation of maintaining a social relationship. On the other hand, the medical institutional order dominates cultural practices for the sake of achieving medical goals: Despite cultural attributions of conversational power to older interlocutors, doctors control the medical consultations, e.g. in terms of initiating conversational actions and focusing on the medical agenda. Olufadi also observed the synchronization of cultural and professional practices: especially in their attempts to provide emotional support to the patient, the doctors produce converging conversational moves, e.g. by using culturally conventionalized emotional expressions.
Oluwaseun Amusa (Adekunle Ajasin University, Nigeria), Eniola Boluwaduro (Redeemer’s University, Nigeria / Radboud University / Netherlands) & Alexandra Groß (University of Bayreuth / Germany) – Bringing up medical concerns in Nigerian and German HIV-consultations.
The talk focused on doctors’ noticings of anomalies in the patient’s body or measurements that are beyond the core agenda of routine consultations with HIV-positive patients. Noticing was considered as a social action of a request for focusing attention on something in the perceptible surrounding (Schegloff 2007, Laner 2022: 4). The presenters highlighted two issues being dealt with by and in consequence to doctors’ noticings:
First, doctors establish a claim of doctorability, in that there might be a medically relevant problem. These claims can be accepted but it was also observed that patients negotiate them. In the latter case, patients in the German data might contest claims of doctorability, whereas the Nigerian patients rather claimed ignorance about the bodily phenomenon.
Second, by uttering noticings doctors show entitlement to comment on bodily phenomena but without the consequence of initiating binding treatment decisions. This way, doctors do not adopt the responsibility for treating the problem but assign the treatment to the patients. Patients in the German data are treated as responsible for adopting a health-supporting behavior and as the main agent in taking steps to solve the problem. In the Nigerian data, in contrast, patients are held responsible for having adopted a health-destructive behavior. The presenters concluded that doctors’ noticings and their conversational consequences contribute to what is already known about how positionings of HIV patients diverge between the cultural contexts, specifically: as being well vs. ill, responsible for taking action vs. not having taken action, for being adherent vs. skeptical, knowledgeable or ignorant about how to live a healthy live as an HIV-patient.
Wolfgang Imo (University of Hamburg / Germany) & Viktoria Fedorovskaja (Setschenov-University Moskow / Russia) – Explications of Medical Terms in German and Russian Oncology Talks.
Imo and Fedorovskaja presented the results of the project From pathology to patient: Optimization of the transfer of knowledge and the securing of understanding for oncology patients, conducted at First Moscow State Medical University and the University of Hamburg. Analyzing diagnosis and therapy planning activities in the two settings, the authors found the following practices of transferring medical knowledge: 1) explaining, 2) clarifying, 3) reformulating, and 4) explicating:
- Explanations need a specific asymmetry of knowledge between speaker and recipient concerning an explanandum. Explanations typically require a certain complexity, amount, and depth of the transferred information.
- Clarifications close a local asymmetry of knowledge without any intention or attempt to anchor the transferred knowledge into larger explanatory contexts. Clarifications are less complex and shorter and their main aim is the local preservation of interaction and intersubjectivity.
- Reformulations are different from the other three concepts as they refer to sequential structures that can be used for many different actions.
- Explications aim at giving a precise meaning to a vague or polysemous expression of everyday language, typically based on very short reformulations of previous utterances.
Their comparative analyses revealed that Russian doctors use explications more frequently than doctors in the German consultations. However, Russian doctors use the same strategies as German ones, such as reformulating a word or rephrasing it in a short sentence. Explicating the meaning of technical terms by giving an everyday term or vice versa not only occurs in both German and Russian oncology talks. The presenters concluded that interlocutors make use of similar linguistic practices, but to varying degrees.
Dominic Hendricks (University of Münster / Germany) & Valeria Schick (University of Hamburg / Germany) – Recommendations with first person singular in German and Russian oncological consultations.
Hendricks and Schick, also members of the joint project From pathology to patient: Optimization of the transfer of knowledge and the securing of understanding for oncology patients, focused on the activities of informing patients about the pathology reports and the diagnosis, as well as of discussing the treatment options and the treatment schedule. The recommending actions were differentiated along the finality of the treatment decision, the deontic authority, and the agency offered to patients. Taking a form-based approach from an interactional-linguistic perspective, the presenters focused on the use of pronouns in treatment recommendations, as they may encode various degrees of agency and responsibility: In contrast to using generic pronouns or the first-person plural, doctors position themselves as solely responsible for the recommendation by using the first-person singular. The presenters raised the question, when doctors mobilize German/Russian ich/я (’I’) in recommendations. Within 56 German and 54 Russian oncological consultations, 55 uses of ich in recommendations in the German data and 108 uses of я in the Russian data were found. Hendricks and Schick showed that both the positioning within the sequential context and the subject are relevant for employing first-person singular pronouns. Moreover, there is a preference for ich würde X (‘I would X’‘)-format in German consultations, while Russian doctors mobilize the three formats (i) я + X-PRSя + X-FUT (’I will X‘) and (iii) я + бы + X-PST (’I would X‘) with nearly the same frequency regarding (non-)radical treatment options.
Minka Džanko (University of Sarajevo / Bosnia and Herzegovina) – Addressing older patients in German and Bosnian medical encounters.
Taking a form-based approach to medical consultations with elderly patients in different Bosnian and German consultations, Minka Džanko focused on address terms in the moment-by-moment conduct of medical interactions in order to explain which features of doctors’ and patients’ talk emerge as significant in the choice of address forms.
German has both informal (du ‘you’) and formal (Sie ‘you’) second-person pronouns, the former being typically coupled with the use of given names and the latter with family names. Džanko observed that German doctors exclusively employ formal pronominal (V) and nominal address forms (Mrs., Ms.). The Bosnian data, in contrast, shows a more varied and less formal use of pronominal address forms (T or V), often associated with first names or terms of endearment (e.g. “granny”). German and Bosnian doctors employ distinct address forms to achieve their respective interactional goals with patients beyond expressing politeness. Nominal address terms in both German and Bosnian data are a lexical resource to establish a polite or more personal doctor-patient relationship. Moreover, in German as well as in Bosnian consultations nominal address terms serve to add more personal quality to a doctor-patients-relationship and to mark epistemic authority in the context of disagreement, whereas only in Bosnian data they can be used to intensify face-threatening acts.
Karin Birkner (University of Bayreuth / Germany), Ahmad Izadi (University of Abadan /Iran, and the University of Bayreuth / Germany) & Akin Odebunmi (University of Ibadan / Nigeria) Address Terms in medical consultations in Germany, Nigeria, and Iran: A comparative perspective.
Focusing on address terms in medical consultations in three countries and four languages (German, Nigerian English & Yoruba, Persian), the presenters aimed at scrutinizing practices that point out micro and macro aspects.in doctor/patient-interaction. Beyond their basic function – selecting a recipient as addressee and/or as next speaker –, the use of address terms is based on both linguistic conventions and cultural notions of human relationships and affiliation. The authors identify three categories of address terms: proper names, generic terms, and solidarity terms, being used in various actions as well as for organizing the talk in different ways in each data set.
As Džanko already described, the German doctors almost exclusively use proper names (Mr/Mrs. + last name), while Nigerian and Persian rarely did so. Generic terms (like doctor or mam, sir) in greetings are uncommon in German; in Iran and Nigeria they are occasionally used by doctors, but frequently used by patients. Solidarity terms (like dear or brother, sister) were found in Iranian and Nigerian data, but not in German. There is a connection between doctoring styles and the use of different address terms: while steeper and more complex institutional hierarchies play a dominant role in Nigerian data, the display of solidarity and hierarchy intertwine in Persian consultations. The German consultations, by contrast, exhibit a flatter hierarchy and at the same time a low affective display of the institutional agents.
In conclusion, the participants found the conference to be very beneficial. Encouragingly, the wealth of findings in medical CA allows for comparative approaches shedding light on a wide range of cultural and socio-economic factors. More will come!