CHAPTER ONE INTRODUCTION
Communication between the doctor and the patient takes a most important role inensuring a successful doctor-patient relationship in the outpatient service. Unlikesurgeons, outpatient doctors depend mainly on their conversations with patients toexamine what type of disease the patient might have and what advice he/she shouldgive. Good communication determines whether patients can trust their doctors,participate in the visit, utilize and adhere to treatment recommendations, andultimately, feel satisfied with the quality of care they are receiving. So effectiveinteraction between the doctor and the patient enables the patient to make informeddecisions and can improve the quality of care and health outcomes (Shipman, 2010).Doctor-patient interaction, unlike two friends’ free chatting, is a seriouslyinstitutional social activity, which means, to some degree, there are certain principlesthat doctors should follow unintentionally, since what they say and how they say mayhave an effect on the patients’ emotion, which may affect the result of treatment.Doctors, who are imbued with power and trust, use their skill and knowledge to healpatients, and play the role as active participants who diagnose, interpret and treatdiseases with the hope to make full use of their skill and effective communication toachieve a successful doctor-patient interaction. Patients, as participants to consultsymptoms and receive treatment, are the passive part, and are always vulnerable todoctors. For example, during medical visits, if the doctor can diagnose the patient’sillness more accurately and carefully, the patient can understand their problems andrecommended treatments better and become more satisfied with the service of thehospital. As a consequence, the patient’s depression and vulnerability to anxiety canbe lessened, and the doctor’s self-achievement is enhanced. Therefore, in order toachieve a successful treatment, how to talk with patients which emphasizes mutualtacit cooperation between doctors and patients, is a key part of doctor-patientinteraction.
1.1 Research Background
Doctor-patient interaction as a heated topic is drawing more and more attentionfrom different fields of scholars including anthropologists and socialists. However, thesocial background of this study is very broad, since it is not only related to therelationship between doctors and patients, but also linked with the development ofsociety. No matter whether in China or other countries, the unharmonious relationshipbetween doctors and patients has led to a lot of problems, such as patients’ in-cooperative behavior and doctors’ impatient attitude. As we know, civilians tend tocomplain about the unpleasant medical experiences, while the medical workers blamepatients’ for misunderstanding and distrusting. Disputes often happen, so scholarshave done some research on doctor-patient relationship to explore the factors thatcause such a kind of language phenomenon and to uncover doctors’ conversationalstrategies during medical visits.Since few linguists study doctor-patient interaction, we choose this topic as aresearch goal. Furthermore, from the perspective of Conversation Analysis, theanalysis of doctors’ repetition is rather new. Many researchers at home and abroadhave studied repetition in specific fields like classroom, interview and courtroom andso forth (Yang, 2002:103). However, according to the study of previous cases, we know most of these studies are from the sociological perspective rather than fromConversation Analysis aspect. Therefore, it is a new aspect to do research of doctors’repetition from Conversational Analysis in order to achieve a successful diagnosis andtreatment.
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1.2 Research Questions
In recent years, more and more researchers are focusing on the studying of therelationship between doctors and patients for it is not only a kind of interpersonalinvolvement but a typical social relationship. However, with more exploration of therelationship between doctors and patients, we find more questions occurring indoctor-patient interaction. With the help of the conversation analysis approach, weaddress the following two questions in this thesis.1. What are the features of the doctor’srepetition in the outpatient service?2. What are the functions of the doctor’s repetition in the outpatient service?
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CHAPTER TWO LITERATURE REVIEW
2.1 Relevant Studies on Doctor-Patient Interaction
A rich tradition in doctor-patient communication research dating backapproximately three decades has led to several insights into patients’ satisfactiontowards doctors’ services and compliance to doctors’ suggestions, health outcomes,and communication skills development (Cegala, 1997; Heritage & Maynard, 2006;Ong, DeHaes, Hoos, & Lammes, 1995; Roter & Hall, 2006). In these circumstances, awealth of research on the interaction between doctors and patients has been publishedand accumulated since the late 20thcentury, including a number of textbooks thatprovide guidelines for communication and for teaching in medical schools. In recentyears particularly, researchers have made a great deal of progress on doctor-patientinteraction both in linguistic and medical fields. There are mainly three approaches inthe linguistics field: the conversation analysis approach, the pragmatic approach andthe socio-linguistic approach.The first book called Doctors Talking to Patients: A Study of the VerbalBehaviors of Doctors in the Consultation on doctor-patient interaction waspublished by Byrne and Long in 1976, which puts an emphasis on the study in thefield of the conversation analysis approach. It studies doctor-patient dialogues froma vast scale based on 2,500 real tape-recording materials, by specifically analyzingeach phase of medical encounters. It is a book which focuses on the study of doctors’behavior as well as ways of expression during each phase. In 1993, a book namedThe Social Organization of Doctor-Patient Communication written by Sue andAlexandra came out, which incorporates Conversation Analysis into analyzing thepatterns of talks that are produced by situational demands of the medical settings.An examination of interplay between clinical reasoning and language use in theorganizational context of health care delivery, from a detailed perspective is also acritical part of this book. As one of the most vital books in studying doctor-patientinteraction, this book shows us the way to study patterns of talk in medical encounters from the aspect of Conversation Analysis and emphasizes theimportance of harmonious relationship between doctors and patients in order tomake a prosperous and satisfied goal. Roter and Hall (2006) make efforts to doresearch on the interaction between doctors and patients, and publish their researchresults in a book called Talking with Patients and Patients Talking with Doctorswhich is targeting at enhancing the communication and building a harmoniousrelationship between doctors and patients. One of the most influential books forresearchers in studying doctor-patient conversation in the medical fields, namedCommunication in Medical Care was written by Heritage and Maynard and waspublished in 2006 too. They take CA as an approach to analyze the doctor-patientdialogues and work out the strategies used by doctors to communicate with patientsas well as to describe the possible dilemmas and conflicts faced by doctors andpatients as they work through medical encounters.
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2.2 Definition of Repetition
Nowadays, as a universal phenomenon, repetition is drawing increasing attentionfrom researchers, since it plays a critical role both in spoken and written forms.Examination of conversations reveals that everyday speech comprised not only newexpressions, but also utterances that have been previously produced. People repeattheir and others’ talks during talking a great deal. Far from being aberrant orinfrequent, repetition is a phenomenon that occurs quite naturally in conversationalspeech (Tannen, 1989). In most kinds of discourse, repetition occurs, performing thefunctions of enhancing information and establishing rapport with the co-participant.However, what is repetition? Although, there are mountains of conceptions imposed upon repetition, concerning the common ground about doctor-patient interaction thereis still a lack of certain consistency between these diverse definitions.In the domain of linguistics, researchers attempt to clarify their definitions ofrepetition in individual study. For instance, as one of the most well-known andinfluential scholars, Tannen (1987; 1989) clarifies that repetition in conversations istaken as spontaneous formulaicity, and repetition is a kind of linguistic strategiesreflecting and creating interpersonal involvement in ordinary conversations. In otherwords, repetition is persuasive, functional, spontaneous and often automatic inconversations for it reflecting and creating interpersonal involvement in daily lifetalks. With regard to structure, Sherzer (1994: 41) states that elements involved inrepetition can be smaller or larger, ranging from sound patterns to grammatical unitssuch as words, phrases, and sentences, to discourse units such as lines, verses, andepisodes. Johnstone (1994:3) points out that, from a broader perspective, repetition ispattern, and pattern is repetition. That means, in its general sense, repetition isconsidered as one of the basis of structural patterns, in that elements which are, insome sense, the “same” are established and defined, and thus distinguished fromelements which are “different”.
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CHAPTER THREE THEORETICAL AND METHODOLOGICALPRELIMINARY .......14
3.1 Theoretical Basis....14
3.2 Data Collection and Analysis.......16
CHAPTER FOUR FEATURES AND FUNCTIONS OF REPETITION.............22
4.1 General Features of Doctors’ Repetition in Doctor-Patient Interaction.....22
4.1.1 Occurrence and Frequency of Doctors’Repetition in Different Stages23
4.1.2 Different Types of Doctors’Repetition in Different Moods......25
4.1.3 The Relationship among Different Types of Repetition ............28
4.1.4 The Intersection of Different Repetition in Doctor-Patient Interaction..........30
4.2 Specific Features of Doctors’Repetition in Three Moods......31
4.3 Functions of Doctors’Repetition in Doctor-Patient Interaction.........38
4.3.1 Repetition for Emphasis......39
4.3.2 Repetition for Acceptance..............40
4.3.3 Repetition for Clarification ............41
4.3.4 Repetition for Confirmation...........42
CHAPTER FIVE CONCLUSION .............43
5.1 Major Findings of This Study......43
5.2 Implications of This Study...........44
5.3 Limitations of the Current Study and Recommendations for FurtherStudy ......45
CHAPTER FOUR FEATURES AND FUNCTIONS OFREPETITION
4.1 General Features of Doctors’ Repetition in Doctor-Patient Interaction
We found four salient features of doctors’ repetition in outpatient departmentsthrough the analysis of the collected data; moreover, it is found that doctors appear torepeat his/her or others’ previous utterances especially under some circumstances,which tends to be related with the process of different stages in medical encounters.First, there is no doubt that doctors’ repetition would happen in different stagesof medical encounters, and the frequency of it is also much various in differentprocedures. As we know, medical encounters generally can be divided into six stagesaccordingly, and in this thesis we adopt the approach suggested by Have(1989:115-135).Although the six-stage division may vary from the real procedures undertaken inhospitals, it is the most widely used approach in academic field and acknowledged byresearchers. In addition, this kind of division, to some degree, has reflected thecommon flow of medical interactions between doctors and patients. However, what isworthy of our attention is that in this thesis both opening and closing are taken out ofconsideration when it refers to the analysis of doctors’ repetition, since greeting andbidding farewell are very short with less useful information of doctor-patientinteraction. Thus, there is no specific example of doctors’ repetition in greeting orbidding farewell stage. What is more, with the advancement of technology andequipment, it is common that increasing hospitals adopt advanced measures to checkup patients’ physical condition rather than by doctors personally. It is impossible fordoctors to repeat without the participation of patients.
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CONCLUSION
There is no doubt that this is a thesis about studying doctors’ repetition from thenew perspective of three moods. With the analysis of a great deal of data fromnaturally occurring clinical talks, the primary contribution of this thesis rests with itseffort to explore the classification, features and functions of doctors’ repetition.Firstly, the classification of doctors’ repetition in this thesis is a critical partwhich cannot be ignored. Four types of doctors’ repetition are categorized based onthe moods and functions, which are confirmative repetition, explanatory repetition,inquisitive repetition and directive repetition. Each of them plays different roles indifferent stages with the different functions.Secondly, the general and specific features of doctors’ repetition are discussed.The general features of doctors’ repetition in this thesis can be summarized in fouraspects. The first one, the occurrence and frequency of doctors’ repetition are differentin different stages. And the data shows that treatment stage, as the maincommunicative part in doctor-patient interaction, has the highest frequency of doctors’repetition compared to problem presentation and diagnosis stages. The second one isdifferent types of doctors’ repetition in different moods. In other words, doctors’repetition is a way to gain, confirm, clarify and emphasize information, and there isconsiderable relation between doctors’ repetition and moods. The third one, a kind ofrelationship among different types of repetition can be found by analyzing the data.The study finds out that there is a relevant correlation among doctors’ different typesof repetition. For example, doctors’ other-repetition mostly occurs in confirmativerepetition and explanatory repetition while the other two types mainly focus on doctors’ self-repetition. The last one is the intersection of different repetition indoctor-patient interaction. Grounded on the seventy research cases, we find a veryinteresting phenomenon, i.e., there is an intersection of different repetition in acompleted doctor-patient interaction. As it is known to us, some doctors, for the sakeof getting precise information from patients and achieving a rather satisfied result,would adopt an effective measure like using the intersection of different repetition inoutpatient departments. In order to make the research become more meaningful andvaluable, we also explore the specific features of doctors’ repetition in three moods.Confirmative repetition in the indicative mood is used to reconfirm information. Indoctor-patient interaction, doctors habitually repeat patients’ previous words, phrasesor utterances, with the aim to make sure the accuracy of information. As a way toconvey information, the use of explanatory repetition in the indicative mood is acrucial part of this thesis. If patients can know their diseases well and with a positiveattitude to cooperate with doctors’directions, it is an efficient way to achieve the mosttherapeutic effect. The use of inquisitive repetition in the interrogative mood as a wayto gain information occurs in the beginning of phase of doctor-patient interaction. Ithappens when patients cannot understand doctors’ questions well, or reply withirrelevant answers, so it is necessary for doctors to repeat the previous questions. Withthe main function to convey command or order, the use of directive repetition in theimperative mood is to arouse patients’ attention.
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References (abbreviated)
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