and medical practice.
study is a hospital based inquiry into discourse strategies employed by
physicians and patients as participants in spoken and written interaction
leading to patients' consent to diagnostic procedures, therapeutic courses,
research protocols, and the like.
The striking increase in patients'
dissatisfaction and complaints, of law suits for malpractice and consequent
physicians' growing insecurity, together with the institutions' awakened sense
of responsibility have converged to constitute the social demand which
motivated the direction of this research.
Observations carried out in the
pilot study, both on the spoken exchanges and on the written consent forms, led
to the realization that physicians and patients, although being of the same
native language background would experience communication difficulties.
hypothesis was formulated by which the patent language-related causes of
communication breakdown could be due to different habits and expectations for
organizing discourse of 'compatriots' belonging to different subcultural groups
and competent in different social dialects.
Crucial to the validity of
a signed informed consent form is the patient's understanding of the information
that is meant to be disclosed.
Exploring the perceived needs of the
individuals (physician and patient) who meet and interact toward one goal ,
within an institution, consideration was in order of the attending implications
(of the study) for the individuals as well as for the institution involved. A
was composed of a relevant number of physician-patient speech events,
personally witnessed and tape recorded, and of a variety of consent
Some of the most striking linguistic problems that were isolated are:
the overly frequent use of academic language rather than service-related
language; the choice of specialised, technical language and jargon unfamiliar to
the patient; the frequent use of 'mitigation' that often results in unclear,
ambiguous messages; doctor instruction speech acts that are uttered as
projection of patients' will, intention and choice; persuasive language
replacing objective motivation for the proposed course of treatment or
diagnostic procedures; possibly unintentional disregard of the language
differences due to diverse socio-economic backgrounds of the verbal
exchange participants, and the like.
The theoretical significance of
the study regards the focus on the social control issue in medical
discourse, in the effort to identify the strictly linguistic patterns more apt
to reach better balanced verbal exchanges, thereby reducing
ambiguity and rhetorical uncertainty as well as the power-solidarity
gap in the physician-patient communication events.