THE DISCOURSE OF HEALTH CARE DILEMMAS
Organizer: Heidi E. Hamilton
Georgetown University
hamilthe@georgetown.edu
Sunday, March 23, 2003, 2:00-5:00
PM invited colloquium
Room: Commonwealth South
Colloquium Summary:
This colloquium brings together scholars who actively practice linguistics in
the world of health care. In contexts as wide-ranging as counseling about predictive
genetic testing to talk by terminally ill patients nearing the end of life,
these papers explore a variety of dilemmas faced by professionals as well as
patients at the intersection of language and health care.
On the shape of doctor-patient
talk
Heidi E. Hamilton (Georgetown University, hamilthe@georgetown.edu)
Doctor-patient talk has been shown to be shaped by participant characteristics
(training, experience), actions (history-taking, treatment recommendations),
and professional and institutional constraints. Based on a meta-analysis of
studies of 10 different diseases involving 395 patients and 105 doctors, I argue
that close and particular investigations of similarities and differences across
diseases can further enhance this understanding of how doctors and patients
communicate.
The dilemma of prognosis: Front-stage
and back-stage discourse
Ellen Barton (Wayne State University, ellen.barton@wayne.edu)
Based on Goffman's (1959) front-stage back-stage distinction, this paper examines
the discourse of prognosis in medical oncology. Front-stage, the discourse of
prognosis is characterized by indirectness, a topic pursued by patients and
family members. Back-stage, the discourse of prognosis is characterized by directness,
with the topic initiated by physicians. I argue that these different discourse
practices are ones that effect a transfer in institutional positioning from
a patient to a case.
Contextualization processes
in interviews: Interpreting psychiatric practices
Branca Telles Ribeiro (Lesley University & Federal University of Rio
de Janeiro, brancaribeiro@attbi.com)
Maria Tereza Lopes Dantas (Catholic University of Rio de Janeiro & Federal
University of Rio de Janeiro)
This paper investigates how a neuropsychiatrist and a psychoanalyst conduct
psychiatric interviews by analyzing contextualization processes in psychiatric
practices. This discussion relates the framings of the psychiatric interview
to institutional and professional discourse, where these two types of professionals
are often placed in antagonistic positions.
Modes of moral and medical
reasoning in genetic counseling discourse
Srikant Sarangi (Cardiff University, sarangi@Cardiff.ac.uk)
Kristina Bennert (Cardiff University, bennert@cardiff.ac.uk)
Lucy Howell (Cardiff University, howelll@cardiff.ac.uk)
Angus Clarke (University of Wales College of Medicine, clarkeaj@cardiff.ac.uk)
Genetic counseling involves ‘medical’ components (test results, clinical
symptoms, family pedigree) and ‘moral’ concerns linked with disclosure
of one’s genetic status. Conflicting demands arise from the imperatives
of patient autonomy/confidentiality vis-à-vis counselors’ professional
ethical stance. We report preliminary findings based on interactional and thematic
mapping of 50 sessions covering different genetic conditions.
My masculinity or my life:
Moral stories of surviving prostate cancer
Barbara G.Bokhour (Boston University, bokhour@bu.edu)
Men who are diagnosed and treated for prostate cancer often find themselves
facing devastating side effects. We explore the narratives of men as they manage
the dilemma of having chosen treatments that result in significant challenges
to their masculinity. We discuss the narratives as identity constructions and
moral stories.
How the terminally ill talk
about dying
Roger Shuy (Georgetown University (Emeritus), rshuy@montana.com)
This paper reports on an ethnographic study of terminally ill patients: how
they got the bad news, talked about death and dying, and described the quality
of care given by their caregivers. Open versus closed awareness, reflected in
their talk, measured how well they made meaning out of this experience.