门诊会话中家属参与诊疗的作用研究
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摘要
基于自然发生的医生-患者-家属互动的语料,使用会话分析和实证研究方法,对门诊会话中家属参与诊疗所采用的语言和话语策略及其社会语用功能进行了细致的分析,并从认知情态的视角加以阐释。研究发现,家属在诊疗过程中主要实现的功能有提供信息,分担责任;提出疑问,参与决策;提出话题,表示建议。这反映了医生-患者-家属基于对交际者认知状态以及认知地位的认识,实时监控并调整话语策略,来表达自己的认知立场,并对门诊交际和沟通提供一定的启示。
Based on the data from naturally occurring corpus of doctor-patient-family medical interactions, this paper presented an empirical analysis of socio-pragmatic functions of family members' contribution in outpatient interaction by employing different linguistic and discursive strategies, with an interpretation from the perspective of epistemics. It found that there were three functions, such as providing information, sharing responsibility; asking questions, participating in decision-making; proposing topics and suggestions. Doctors, patients and family members employed different linguistic and discursive strategies to express their epistemic stance on the basis of their understandings of the epistemic status of themselves and of their interlocutors, which provideed implications for outpatient communication.
Based on the data from naturally occurring corpus of doctor-patient-family medical interactions, this paper presented an empirical analysis of socio-pragmatic functions of family members' contribution in outpatient interaction by employing different linguistic and discursive strategies, with an interpretation from the perspective of epistemics. It found that there were three functions, such as providing information, sharing responsibility; asking questions, participating in decision-making; proposing topics and suggestions. Doctors, patients and family members employed different linguistic and discursive strategies to express their epistemic stance on the basis of their understandings of the epistemic status of themselves and of their interlocutors, which provideed implications for outpatient communication.
引文
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[19] DREW P.Asymmetries of knowledge in conversation interactions[M]//MARKOVá I,FOPPA K.Asymmetries in Dialogue.Harvester Wheatsheaf:Hemel Hempstead,1991:21-49.
[2] 姚坚.建立良好医患沟通,推进和谐医患关系[J].中国医学伦理学,2010,23(1):28-29.
[3] FIORAMONTE A,VASQUEZ C.Multi-party talk in the medical encounter:Socio-pragmatic functions of family members' contributions in the treatment advice phase[J].J Pragmatics,2018,139:132-145.
[4] HALKOWSKI T.Medical discourse[M]//HYLAND K,PALTRIDGE B.The Bloomsbury Companion to Discourse Analysis.London:Bloomsbury,2011:321-331.
[5] 马文,高迎.汉语医患会话中同话轮内自我修正研究[J].外国语,2018,41(3):42-54.
[6] 杨子,王雪明.患-陪就诊同盟的会话参与模式研究[J].现代外语,2019,42(2):231-242.
[7] JEFFERSON G.Notes on a systematic deployment of the acknowledgement tokens "Yeah" and "Mm hm"[J].Res Lang Soc Interac,1984,17(2):197-216.
[8] 于国栋,梁红艳.选择疑问句“X还是(Y)”中对于X的结构优先[J].外国语,2018,41(1):49-59.
[9] 刘兴兵,刘琴,邵艳.使用会话分析研究中国医患[J].医院管理论坛,2007,128(6):50-55.
[10] BEISECKER A E.The influence of a companion on the doctor-elderly patient interaction[J].Health Communication,1989,1 (1):55-70.
[11] HASSELKUS B R.The family caregiver as interpreter in the geriatric medical interview[J].Med Anthropol Q,1992,6(3):288-304.
[12] MAZER B,CAMERON R,DELUCA J,et al."Speaking-for" and "Speaking-as":Pseudo-surrogacy in physician-patient-companion medical encounters about advanced cancer[J].Patient Educ Counsel,2014,96:36-42.
[13] CLAYMAN M L,ROTER D,WISSOW L S,et al.Autonomy-related behaviors of patient companions and their effect on decision-making activity in geriatric primary care visits[J].Soc Sci Med,2005,60:1583-1591.
[14] TATES K,ELBERS E D,MEEUWESEN L,et al.Doctor-parent-child Relationships:A 'pas de trois'[J].Patient Educ Counsel,2002,48:5-14.
[15] HERITAGE J,ROBINSON J D.Accounting for the visit:Giving reasons for seeking medical care[M]//HERITAGE J,MAYNARD D W.Communication in Medical Care:Interaction between Primary Care Physicians and Patients.Cambridge:Cambridge University Press,2006:48-85.
[16] HERITAGE J.Epistemics in conversation[M]//SIDNELL J,STIVERS T.The Handbook of Conversational Analysis.Malden,MA:Blackwell Publishing Ltd,2013:370-394.
[17] 张帅.医患门诊会话中回声问的特征分析[J].上海理工大学学报,2018,2:207-212.
[18] 张帅,龚卫东.医患门诊会话中回声问的语用修辞功能研究[J].外语学刊,2018,3:44-51.
[19] DREW P.Asymmetries of knowledge in conversation interactions[M]//MARKOVá I,FOPPA K.Asymmetries in Dialogue.Harvester Wheatsheaf:Hemel Hempstead,1991:21-49.