Communication & Medicine <p>Since its inception in 2004,&nbsp;<em>Communication &amp; Medicine</em>&nbsp;has been consistently interrogating the `black box’ of what is routinely characterised as `the communicative turn’ in healthcare practice in clinical and public health domains. It is now firmly established as a leading forum for these critical debates.</p> Equinox Publishing Ltd. en-US Communication & Medicine 1612-1783 <p>copyright Equinox Publishing Ltd.</p> Getting to ‘no’ <p>This paper aims to describe the interactional processes through which a medical professional and a patient collaboratively accomplish filling out answers to a questionnaire. Empirical analysis of three different sequences from a video-recorded doctor-patient interaction in which questions of a questionnaire were answered with a ‘no' reveals three different ways (or methods) in which doctor and patient accomplish this jointly. Applying ethnomethodological conversation analysis (EMCA) as our methodological framework, we conclude that the three interactional practices are fitted in relation to the constraints of the interview that is itself methodically aligned to the practices and organizational structures of the institution, a Danish hospital. Furthermore, we make the case that questionnaires are designed as idealizations of question-answer sequences, and as such do not operate at the same level of detail as the actual question-answer situation. Details that are crucial for the objective of the questionnaire (in this case providing information to a third party) may not be included in the recorded answer. Thus, we argue that in order to understand the informational value of recorded answers in questionnaires, we need to diagnose the interaction in which they were produced, i.e. to critically examine it.</p> Elisabeth Muth Andersen Gitte Rasmussen Catherine E. Brouwer Jytte Isaksen Copyright (c) 2019 Equinox Publishing Ltd. 2019-07-03 2019-07-03 15 1 1 13 10.1558/cam.32459 Insulin restriction, medicalisation and the Internet <p>Diabulimia is a contested eating disorder characterised by the deliberate restriction of insulin by people with type 1 diabetes in order to lose and control body weight. This article reports the first discourse-based study of diabulimia. It employs a combination of quantitative and qualitative techniques afforded by corpus linguistics, a methodology for examining extensive collections of digitised language data, to interrogate the discourse surrounding diabulimia in an approx. 120,000-word collection of messages posted to three English-speaking online diabetes support groups. The analysis shows how, despite lacking official disease status, diabulimia was nonetheless linguistically constructed by the support group contributors as if it were a medically legitimate mental illness. This article explores some of the consequences that such medicalising conceptions are likely to have for people experiencing diabulimia, as well as their implications for health professionals caring for people presenting with this emerging health concern in the future.</p> <p>Open Access: CC BY</p> <p>This research was supported by the Economic and Social Research Council (ESRC) (grant number: ES/J500100/1). Open Access funding was provided by the ESRC Centre for Corpus Approaches to Social Science (grant number ES/K002155/1).</p> Gavin Brookes Copyright (c) 2019 Equinox Publishing Ltd. 2019-07-03 2019-07-03 15 1 14 27 10.1558/cam.33067 Patients’ representations of depressive symptoms and physicians’ responses in clinical encounters <p>Depression is defined by a list of symptoms. However, patients' experiences of these symptoms and the ways they are represented in medical consultations are not well described. Applying the methods of systemic functional linguistics and conversation analysis, we aim to explore how patients diagnosed with depression represent their depressive symptoms in medical consultations, and how physicians respond to patients' representations.We analyzed 30 video-recorded consultations between general practitioners or psychiatrists and patients with moderate depression, and found that one third of the patients represented experiences of activity located in the head or brain. The patients' representations of such head/brain symptoms were instantiated through a delimited set of transitivity patterns - material Processes and relational Processes - without any specification of agency. The transitivity patterns reflected experiences of head/brain symptoms taking place outside the patients' control. When physicians engaged with patients' head/brain experiences, they tried to make them fit into their own understanding of depression, which did not include head/brain symptoms detached from the patients' agency.</p> <p>Linguistic and interactional methods could promote insights into patients' experiences of depressive illness and we suggest that more focus should be placed on understanding patients' experiences, and that the intersubjective understanding of the patient could be further studied using linguistic methods.</p> Christina Fogtmann Fosgerau Annette Sofie Davidsen Copyright (c) 2019 Equinox Publishing Ltd. 2019-07-03 2019-07-03 15 1 28 39 10.1558/cam.32486 Interactions in psychiatric care consultation in Akan speaking communities <p>The present paper examines interactions in psychiatric care consultation in selected hospital settings in three Akan-speaking communities in Ghana, based on 45 audio-recorded doctor/nurse-patient interactions. Using a discourse pragmatics approach, we note how language is used in the management of communication in psychiatric consultations, and how the dominance of healthcare practitioners is enacted. Specifically, we focus on some of the strategies used by the participants to manage the multilingual communicative settings, such as code-mixing. Our findings also suggest that the use of proverbs as a diagnostic tool in psychiatric consultations in Ghana needs to be reviewed. We propose that in order for patients to experience consultation sessions that are more interactive, with possible therapeutic benefits, health practitioners need to make considerable efforts to involve the patients in decisions regarding their health.</p> Nana Aba Appiah Amfo Ekua Essumanma Houphouet Eugene K. Dordoye Rachel Thompson Copyright (c) 2019 Equinox Publishing Ltd. 2019-07-03 2019-07-03 15 1 40 52 10.1558/cam.32241 Nurturing anaesthetic expertise <p>This article seeks to establish the educational and social significance of narrative and affect in anaesthetic training. Data were obtained from focus group discussions involving three groups of eight (total 24) young anaesthetists from around Australia held at an Australian and New Zealand College of Anaesthetists (ANZCA) residential conference. Analysis applied to transcripts of the discussions revealed the prominence of narratives used among trainees and supervisors as a medium for explaining and nurturing anaesthetic expertise. Nurturing expertise was accomplished by sharing narratives about extreme circumstances that highlighted a need for constant vigilance directed towards not just clinical circumstances but also colleagues. The article suggests that the narrative emphasis on remaining vigilant and maintaining personal resourcefulness may explain graduands' tendency towards social exclusivity (avoidance of non-colleague others), and contribute to a better understanding of medicine's professional inclusivity (strong in-group bonding).</p> Rick Iedema Christine Jorm Copyright (c) 2019 Equinox Publishing Ltd. 2019-07-03 2019-07-03 15 1 53 64 10.1558/cam.32897 Inter-organisational use of the electronic health record in mental health <p>The creation and use of electronic records in welfare services is a subject that has received widespread attention. The electronic health record (EHR) is used by different stakeholders (NGOs, hospitals, health care clinics and commissioning agencies) and thus enables the distribution and sharing of recorded information between them, and in this article we focus on the tensions that arise from the inter-organisational use of the EHR in the context of mental health services. The data corpus consists of four focus group interviews from three NGOs in Finland, and we draw on ethnomethodology to analyse the ways in which mental health workers together talk and make sense of these tensions in their interview talk. Our findings suggest that the EHR addresses concerns about the dislocation of clients and continuity of care, which create a need for mental health workers to trace clients' service use and also the contributions by other professionals. However, the introduction of the EHR has increased the recording work of mental health workers as well as of the monitoring of their work performance. Our findings strengthen the case for more transparent practices and rules of recording and information sharing among the different users of the EHR.</p> Jenni-Mari Räsänen Kirsi Günther Copyright (c) 2019 Equinox Publishing Ltd. 2018-07-03 2018-07-03 15 1 65 76 10.1558/cam.32398 Verbal and nonverbal communication of agency in illness narratives of patients suffering from medically unexplained symptoms (MUS) <p>The objective of the study is to explore how patients presenting medically unexplained symptoms (MUS) - that is, symptoms that do not have an obvious underlying diagnosis - communicate agency. It is assumed that agency can be exercised verbally through narrative structure and content as well as nonverbally through patients' behaviours, in particular their gestures. This, in turn, points to the ways patients conceptualize their identities and selves. Pauses and disfluencies in the patients' accounts as well as an imprecise use of gestures can indicate a cognitive or conceptual conflict and uncertainty related to MUS. This paper reports on preliminary findings obtained from the analysis of 20 video-filmed interviews with Polish patients with MUS, and presents two case studies of patients who, despite fairly similar medical test results, deliver different illness narratives: (1) a narrative indicative of low agency and characterized by fragmentation, vagueness, repetitiveness and redundancy of content, dispreference markers and the imprecise use of gestures; and (2) a narrative reflecting high agency, characterized by specificity, coherence and the precise use of gestures.</p> Agnieszka Sowińska Copyright (c) 2019 Equinox Publishing Ltd. 2019-07-03 2019-07-03 15 1 77 89 10.1558/cam.32305 Perceptions of the need for minority languages by nurses in Southern Taiwan <p>Background: While language barriers between healthcare providers and minority-language-speaking patients often lead to miscommunication and jeopardize patient safety, language audits of the former have received little attention.Goal: Based on the context in Southern Taiwan, where the elderly population mainly speaks the local dialect Taiwanese, this study examines nurses' perceptions of their proficiency in and need for medical Taiwanese (‘MED-TW'), and attitudes toward it.</p> <p>Method: A questionnaire survey was conducted among 859 nurses from three levels of healthcare units: primary care stations (H1), a regional hospital (H2) and a medical center (H3).</p> <p>Results: Nurses from the rural-based H1 unit displayed significantly stronger needs for Taiwanese (TW) than those from urban-based H2 and H3. Specifically, H1 nurses reported encounters with the largest proportion of TW-speaking clients (p&lt;0.001) and the highest frequency of using TW with clients (p&lt;0.001). However, H1 nurses' self-evaluation of their TW proficiency revealed a lower score than those of the H2 and H3 nurses, especially with regard to medical TW proficiency (p&lt;0.05). Finally, while nurses with a high command of TW felt it helped their work, those with a low level did not feel this impacted their performance.</p> <p>Conclusion: Nurses working in locations where the use of the minority language is prevalent would benefit more from learning this language.</p> Mei-Hui Tsai Huan-Fang Lee Shuen-Lin Jeng Sheng-Che Lin Li-Wei Hsieh Jen-Pin Chuang Elizabeth A. Jacobs Copyright (c) 2019 Equinox Publishing Ltd. 2019-07-03 2019-07-03 15 1 90 104 10.1558/cam.33283