Thanks for trusting me, parent
Chinese pediatricians’ epistemic behaviour for trustworthiness in online medical consultations
DOI:
https://doi.org/10.1558/eap.22552Keywords:
Online medical consultation, trustworthiness, epistemics, discursive practices, pragma-linguistic resourceAbstract
Despite an increasing scholarly interest in doctors’ behaviour in online settings, doctors’ epistemic behaviour (i.e. how doctor employs discursive practices to deal with their side and patients’ side knowledge) in online medical consultation (OMC) is still underexplored in research. Drawing on 300 highly rated OMC cases retrieved from dxy.com, a well-known digital health consulting platform in China, this study explores how Chinese pediatricians discursively deploy different types of epistemic behaviour in OMC settings. Data analyses yield three typical types of epistemic behaviour by Chinese pediatricians: strengthening epistemic primacy, mitigating epistemic certainty and showing concerns about parents’ epistemic domain. It is argued that pediatricians conduct epistemic behaviour to win parents’ perceptions of their trustworthiness. The three types of epistemic behaviour are targeted at the three dimensions of trustworthiness – ability, integrity, and benevolence. This study could yield insightful suggestions for online doctors’ strategic choice of discursive practices to promote a trusting doctor–patient relationship and harmonious consulting atmosphere in e-health activities.
References
Austin, J. L. (1962). How to do things with words. Oxford: Clarendon Press.
Barry, C. A., Stevenson, F. A., Britten, N., Barber, N., & Bradley, C. P. (2001). Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor–patient communication in general practice. Social Science & Medicine, 53, 487–505.
Bensing, J. M., Deveugele, M., Moretti, F., Fletcher, I., Vliet, L. V., Bogaert, M. V., & Rimondini, M. (2011). How to make the medical consultation more successful from a patient’s perspective? Tips for doctors and patients from lay people in the United Kingdom, Italy, Belgium and the Netherlands. Patient Education and Consulting, 84, 287–293. https://doi.org/10.1016/j.pec.2011.06.008
Bonvicini, K. A., Perlin, M. J., Bylund, C. L., Carroll, G., Rouse, R. A., & Goldstein, M. G. (2009). Impact of communication training on physician expression of empathy in patient encounters. Patient Education and Counseling, 75, 3–10. https://doi.org/10.1016/j.pec.2008.09.007
Bromme, R., & Thomm, E. (2016). Knowing who knows: Laypersons’ capability to judge experts’ pertinence for science topics. Cognitive Science, 40, 241–252. https://doi.org/10.1111/cogs.12252
Brown, P., & Levinson, S. C. (1978). Politeness: Some universals in language usage. Cambridge: Cambridge University Press.
Ciapuscio, G. E. (2003). Formulation and reformulation procedures in verbal interactions between experts and (semi-)laypersons. Discourse Studies, 5(2), 207–233. https://doi.org/10.1177/1461445603005002004
Clark, H. H. (1992). Arenas of language use. Chicago, IL: Chicago University Press.
Cole, L., LeCouteur, A., Feo, R., & Dahlen, H. (2021). “Cos you’re quite normal, aren’t you?”: Epistemic and deontic orientations in the presentation of model of care talk in antenatal consultations. Health Communication, 3, 381–391. https://doi.org/10.1080/10410236.2019.1692492
Dictionary Editorial Room, Institute of Linguistics, Chinese Academy of Social Sciences. (2005). Modern Chinese Dictionary (5th ed.). Beijing: Commercial Press.
Drew, P. (1991). Asymmetries of knowledge in conversation interaction. In I. Markova & K. Foppa (Eds.), Asymmetries in dialogue (pp. 29–48). Hemel Hempstead: Harvester Wheatsheaf.
Drew, P. (2018). Epistemics in social interaction. Discourse Studies, 20(1), 163–187. https://doi.org/10.1177/1461445617734347
Ekberg, K., & LeCouteur, A. (2015). Clients’ resistance to therapists’ proposals: Managing epistemic and deontic status. Journal of Pragmatics, 90, 12–25. https://doi.org/10.1016/j.pragma.2015.10.004
Elder, C. (2015). Classifying conditionals: The case of metalinguistic IF YOU LIKE. Cambridge Occasional Papers in Linguistics, 7, 61–82.
Fei, X. T. (1992). From the soil: The foundation of Chinese society. Berkeley, CA: University of California Press.
Fugelli, P. (2001). Trust in general practice. British Journal of General Practice, 51(468), 575–579. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314053/pdf/11462321.pdf
Fuoli, M., & Paradis, C. (2014). A model of trust-repair discourse. Journal of Pragmatics, 74, 52–59. https://doi.org/10.1016/j.pragma.2014.09.001
Grice, H. P. (1975). Logic and conversation. In P. Cole & J. L. Morgan. (Eds.), Syntax and semantics, vol. 3, Speech acts (pp. 41–58). New York: Academic Press.
Heritage, J. (2012). Epistemics in action: Action formation and territories of knowledge. Research on Language and Social Interaction, 45(1), 1–29. https://doi.org/10.1080/08351813.2012.646684
Holmes, J. (1984). Modifying illocutionary force. Journal of Pragmatics, 8, 345–365. https://doi.org/10.1016/0378-2166(84)90028-6
Huang, K. K. (1988). The Chinese power game. Taipei: Chi Liu Press.
Hyland, K. (2005). Metadiscourse: Exploring interaction in writing. London: Continuum.
Jarvenpaa, S. L., Shaw, T. R., & Staples, D. S. (2004). Toward contextualized theories of trust: The role of trust in global virtual teams. Information System Research, 15(3), 250–267. https://doi.org/10.1287/isre.1040.0028
Jucks, R., & Paus, E. (2012). What makes a word difficult? Insights into the mental representation of technical terms. Metacognition Learning, 7, 91–111. https://doi.org/10.1007/s11409-011-9084-6
Kamarainen, A., Bjorn, P., Eronen, L., & Karna, E. (2019). Managing epistemic imbalance in peer interaction during mathematics lessons. Discourse Studies, 21(3), 280–299. https://doi.org/10.1177/1461445619829236
Kamio, A. (1997). Territory of information. Amsterdam: John Benjamins.
Labov, W., & Fanshel, D. (1977). Therapeutic discourse: Psychotherapy as conversation. New York: Academic Press.
Labrie, N. (2019). “Doctor, I disagree”: Development and preliminary validation of a patient argumentativeness scale. Journal of Argumentation in Context, 8(3), 336–353. https://doi.org/10.1075/jaic.18018.lab
Landqvist, M. (2016). Sense and sensibility: Online forums as epistemic arenas. Discourse, Context & Media, 13, 98–105. https://doi.org/10.1016/j.dcm.2016.05.007
Liao, M. (2005). The principle of goal and goal analysis: A new way of doing pragmatics. Rhetorical Learning, 3, 1–10.
Lindström, J., & Karlsson, S. (2016). Tensions in the epistemic domain and claims of no-knowledge: A study of Swedish medical interaction. Journal of Pragmatics, 106, 129–147. https://doi.org/10.1016/j.pragma.2016.07.003
Lindström, J., & Weatherall, A. (2015). Orientations to epistemics and deontics in treatment discussions. Journal of Pragmatics, 78, 39–53. https://doi.org/10.1016/j.pragma.2015.01.005
Mao, Y., & Zhao, X. (2018). I am a doctor, and here is my proof: Chinese doctors’ identity constructed on the online medical consultation websites. Health Communication, 34, 1645–1652. https://doi.org/10.1080/10410236.2018.1517635
Mao, Y., & Zhao, X. (2020). By the mitigation one knows the doctor: Mitigation strategies by Chinese doctors in online medical consultations. Health Communication, 35(6): 667–674. https://doi.org/10.1080/10410236.2019.1582312
Markham, A., & Buchanan, E. (2012). Ethical decision making and internet research: Recommendations from the AoIR Ethics Working Committee (Version 2.0). Retrieved from: http://aoir.org/reports/ethics2.pdf
Marková, I., & Gillespie, A. (2008). Trust and distrust: Sociocultural perspectives. Charlotte, NC: Information Age Publishing.
Meyer, R. C., Davis, J. H., & Schoorman, F. D. (1995). An integrative model of organizational trust. Academy of Management Review, 20(3), 709–734. https://doi.org/10.5465/amr.1995.9508080335
Mishler, E. G. (1984). The discourse of medicine: The dialectics of medical interviews. Norwood, NJ: Ablex.
Myers, G. (1990). Writing biology: Texts in the social construction of scientific knowledge. Wisconsin: University of Wisconsin Press.
Nikolova, N., Mollering, G. & Rehlen, M. (2015). Trusting as a ‘Leap of Faith’: Trust-building practices in patient–consultant relationships. Scandinavian Journal of Management, 31(2), 232–245. https://doi.org/10.1016/j.scaman.2014.09.007
Pomerantz, A. M. (1980). Telling my side: “Limited access” as a “fishing” device. Sociological Inquiry, 50, 186–198. https://doi.org/10.1111/j.1475-682x.1980.tb00020.x
Pounds, G. (2018). Patient-centred communication in ask-the-expert health care websites. Applied Linguistics, 39, 117–134. https://doi.org/10.1093/applin/amv073
Raymond, G. (2010). Grammar and social relations: Alternative forms of yes/no-type initiating actions in health visitor interactions. In A. Free & S. Ehrlich (Eds.), “Why do you ask?” The function of questions in institutional discourse (pp. 42–48). New York: Oxford University Press.
Raymond, G., & Heritage, J. (2005). The epistemic of social relations: Owning grandchildren. Language in Society, 35(5), 677–705. https://doi.org/10.1017/S0047404506060325
Sacks, H. (1975). Everyone has to lie. In M. Sanchez & B. Blount (Eds.), Sociocultural dimensions of language use (pp. 57–80). New York: Academic Press.
Sert, O. (2013). “Epistemic status check” as an interactional phenomenon in instructed learning settings. Journal of Pragmatics, 45, 13–28. https://doi.org/10.1016/j.pragma.2012.10.005
Sharrock, W. (1974). On owning knowledge. In R. Turner (Eds.), Ethnomethodology (pp. 45–53). Harmondsworth: Penguin Books.
Shen, X. C. (2019). Medical experts as health knowledge providers: A case study of nutritionists’ identity construction in “wemedia”. East Asian Pragmatics, 4(2), 263–291. https://doi.org/10.1558/eap.37686
Skirbekk, H., Middelton, A., Hjortdahl, P., & Finset, A. (2011). Mandates of trust in the doctor–patient relationship. Qualitative Health Research, 21(9), 1182–1190. https://doi.org/10.1177/1049732311405685
Stivers, T., & Timmermans, S. (2020). Medical authority under siege: How clinicians transform patient resistance into acceptance. Journal of Health and Social Behavior, 61(1), 60–78. https://doi.org/10.1177/0022146520902740
Thon, F. M., & Jucks, R. (2017). Believing in expertise: How authors’ credentials and language use influence the credibility of online health information. Health Communication, 32(7), 828–836. https://doi.org/10.1080/10410236.2016.1172296
Tseng, M., & Zhang, G. (2018). Pragmeme, adaptability, and elasticity in online medical consultations. Journal of Pragmatics, 137, 40–56. https://doi.org/10.1016/j.pragma.2018.09.004
White, P. R. R. (2003). Beyond modality and hedging: A dialogic view of the language of intersubjective stance. Text & Talk, 23(2), 259–284. https://doi.org/10.1515/text.2003.011
Wynn, R., & Wynn, M. (2006). Empathy as an interactionally achieved phenomenon in psychotherapy: Characteristics of some conversational resources. Journal of Pragmatics, 38, 1385–1397. https://doi.org/10.1016/j.pragma.2005.09.008
Yu, G. D., & Wu, Y. X. (2022). A conversational analysis of resistance to medical recommendations. Modern Foreign Languages, 45(1), 17–28.
Zand, D. E. (1972). Trust and managerial problem solving. Administrative Science Quarterly, 17, 229–239. https://doi.org/10.2307/2393957
Zhang, Y. (2021). How doctors do things with empathy in online medical consultations in China: A discourse-analytic approach. Health Communication, 36(7), 816–825. https://doi.org/10.1080/10410236.2020.1712527
Zhao, X., & Mao, Y. (2021). Trust me, I am a doctor: Discourse of trustworthiness by Chinese doctors in online medical consultations. Health Communication, 36(3), 372–380. https://doi.org/10.1080/10410236.2019.1692491
