Clinical communication training for the general practice of medicine – A case for including discourse analytical findings from real-world practice
DOI:
https://doi.org/10.1558/japl.31860Keywords:
clinical communication training, discourse analysis, empathy, ethnography, general practice, ineffective empathyAbstract
Communication is central to the clinical training of doctors preparing for Fellowship of the Royal Australian College of General Practitioners. Currently, medical educators use a comprehensive problem-solving methodology that includes engaging registrars in role-plays of consultations as a means for reflection on practice. To date, however, this interactive training has made little use of the evidence from real-life clinical encounters that discourse analysis affords. This paper presents a case for the use of discourse analytical findings to complement existing training processes. Drawing from ethnographic observations of clinical communication training and focusing particularly on the development of empathic communication, the paper looks closely at current training practice. Turning to discourse analytical findings from real-life practice, and focusing on moments of empathic opportunity, the paper brings to light the impact of a doctor's selective empathic formulations on the direction and outcomes of the consultation, in order to make visible what constitutes clinically ineffective empathy. The paper goes on to suggest a training approach that deploys such discourse analytical findings as a means to enhance clinical communication training and to support processes of critical reflection on practice.
References
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Sarangi, S. (2002) Discourse practitioners as a community of interprofessional practice: Some insights from health communication research. In C. N. Candlin (ed.) Research and Practice in Professional Discourse, 95–135. Hong Kong: City University of Hong Kong Press.
Sarangi, S. (2004) Editorial: Towards a communicative mentality in medical and healthcare practice. Communication & Medicine 1 (1): 1–11. https://doi.org/10.1515/come.2004.002
Sarangi, S. and Roberts, C. (1999) The dynamics of interactional and institutional orders in work-related settings. In S. Sarangi and C. Roberts (eds) Talk, Work and Institutional Order, 1–57. Berlin: Mouton de Gruyter. https://doi.org/10.1515/9783110208375.1.1
Schön, D. (1983) The Reflective Practitioner: How Professionals Think in Action. New York: Basic Books.
Seale, C., Butler, C., Hutchby, I., Kinnersley, P. and Rollnick, S. (2007) Negotiating frame ambiguity: A study of simulated encounters in medical education. Communication & Medicine 4 (2): 177–187. https://doi.org/10.1515/CAM.2007.021
Stivers, T. and Heritage, J. (2001) Breaking the sequential mold: Answering ‘more than the question’ during comprehensive history taking. Text 21 (1–2): 151–185. https://doi.org/10.1515/text.1.21.1-2.151
Suchman, A., Markakis, K., Beckman, H. and Frankel, R. (1997) A model of empathic communication in the medical interview. Journal of the American Medical Association 277 (8): 678–682. https://doi.org/10.1001/jama.1997.03540320082047
Tapsell, L. (2000) Using applied conversation analysis to teach novice dietitians history taking skills. Human Studies 23 (3): 281–307. https://doi.org/10.1023/A:1005688709805
Antaki, C., Barnes, R. and Leudar, I. (2005) Diagnostic formulations in psychotherapy. Discourse Studies 7 (6): 627–647. https://doi.org/10.1177/1461445605055420
Candlin, C. (1987) Explaining moments of conflict in discourse. In R. Steele and T. Threadgold (eds) Language Topics: Essays in Honour of Michael Halliday, 413–430. Amsterdam: John Benjamin.
Candlin, S. (2007) Therapeutic Communication: A Lifespan Approach. Sydney: Pearson Education Australia.
Candlin, C., Maley, Y., Crichton, J. and Koster, P. (1994) The Language of Lawyer-Client Conferencing: A Report to the Law Society of New South Wales. Sydney: Centre for Language in Social Life, Macquarie University.
Candlin, S. and Roger, P. (2013) Communication and Professional Relationships in Healthcare Practice. Sheffield: Equinox.
Davis, K. (1986) The process of problem re(formulation) in psychotherapy. Sociology of Health and Illness 8 (1): 44–74. https://doi.org/10.1111/1467-9566.ep11346469
De La Croix, A. and Skelton, J. (2009) The reality of role-play: Interruptions and amount of talk in simulated consultations. Medical Education 43 (7): 695–703. https://doi.org/10.1111/j.1365-2923.2009.03392.x
Frankel, R. (2009) Empathy research: A complex challenge. Patient Education & Counseling 75 (1): 1–2. https://doi.org/10.1016/j.pec.2009.02.008
Gask, L., Usherwood, T. and Standart, S. (1992) Training teachers to teach communication skills: A problem-based approach. Postgraduate Education for General Practice 3: 92–99.
Goffman, E. (1967) Interaction Ritual: Essays on Face-to-Face Behaviour. New York: Pantheon.
Goffman, E. (1986 [1974]) Frame Analysis: An Essay on the Organisation of Experience. Boston: Northeastern University Press.
Goodwin, C. (1994) Professional vision. American Anthropologist 96 (3): 606–633. https://doi.org/10.1525/aa.1994.96.3.02a00100
Gumperz, J. (1999) On interactional sociolinguistic method. In S. Sarangi and C. Roberts (eds) Talk, Work and Institutional Order, 453–472. Berlin: Mouton de Gruyter https://doi.org/10.1515/9783110208375.4.453
Jefferson, G. (1988) On the sequential organisation of troubles-talk in ordinary conversation. Social Problems 35 (4): 418–451. https://doi.org/10.2307/800595
Leahy, M. and Walsh, I. (2008) Talk in interaction in the speech-language pathology clinic: Bringing theory to practice through discourse. Topics in Language Disorders 28 (3): 229–241. https://doi.org/10.1097/01.TLD.0000333598.53339.5a
Levinson, S. (1979) Activity types and language. Linguistics 17: 356–399. https://doi.org/10.1515/ling.1979.17.5-6.365
Mercer, S. and Reynolds, W. (2002) Empathy and quality of care. British Journal of General Practice 52 (suppl.): S9–S12.
Neumann, M. (2009) Analyzing the ‘nature’ and ‘specific effectiveness’ of clinical empathy. Patient Education and Counseling 74 (3): 339–346. https://doi.org/10.1016/j.pec.2008.11.013
Neumann, M. Bensing, J., Mercer, S., Erntsmann, N., Ommen, O. and Pfaff, H. (2009) Analyzing the ‘nature’ and ‘specific effectiveness’ of clinical empathy: A theoretical overview and contribution towards a theory-based research agenda. Patient Education and Counseling 74 (3): 339–346. https://doi.org/10.1016/j.pec.2008.11.013
O’Grady, C. (2011) Teaching the communication of empathy in patient-centred medicine. In B. Hoekje and S.Tipton (eds) English Language and the Medical Profession, 43–72. Bingley, UK: Emerald.
Polanyi, M. (1969) Knowing and Being: Essays by Michael Polanyi, ed. M. Grene. Chicago: University of Chicago Press.
Roberts, C., Atkins, S. and Hawthorne, K. (2014) Performance Features in Clinical Assessment: Linguistic and Cultural Factors in the Membership Exam of the Royal College of General Practitioners. London: King’s College London with the University of Nottingham.
Roberts, C., Atwell, C. and Stenhouse, J. (2006) Words in Action: An Educational Resource for Doctors New to UK General Practice [DVD]. London: NHS London Postgraduate Deanery.
Roberts, C. and Sarangi, S. (1999) Hybridity in gatekeeping discourse: Issues of practical relevance for the researcher. In S. Sarangi and C. Roberts (eds) Talk, Work and Institutional Order, 473–503. Berlin: Mouton de Gruyter.
Roberts, C., Wass, V., Jones, R., Sarangi, S. and Gillett, A. (2003) A discourse analysis study of ‘good’ and ‘poor’ communication in an OSCE: A proposed new framework for teaching students. Medical Education 37 (3): 192–201. https://doi.org/10.1046/j.1365-2923.2003.01443.x
Sarangi, S. (2002) Discourse practitioners as a community of interprofessional practice: Some insights from health communication research. In C. N. Candlin (ed.) Research and Practice in Professional Discourse, 95–135. Hong Kong: City University of Hong Kong Press.
Sarangi, S. (2004) Editorial: Towards a communicative mentality in medical and healthcare practice. Communication & Medicine 1 (1): 1–11. https://doi.org/10.1515/come.2004.002
Sarangi, S. and Roberts, C. (1999) The dynamics of interactional and institutional orders in work-related settings. In S. Sarangi and C. Roberts (eds) Talk, Work and Institutional Order, 1–57. Berlin: Mouton de Gruyter. https://doi.org/10.1515/9783110208375.1.1
Schön, D. (1983) The Reflective Practitioner: How Professionals Think in Action. New York: Basic Books.
Seale, C., Butler, C., Hutchby, I., Kinnersley, P. and Rollnick, S. (2007) Negotiating frame ambiguity: A study of simulated encounters in medical education. Communication & Medicine 4 (2): 177–187. https://doi.org/10.1515/CAM.2007.021
Stivers, T. and Heritage, J. (2001) Breaking the sequential mold: Answering ‘more than the question’ during comprehensive history taking. Text 21 (1–2): 151–185. https://doi.org/10.1515/text.1.21.1-2.151
Suchman, A., Markakis, K., Beckman, H. and Frankel, R. (1997) A model of empathic communication in the medical interview. Journal of the American Medical Association 277 (8): 678–682. https://doi.org/10.1001/jama.1997.03540320082047
Tapsell, L. (2000) Using applied conversation analysis to teach novice dietitians history taking skills. Human Studies 23 (3): 281–307. https://doi.org/10.1023/A:1005688709805
Published
2018-12-31
Issue
Section
Articles
License
Equinox Publishing Ltd.
How to Cite
O'Grady, C. (2018). Clinical communication training for the general practice of medicine – A case for including discourse analytical findings from real-world practice. Journal of Applied Linguistics and Professional Practice, 13(1-3), 254-275. https://doi.org/10.1558/japl.31860
