Definition

Discourse plays an important role in medicine, and medical

discourse in the broadest sense (discourse in and about healing, curing, or
therapy; expressions of suffering; and relevant language ideologies) has
profound anthropological significance. As modes of social action, writing
and speaking help constitute medical institutions, curative practices, and
relations of authority in and beyond particular healing encounters.
Communication can be seen as the main ingredient in medical
care. In reviewing doctor-patient communication, the following topics
are addressed: (1) different purposes of medical communication;
(2) analysis of doctor-patient communication;
(3) specific communicative behaviors;
(4) the influence of communicative behaviors on patient outcomes
(5) concluding remarks.
Three different purposes of communication are identified, namely: (a)
creating a good inter-personal relationship; (b) exchanging
information; and (c) making treatment-related decisions.
Communication during medical encounters can be analyzed by using
different interaction analysis systems (IAS). These systems differ with
regard to their clinical relevance, observational strategy,
reliability/validity and channels of communicative behavior.
The interaction between doctor patient
Certain aspects of doctor-patient communication seem to have an
influence on patients' behavior and well-being, for example
satisfaction with care, adherence to treatment, recall and

understanding of medical information, coping with the disease, quality

of life, and even state of health [3-20].
Interaction and communication are especially important in the case of
life threatening diseases, such as cancer. The 'bad news consultation'
for instance, has become an important topic for research during the
past decade [21-34]. Recently, researchers
of communication have increasingly been paying
attention to psychosocial aspects of cancer. For this reason, studies
from psychosocial oncology will serve as examples in the following
review. The presented literature refers mainly to British, Dutch and
American data with cross-cultural references where they are thought
appropriate.
To understand more fully why communication
between doctors and patients (and cancer patients
in particular) is such a powerful phenomenon, it is
important to look at:
(1) the different purposes of medical communication;
(2) the analysis of doctor-patient communication;
(3) the specific communicative behaviors displayed during
consultations; and
(4) the influence of communicative behaviors on
certain patient outcomes.
Simple Conversation with A Doctor :
Doctor : Hello! What can I do for you?

Patient : Good Morning Doctor. I am not well.

Doctor : Come and sit here.
Doctor : Open your mouth.
Doctor : How long are you not well?
Patient : Since yesterday.
Doctor : No problem-did you have Motion yesterday?
Patient : No Doctor-not so freely.
Patient : Doctor I feel giddy.
Patient: I dont feel like eating at all.
Doctor : then?
Patient : I feel like vomiting.
Doctor : Do you take a lot of water?
Patient : No, doctor I don take too much.
Doctor : Did you take any medicine?
Patient : Yes Doctor, I took Anacin.
Doctor : who told you to take it?
Patient : Nobody Doctor I took it myself.
Doctor : why did you take it?
Patient Because I felt headache.
Doctor : Nothing to be worried at.
Doctor : Do you need immediate relief?
Patient : No need sir. It is enough you give medicines.
Patients communication
Patients are advising each other to "educate yourself and ask questions".
Patient satisfaction with their care, rests heavily on how successfully this
transition is accomplished.

Speech acts revisited

In accordance with the research which has already been completed, I under-stand speech acts
as acts of communication performed by the use of lan-guage, either in speech or writing,
involving reference, force, and effect (Widdowson 1996: 131). These acts are usually
classified into five categories: namely declarations, representatives, expressives, directives,

and commis-sives (e.g. Searle 1976). A distinction is also made between direct speech acts
and indirect speech acts.
Despite what the motto at the beginning of the paper suggests, the speech act theory has been
heavily criticised.3 Conversation analysts have specifically argued that speech act theorists
do not address a cultural, or contextual, so-ciological analysis, and that the basic unit of
analysis used is the self-contained action rather than the interaction unit, where context and
the role of all the participants are important (Todd 1983: 161). Nevertheless, I still find this
approach useful as it contributes to a broader view of how power and asymmetry are
distributed in the medical encounter.
In order to satisfy the specific needs of doctor-patient communication, Todds classification of
speech acts has been adopted.4 As a result, five cate-gories: statements (Example 1),
questions (Example 2), answers (Example 3), directives (Example 4), and reactives
(Example 5), have been distinguished. The distinction between answers and reactives consists
in the fact that the re-actives usually follow the answers and are provided by doctors, who use
them to acknowledge the answers provided by patients.
Example 1
D: Some of the slides that Ill take from you today will be looked at in clinic, and
from these Ill decide whether you require treatment or not.
Example 2
D: Could you describe what the vomiting is like Mrs Smith, for example, does it
clear your lap and land on the floor?
Example 3
D: Was it managerial did you have a lot of responsibility?
P: Yes, I was in charge of a large department.
Example 4
D: Now let me have a look at you. Sit down, open your mouth, head slightly forward.
Let me put this tongue depressor on your tongue.
Example 5
D: Have you been abroad to any tropical or developing coun-tries recently?

P: Yes, I just came back from Thailand a few months ago.

D: I see.
Compared to Searles classification, there are a few differences in my ap-proach. Noticeably,
besides others, two speech acts, namely expressives and commissives, have been excluded
from the analysis. Although speech acts of these types do emerge in doctor-patient talk, their
occurrence is not conspicu-ous and is rather infrequent (Examples 6 and 7). As Todd (1983:
161) main-tains: Strong emotion is not considered appropriate and actions such as vowing
and exasperation tend to be played down and absorbed into other acts.
Example 6
D: Do you have a job at the moment?
P: No, Ive just been made redundant.
D: Oh, I am sorry. What was your job?
P: I was desk-bound, Im afraid. (expressive)
Example 7
P: Oh, Thank God! No sign of cancer! No sign at all?
D: Yes, thats right. But listen for a moment. In the future you really must try
to stop smoking, as long as you keep smoking you can get more trouble with
your voice, and one day it could turn nasty.
P: Oh, yes, Doctor. I am trying Ive cut d.
5- Medical terminology :
Medical terminology is the core point in the analysis of the medical
discourses for both written and spoken form, also the breaking up of words
is very crucial. First of all, some words would be written and uttered
differently like: skin, bone, etc. These words in medicine refer to derm ,
oste(o),etc. Besides, there are several examples of breaking up words
especially those which are related to affixes such as:
Prefixes
Related to : size, color ,direction,etc

Root
Related to: a part of the body

Like: hypo, hyper

4- Illness language Vs disease language :

like : eryth ,leuk

Medical language, as various observes have pointed out ( McCullough

1989 ; Mintz 1992 ) , is an abstract discourse about diseases and organs.
Its not about patients and their experience of illness language , physicians
have no other language at their disposal than the abstract language of
disease . ( illness language related to the patients whereas the disease
language related to the physians ) .