Running head: A SMALL DISCOURSE COMMUNITY IN A LARGE DISCOURSE

A Small Discourse Community in a Large Discourse Community: Physicians of

Emergency Medicine
Chiharu Takashi
University of California Davis

A SMALL DISCOURSE COMMUNITY IN A LARGE DISCOURSE

A Small Discourse Community in a Large Discourse Community: Physicians of

Emergency Medicine
A group of physicians is a discourse community of medicine. According to the
Swales characteristics, which Downs and Wardle (2011) excerpted from ''The Concept of
Discourse Community" of his book Genre Analysis: English in Academic and Research
Settings, to determine if a community is a discourse community, a group of physicians
fulfills them to be a discourse community of medicine. However, I claim that many
smaller discourse communities based on physicians specialties exist in the large
discourse community. If so, there should be some special characteristics belonging only
to one while sharing same features among them. This is not what Swales considered
about a discourse community. This research is conducted to discover how one small
discourse community can be different from other small ones even though they are in a
same large discourse community. The discourse community can be broken down into the
small communities, which each also can be a discourse community possessing unique
characteristics. Specifically, I approach to the differences of physicians of emergency
medicine from physicians of other specialties.
History of Emergency Medicine
Medicine has been developed since ancient times and so as different specialties in
medicine. However, emergency medicine (EM) has only 50 years of history since it was
considered as a specialty. According to Suter (2012), medical knowledge and technology
have advanced in specialties to give better outcomes for most medical and surgical
problems (Early Formation of Emergency Department, para. 2). This was not true for

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EM before it became to a real specialty. The fact of an unexpected visiting of a patient

who needed a specialty emergency care made it difficult for physicians out of the
specialty to provide best treatments at the time. No specialty could respond to wide types
of medical problems. With the need to develop EM as a specialty, the American College
of Emergency Physicians (ACEP) was established in 1968. After the recognition of EM
as a specialty by the American Medical Association (AMA), EM had progressed to
become a distinct specialty (Suter, 2012). From this time, EM has played its special role,
which other specialties cannot.
Defining a Discourse Community of Emergency Medicine
Before looking at the special characteristics of emergency medicine, I would like
to briefly illustrate EM as one discourse community despite the fact of that EM is
relatively new to other specialties. It can be seen by carefully examining a community of
emergency physicians. There are many slightly different definitions of a discourse
community because of its vague concept, but I would like to use the idea of Swales cited
by Downs and Wardle (2011) in Writing about Writing here as I did above. According to
his six characteristics, emergency physicians form a discourse community of EM. First,
emergency physicians have a broadly agreed set of common public goals (A
Conceptualization of Discourse Community, 1). Their purpose of practicing EM is to
save peoples lives, which is also true for all physicians. Second, they share mechanisms
of intercommunication among its members (A Conceptualization of Discourse
Community, 2). Some of the mechanisms are same for all physicians. Mainly physicians
talk directly to other physicians. For emergency physicians, they communicate by not

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only direct talking but also explaining a situation using radio contact in a helicopter.
Third, they have participatory mechanisms primarily to provide information and
feedback (A Conceptualization of Discourse Community, 3), which means that there
exists an organization for a discourse community to exchange information among the
members. There are associations of physicians in the United States, but each specialty has
its own associations. Specifically, the associations of EM are American Academy of
Emergency Medicine (AAEM), American College of Emergency Physicians (ACEP), etc.
If a physician is a member of AAEM, for example, he or she is able to view news of
emergency medicine from the world, journals, blogs, etc.) Forth, they have one or more
genres in the communicative furtherance of its aims (A Conceptualization of Discourse
Community, 4). EM has its own topics of the specialty to focus on, its own form to
practice, and its special function to perform. In fact, EM basically covers topics of all
specialties, but it can be considered as a new specialty because no specialty covers that
broad topics. Fifth, they use some specific lexis (A Conceptualization of Discourse
Community, 5) when communicating each other. All physicians learn and acquire to use
technical medical terms, but as medicine develops and each specialty needs to define new
terms for efficient communication among its physicians, certain terminology or
abbreviations can evolve only within the community. In fact, the government releases
General Acronyms for EMS [Emergency Medicine Service] Communications. It lists
acronyms used often in emergency medicine. Also, not all medical terms is used often by
all physicians. Internal physicians, for example, use the terms used in surgery less or not
at all whereas surgeons often use them. Emergency physicians use variety of terms of

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many disciplines because of their work with a various types of patients. Last, they have
suitable degree[s] of relevant content and [are] discoursal expertise[s] (A
Conceptualization of Discourse Community, 6). All physicians need to have
undergraduate degrees to enter medical schools, earn Doctor of Medicine degrees, and
pass standardized national licensure exams. However, depending on their specialties to
proceed, internship and residency programs are different and can be from 3 to 7 years
(How to Become a Physician or Surgeon, 2015). Within a residency of a specialty,
physicians become experts in the field. Therefore, physicians on EM residency enter the
field along with acquiring terms, skills, and techniques of the specialty. From these
characteristics I gave above, there are some shared in all small discourse communities of
the discourse community of physicians and some applied to only EM. After all, it is able
to see that EM is a distinct discourse community from discourse communities of other
specialties while sharing same characteristics with them and making the large discourse
community of physicians as a whole.
Characteristics of Emergency Medicine
If emergency medicine is a small discourse community in the large discourse
community of physicians as I concluded above, what makes it different from other
specialties. I mentioned some of the differences when defining a discourse community
above. Now, I would like to examine more specifically by incorporating the voices of
professionals of EM. Since the difficulty could exist to interview physicians, I instead use
the interview done by Betty Hua, Kristen Meler and Sarp Aksel, who were the second

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year medical students in Albert Einstein College of Medicine. The interviewees were
Thomas Perera, an associate professor of clinical medicine in Albert Einstein College of
Medicine and also residency director of emergency medicine at Jacobi Medical Center
and Montefiore Medical Center, and Mary Hannon, a fourth-year resident of emergency
medicine at the Medical Centers. In addition to the interview, the online sources were
also used in the research.
Unlike other specialties only take care of patients of their fields, emergency
physicians accept all kinds of patients. In fact, this was the reason why emergency
medicine was organized as I mentioned in the history of EM. Perera described EM as
the front door of the hospital because emergency physicians are mandatory to
appropriately treat anyone for any reason (Albert Einstein College of Medicine, 2012).
This means that they cannot expect what kinds of patients to come. This is really special
for EM that physicians do not know what type of a medical problem a patience struggles.
Even though EM still handles medical problems as the other specialties do, this
characteristic only belongs to it.
In order to handle this unique characteristic of being unaware of what to come to
EM, emergency physicians need to have knowledge across other specialties to prepare for
various possible situations. That is saying that, for example, an emergency physician may
need the knowledge of internal medicine when a patients stomach hurts or the
knowledge of orthopedic surgery if a patient feels pain in an arm. Due to this nature of
that emergency medicine touches on so many field, Perera claims that it is important
for emergency physicians to have a continual desire to learn (Albert, 2012). The

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passion and attitude to actively learn and progress enable them to be aware of the
advancements of all the fields and correspond to every possible situation they encounter.
Even though all physicians need to actively study new things, EM needs to more passion
to learn as widely as possible.
In fact, this special characteristic of emergency medicine of having wide range of
knowledge is recognized by other specialties according to the research by Stephenson D.
and Bowden L. (2009). The result of the questionnaires from physicians of other
specialties in a district general hospital in Northern England indicates that other
specialties may rely on emergency practitioners to train juniors in acute care because
they see training of junior doctors from all specialties [are] important (The Purpose of
EM, para. 3). This demonstrates that even members of the discourse community of
medicine see EM as a different community possessing various knowledge.
Emergency physicians can have major trauma coming into emergency
department. The abundant knowledge plays a large role in this situation. In addition, as
Overton, who is an advisor of applicants to emergency medicine programs, states,
emergency physicians must be comfortable with making important decisions, sometimes
with an incomplete database in the situation (n.d., Cons: Decision-Orientation), the skill
to make quick judgments with what is known is also important. They cannot do preresearch to gather data and information for a case before they need to make an immediate
decision. Based on the knowledge they know, they need to decide at that moment and
place. Upon making decisions, as Hannon said, they are required to have high skills in
order to manage a life or death situation of someone who you never met in a short time

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(Albert, 2012). With such a short time from when a patient comes in until they save the
patient in the emergency situation, emergency physicians really need the skill to make
quick judgments and the technique to actually do medical practices. Various emergency
situations are only for EM, which almost all patients visit first no matter what their
reasons are, in the contrast to the other specialties having emergency situations relating to
their specific fields.
In addition to the unique characteristics of covering various subjects of
specialties, being passionate about learning, and having skills to deal with all kinds of
emergency situations, Perera added that they also should [have] a very high work ethic.
Being the front door of the hospital, emergency department sees huge number of
patients (Albert, 2012). In order to increase more patients to be seen and saved, it is
important that emergency physicians are active about taking as many patients as possible.
Perera implied this when he said that emergency physicians need to be motivated to get
up and see the next one, two, three patients and organize as much as possible to hand
tasks to next emergency physicians in shifts (Albert, 2012). Not only being active to
accept more patients on weekdays when hospitals are open, they also have to work their
share of midnights, weekends, holidays, and other times when the rest of the world is
home, with their families and friends or asleep (Overton, n.d., Cons: Lifestyle). This life
style of EM is much different from physicians of other specialties who typically work
during when hospitals are open.
All of the characteristics I identified above are specific to emergency medicine
but not to other specialties. Studying all different specialties, emergency physicians have

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broad knowledge of medicine in order to diagnose all kinds of patients and are active
about learning new developments of other specialties. In addition, they have a desire to
work as much as they can during their shifts when hospitals are open or when other
people are rest. These elements characterize EM as a distinct community from other
specialties communities. This, as a result, makes EM a small discourse community by
having different characteristics to achieve the public goal of the large discourse
community of medicine.
Conclusions
I have been given the differences of emergency medicine from other specialties,
which therefore make EM into a distinct discourse community, while sharing the same
public goal with all specialties as a discourse community of medicine. Furthermore, those
different characteristics lead each discourse community to have different environment
and therefore different atmosphere.
How different characteristics or discourse communities lead to different
atmosphere can be seen clearly by comparing family medicine and emergency medicine.
The pictures below show the working environment of family medicine and emergency
medicine. The picture on left is family medicine (Mercy, n.d.) and the one on right is
emergency medicine (American College, n.d.). Looking at the pictures, it is able to easily
see the differences.

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According to American Dental Education Association (2016), most family

physicians work with patients in their own offices. The physicians is more likely to build
relationships with the patients because family medicine is where people go often to
prevent disease before going to hospitals. In addition, the physician has more flexible life
style. As a result of these characteristics, family medicine has its unique relaxed
atmosphere.
In contrast to family medicine, emergency medicine has totally different
atmosphere. Emergency physicians are motivated and passionate more about taking care
of as many patients as they can during their shifts even on a weekend, holiday, or
nighttime. In addition to their work times, they spend times to learn advancements in all
specialties so that they can quickly correspond to any problem of a patient to come. As a
team, emergency physicians come to corporate to diagnose as many patients as possible.
These elements differentiate the community of EM to have energetic atmosphere
resulting from being active about saving more patients and learning new developments.
Also, emergency physicians connect to not only within emergency department but
also outside of their department, which is one of the defining features of the emergency
physician according to the College of Emergency Medicine (as cited in Reid,

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Stephenson and Bowden, 2009, para.1). In Pereras words, emergency physicians take up
patients from downstairs to upstairs of hospitals (Albert, 2012). By diagnosing patients
and transferring to proper specialties, the emergency physicians play a role of the bridge.
They reach out to other fields in terms of both knowledge and connections. As a result,
EM functions dynamically in hospitals and acts energetically.
As shown in the example of comparing family medicine and emergency medicine
above, each smaller discourse community of a specialty composing the large discourse
community of medicine has different features from the other small ones. The differences
make a small discourse community distinct from each other and give different
atmosphere while contributing its own roles to the large discourse community for
achieving the public goal of physicians, which is saving people. In this research, I
specifically focused on physicians in emergency medicine seeing it as a small discourse
community in the large discourse community of physicians. However, in order to
generalize my arguments, more extensive research needs to be conducted for different
discourse communities.

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References
Albert Einstein College of Medicine (2012, March 29). Inside the Doctors Studio:
Emergency Medicine. [You Tube]
Retrieved from https://www.youtube.com/watch?v=WIz5A7i0JaA
American College of Emergency Physicians. (n.d.). Image Gallery. American College of
Emergency Physicians. Retrieved from
http://newsroom.acep.org/image_gallery?cat=2749
American Dental Education Association. (2016, November 15). Family Medicine.
Explore Health Careers.org. Retrieved from
http://explorehealthcareers.org/en/Career/138/Family_Medicine
Downs and Wardle. (2011). Writing about Writing. Boston.
Mercy St. Vincent Residency Programs. (n.d.). Family Medicine. Mercy. Retrieved from
http://mercymedicalresidency.org/wp/index.php/family-medicine/
Overton, David T. (n.d.). Advice for Emergency Medicine Applicants. Homer Stryker
M.D. School of Medicine. Retrieved form
http://med.wmich.edu/education/internshipresidency/emergency-medicine/adviceemergency-medicine-applicants
How to Become a Physician or Surgeon. (2015). Occupational Outlook Handbook.
Retrieved from United States Department of Labor
http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm#tab-4
Perera, T. (2012, March). The Joy and Stress of Being an Emergency Physician. [Web

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log post] The Doctors Tablet Blog. Retrieved from

http://blogs.einstein.yu.edu/the-joy-and-stress-of-being-an-emergency-physician/
Reid, S., Stephenson, D., & Bowden, L. (2009). Perception of Emergency Medicine by
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Medicine Journal, 26.10, 706-710.
http://emj.bmj.com/content/26/10/706.long#T2
Suter, Robert E. (2012). Emergency Medicine in the Unite States: A Systemic Review.
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