INTRODUCTION
Statement of the problem
For many years, interpersonal linguistic realization of doctor talk at consultations has become the focus of increasing interest in healthcare studies A large number of contributors have explored this domain to identify communication trend of doctors’ consultation with patients (Davis, 1988; Donabedian, 1988; Fairclough, 1995; Adam,
2014) The aim is to find effective ways of healthcare delivery to medical encounters
In fact, the quality of treatment depends on a number of different factors such as medical equipment, sources of drug supply, procedures and methods of treatment, and so on However, one of the most important issues that directly affects the quality of healthcare service is the language doctors use to interact with their patients at the time of encounters The effect of this crucial factor on the quality, procedures and results of consultations has been proved in a plethora of linguistic studies (Frankel, 1990;
Ainsworth-Vaughn, 1992; Heath, 1992; Ong et al., 1995; Fairclough & Wodak, 1997;
Hyden & Mishler, 1999; Ruusuvori, 2000; Robinson & Heritage, 2006 and many others) To some extent, these studies have provided findings of the internal complexity of doctor-patient interpersonal relationship and highlighted the direct effects of the language doctors use for consultation on the quality of treatment and patients’ satisfaction Despite a growing number of investigations into doctor talk, linguistic evidence of doctor-patient interaction at consultation is not enough to meet the great demand from researchers with interests in a complicated language – the language of medicine
In Vietnam, whilst great efforts are placed on the improvement of medical technologies for treatment, only some sociolinguistic and linguistic studies health providers’ behavior and clients’ expectation have been conducted (Nguyễn Thị Thanh Hà, 2000; Nguyễn Sinh Phúc, 2000; Chu Văn Long, 2010; Phan Thị Dung et al., 2010; Nguyễn Khánh Chi et al., 2012; Lê Thu Hòa, 2013; Đỗ Mạnh Hùng,
2014) Although these studies have contributed a great number of pedagogical implications to the domain of doctor-patient interaction, there is a growing need of linguistic evidence supporting the enhancement of medical morality among healthcare providers In Western countries, the model of interpersonal communication that places great emphasis on doctor-patient relations as an integral part of healthcare services have witnessed a lot of success in meeting patients’ satisfaction Thus, this model emphasizes the increasing trend towards informality in medical discourse which allows doctors to establish solidarity and intimacy in the doctor-patient relationship Using this model as criterion, my strong recommendation is that recognition of appropriate communication in healthcare service should come to terms with health policies as well as educational policies In particular, there should be collections of linguistic samples that provide healthcare providers with practical lessons to exercise interpersonal communication during interactions with clients However, in Vietnam, prior to my research, there had been no literature investigating the interpersonal features in Vietnamese doctor talk
Moreover, no substantial research has shown the linguistic benefits of the Western consultation style that Vietnamese doctor talk can adopt For this reason, my thought is that it is imperative to implement a research study on the issue of interpersonal meanings in doctor talk In other words, the lack of empirical data on doctor-patient communication in Vietnamese urged the researcher to strongly hypothesize that a comparison of the interpersonal features used in the language that English and Vietnamese doctors use at consultancies needs to be conducted
My hope is to shed some light on the realization of interpersonal features in English and Vietnamese doctor talks In other words, the current research is expected to enable healthcare providers, teachers and students of medical studies to have a deeper understanding of the interpersonal flavour reflected in doctors’ consultation discourse, and then to better use the language of doctors in medical contexts In general, this research is hoped to be considered as a useful tool for the author and anyone with interest in this specific area to develop educational careers
As a corollary, this study gives the author, Vietnamese educators as well as students of medicine opportunities to be more aware of a new insight into teaching and learning how to interact with patients.
Aims and objectives of the study
The overarching aim of the study is twofold: (i) to explore the interpersonal meanings English and Vietnamese doctors employ in their talks at consultation, and (ii) to compare these interpersonal meanings found in their talks to establish the similarities and differences between English and Vietnamese doctor talks at consultation The focus is to gain insights into the possibility of identical and distinct characteristics of interpersonal meanings in English and Vietnamese doctor talks through series of procedures of piloting, collecting data, analyzing data and comparing data By doing so, this study is expected to submit a detailed explanation of the repertoires of doctor talk in medical consultations in both English and Vietnamese
In order to achieve the overarching aim, the study investigates how doctor talk in English and Vietnamese is organized in terms of mood and modality Then, the focus is on interpreting and comparing IRs deployed in both English and Vietnamese to find out the similarities and differences in terms of interpersonal meanings constructed between the two languages In general, these above aims raise the following core project objectives: (i) to demonstrate the great demand of understanding interpersonal meanings in global healthcare context in general and in Vietnamese medical environment in particular; (ii) to highlight a theoretical and methodological framework that enables the researcher to conduct an effective way in realizing and comparing interpersonal meanings in the two languages; (iii) to describe two types of lexico-grammatical resources of mood and modality (and their subtypes) occurring in terms of proportions and realisations in a particular language, and then to compare English and Vietnamese doctors’ uses of these resources that construct interpersonal meanings; (iv) to propose both theoretical and practical implications in which quality of doctor talks at consultation may be improved toward intimacy, politeness and solidarity.
Significance of the study
In the world, there are a number of studies on doctor talk at consultation Each study uses a different theoretical framework: some use conversational analysis as the theoretical framework (Frankel, 1983; Heath, 1982, 1986), some others use of critical conversational analysis as the theoretical framework (Fairclough, 1998; Candlin,
2006), and still some others use of pragmatics (Levinson, 1979; Maynard, 2004;
Odebunmi, 2013) These different studies with different theoretical framework have contributed enormously to the domain of doctor talk at consultations However, within the literature available, very few studies of doctor talk at consultation are conducted using SFL as the theoretical framework In Vietnam, the domain of research on the language doctors utilize at the time of consultation, an important issue that contributes crucially to the shift of interpersonal communication has been very limited in literature of medical research Moreover, no comparative study has ever been attempted to use SFL as the theoretical framework to find out the similarities and differences relating to the language of English and Vietnamese doctors used in their talks at consultation in English and Vietnamese Therefore, this study can be considered the first one to apply SFL - as a tool for describing, analyzing, explaining and comparing the language used by Vietnamese and English- speaking doctors in their talks to patients at consultation The findings of this study not only prove a large amount of evidence that can be able to meet a great demand of understandings of interpersonal meanings in doctor talks but also redound to the effectiveness of a preferable style considering the patient as an important role in doctor-patient consultation Thus, the significance of the study is not the application of the SFL as the most relevant and useful theory framework in finding out interpersonal meanings in doctor talks However, a large number of spontaneous patterns of doctor talk analyzed under SFL framework have contributed to providing another perspective on understanding linguistic features of doctor talk at consultation Also, the study indicates the power of applicability of SFL that allows descriptions, analyses, explanations and comparisons of linguistic features of a particular text type – ‘doctor talk at consultation’ in the two languages more suitable and convincing.
Scope of the study
The aim of this research makes it unnecessary to look at details of whole paradigm of SFL Therefore, the scope of this study is only on lexico-grammatical resources of mood and modality to investigate the interpersonal features of the language doctors utilize at consultations in English and Vietnamese Noticeably, other aspects of the SFL, especially contextual and semantic analyses should not be automatically excluded when examining doctor talk at consultancy in English and Vietnamese from an interpersonal meaning perspective For this reason, the current study follows the bottom-up approach to propose a description of the interpersonal meanings In particular, through the detailed analyses of lexico-grammatical choices of mood and modality in English and Vietnamese doctor talk, the study reflects the account of tenor in context
The study works on the data corpus which was collected from doctor-patient consultations in both English and Vietnamese The Vietnamese data were taken from natural consultations in four general hospitals in Vietnam The English data, however, were collected from simulated doctor-patient consultations from YouTube The study narrows down its investigation of interpersonal meanings in doctor talks at six selected groups of diseases (Cardiology, Endocrinology, Neurology, Gastroenterology, Oncology, and Otorhinolaryngology) However, to serve the overarching aim of this study, the scope of the data analysis is not on comparing doctor talks across these groups of diseases, but is mainly on forms and interpersonal meanings of doctor talks within these diversified contexts of doctor- patient interaction In particular, the scope of the current dissertation is narrowed down at comparing proportions and realisations of lexico-grammatical resources of mood and modality to find out similarities and differences of interpersonal meanings in English and Vietnamese doctor talks However, since doctor-patient consultations are not monologue, an investigation into the doctors’ talks at consultations is unreliable if it is conducted without looking into the patients’ responses As a result, this thesis also takes the patients’ locution into consideration
In particular, it uses the patient’s talks as a supplementary source to verifying the data collected from the doctor’s talks Natural features such as nonverbal behaviours and cultural factors are not the concern of the research Also, paralinguistic and extralinguistic factors are also excluded although they are of vital importance in interpreting the ‘how’ in interpersonal communication.
Research questions
To fulfill the research aims as set in Section 1.2 above, this study attempts to address the following research questions:
1 What interpersonal resources that construct interpersonal meanings do English and Vietnamese doctors employ to talk to their patients at doctor- patient consultations?
2 What are the similarities and differences between English and Vietnamese doctor talks at doctor-patient consultations in terms of interpersonal meanings?
The first question primarily presents and explains the results of the analysis of interpersonal resources (hereafter IRs) in English and Vietnamese doctor talk in terms of mood and modality resources IRs in SFL’s theory is a source that is based on mood and modality resources to reflect interpersonal exchanges Therefore, the first research question is broken down into the following subsidiary-questions:
1.1 What mood resources are employed in English and Vietnamese doctor talks?
1.2 What modality resources are employed in English and Vietnamese doctor talks?
The second question is based on the analyses of Research Question One that investigates the uses of mood and modality resources in English and Vietnamese to compare interpersonal meanings in the two languages of consultation This work involves a combination of qualitative and quantitative methods, of which qualitative method is given priority.
Research design and methodology
The study is based on the Mood system of SFL which includes different mood and modality to design its coding schemes, analyses, descriptions and comparisons of interpersonal features used in English and Vietnamese doctor talks It is designed as a descriptive, qualitative, quantitative and comparative study In particular, the analytical approach of comparative method is used to compare the shared and unshared lexico- grammatical signs in doctor talk of the two languages and their meanings
The research methods are presented at length in the section on methodology
However, in general, the current study chooses triangulation of qualitative, quantitative and comparative research methods to answer the research questions
Moreover, since the current study reports interpersonal meanings in English and Vietnamese doctor talk via proportions and realisations of specific linguistic evidence, it also uses methodologies of qualitative content analysis for coding, identifying and interpreting meanings emerged from the data
Besides, the procedure methodologies of how to conduct the current thesis can be summarized in the following steps: (i) Framing the analytical framework by selecting lexico-grammar resources published from previous studies in English and Vietnamese; (ii) Collecting and transcribing data of doctor-patient interaction at consultation rooms into texts to develop two data material sources of doctor talk for exploring, understanding the phenomenon in depth and conceptualizing, evaluating; (iii) Utilizing the combination of descriptive, quantitative, qualitative and comparative methods to examine the mood and modality resources used in English and Vietnamese doctor talks; (iv) and quantitatively and qualitatively comparing interpersonal features of doctor talk in English and Vietnamese doctor talk to establish the similarities and differences of the two selected corpora.
Research data
The data collected for this study were taken from the corpora of doctor- patient consultations in both English and Vietnamese The Vietnamese data were audio recorded at the fields of consultation in four selected hospitals from the North and the South of Vietnam During the process of getting access to the Vietnamese data collection sites, the researcher received great support from colleagues, army officers and commanders from Vietnam Military Medical University (VMMU) where she has been working for nearly twenty years
Moreover, the researcher’s status as an army officer as well as a lecturer of English helps her associate much more easily with the Vietnamese doctors since all of them were her post-graduate students Thus, the relationships and working experiences have provided the researcher with a favorable condition for getting allowed access In particular, during her business trips of teaching English, the researcher was also allowed to access student doctors from the South of Vietnam
This permission enabled the researcher to get diversified linguistic patterns in the data of Vietnamese doctor talk
However, to collect data recordings of English doctor-patient consultations at fieldwork, the researcher also needs to obtain consents from all participants This process is extremely restricted in Western cultures where privacy is highly respected Thus, the collection of English natural data is infeasible and challenges the researcher with confidentiality issues Therefore, the current study synthesized source of authentic English consultations from medical training webpages The researcher consulted experienced colleagues, doctors and professors to select the most natural consultations from internet sources In general, an approximate 100,000-word corpus was set up by the data collection consultations from the real life and from YouTube
The corpus of doctor-patient interaction in Vietnamese includes 60 recordings and that in English also consists of 60 video clips from YouTube The data were then transcribed into text for further analysis However, only some transcriptions of interactive symbol have been taken to serve the investigation of the study, some others were ignored (e.g tone, volume, overlapping, etc.) Next, the coding of grammatical symbols was based on Halliday and Matthiessen
(2004) Finally, all the data were computerized for the frequencies of choices of mood and modality.
Structure of the thesis
This research is organized into six chapters as follows:
Chapter 1 – Introduction - includes an introduction of the rationale, the main reasons for the researcher to conduct this research and the research questions Also, the chapter presents the aims, significance, scope, primary research design, methods and data
Chapter 2 – Literature Review – is concerned with presenting different linguistic approaches of previous studies on the theme of doctor-patient interaction
This chapter is developed in two main steps The first step provides fundamental concepts relating to the issue of interpersonal communication at consultations The second step provides a critical review of different approaches of doctor-patient interpersonal exchanges The aim is to show the contributions of the previous studies and to establish the gap that needs fulfilling in the domain of doctor-patient communication Also, the chapter highlights the important role of SFL in exploring the interpersonal features which this current study aims to discover
Chapter 3 – Theoretical and Methodological Frameworks – proposes a detailed research design, theoretical framework and methodology for this study This chapter firstly elaborates major types of approaches for the current study Then, it describes in details the choice of mood and modality as the theoretical framework This is followed by a critical review, explanations, necessary adjustments, adaption, and application of the coding scheme of this study And finally, this chapter details the procedures of data collection, transcription, exploration and analysis as well as the treatment process of analyzed data The explanation and elaboration details in this section are evidenced by statistical data extracted from the current study
Chapter 4 – Deployment of Interpersonal Resources presents the main results of mood and modality resources that create interpersonal meanings in English and Vietnamese doctor talks at consultation
Chapter 5 – Comparisons of Interpersonal Meanings – compares, discusses, and evaluates the similarities and differences of interpersonal meanings through mood and modality resources English and Vietnamese doctors used in their talks at consultations
Chapter 6 – Conclusion – serves three main aims First, it summarizes the prominent findings Then, it attempts to point out the implications, contribution, limitations of the study And finally, it provides suggestions for future studies.
LITERATURE REVIEW
Conceptual background of doctor talk at doctor-patient consultations
In fact, doctor talk at consultations is not a large area of research However, in order to establish an appropriate theoretical background for this thesis that aims to investigate a broad issue of interpersonal meanings of doctor talk at doctor-patient consultations, it is necessary to systematize linguistic theories of doctor-patient consultations from the primary concepts of doctor talk to doctor-patient consultation, doctor-centeredness, and patient-centeredness to interpersonal communication at consultation
The term ‘doctor talk’ can be understood in various ways due to the variety of research approaches and aims In fact, the terminology used for doctor talk – the provider talk of health care - has received considerable attention (Frederickson &
Bull, 1995; Cassell & Skopek, 1997) Mintz (1992) states that doctor talk is a type of discourse that can create a social distance between doctors and patients The term doctor talk can be defined as unbalanced proportion of talk between the doctor and the patient (Aarrons, 2005, p 14) Thus, Toronto Consensus Statement states that the distance and unequal amount of talk between doctors and clients can be caused by unclear discourse of doctor talk The Statement explains ‘the language doctor use is often unclear as regards to the use of jargon and in relation to a lack of the expected shared meanings of relatively common terms’ (Simpson et al., 1991, p 1385)
However, in recent time, the concept of doctor talk has been changed In particularly, the concept of doctor talk has been divided into two trends Lee et al
(2002) state that doctor talk can be an active or a passive element Active doctor talk indicates a dominant choice of communication or controls of ‘the nature of the message’ (Tanner, 1976) Passive doctor talk indicates intentional and unintentional communication between doctors and patients Here, the important meaning of doctor-patient communication is the cross-over In other words, what the doctor transmits unintentionally may be perceived by the patient as intentional, and vice- versa (Aarrons, 2005, p 16) Furthermore, doctor talk is defined contrastively by Hyden and Mishler (1999) with two opposite trends, namely talk to and talk with the patient during a consultation Thus, talk to refers to the issue of one-sided talk between physicians and their patients The former plays an active role in eliciting and conveying information, and making decision during the consultation Talk with, in contrast, focuses on the equal spoken exchange by both parties When doctor talk is the talk to, the power is generated from the doctors’ higher social status, greater scientific knowledge In fact, Freidson (1987, p 23) has explained that the doctor’s knowledge and scientific skills can only be achieved after a long period of training and study The skill of the doctor is regarded as being ‘a purely individual achievement’ and the doctor is rewarded through being given higher status and greater authority in society When doctor talk is the talk with, the power is generated by greater informality, intimacy and sharing responsibility (Roter & Hall, 1992; Silverman, 1987; Helman, 1990) In fact, power in doctor talk has been identified by many linguistic scholars with various definitions It can be argued that doctors should be rewarded and they have the right to determine the ‘power’ in decision-making because of their professionalism, knowledge and skill (Freidson,
1987, p 23).As a consequence, a doctor should not waste time talking with patients because the patients might fail to comprehend what they are told at the time of the consultation with ease due to their lack in medical knowledge (Frankel, 1990;
Fairclough & Wodak, 1997) Therefore, Ten Have (1991) argues that power in doctor talk can be defined as a model that constrains patients with sequences of doctors’ questions Ainsworth-Vanghn (2001, p 462) agrees that power in doctor talk is exercised when doctors ask Moreover, a large number of researchers share a general opinion that defines power in doctor talk is doctors’ control over the clinical enterprise (Fisher, 1990; Mishler, 1984; Roter & Hall, 1992; Waitzkin, 1991) As a result, Fairclough (2001, p 53) appeals to doctors to shift in their discourse which provide their patients with a chance to become involved in the consultation Here, both the doctor and the patient become engaged in the consultation ‘through which the particular structure and organization of the medical interview is jointly constructed’ (Hyden & Mishler, 1999, p 176)
2.1.2 Concepts of doctor-patient consultation
The concepts of doctor-patient consultation have been approached and discussed broadly by numerous linguists The reason why there is a variety in the ways of defining doctor-patient consultation is that it is approached from different aspects with different purposes of linguistic studies Adam (2014, p 14), for example, defines doctor-patient consultation as a process of delivering care, in which doctors encounter a diverse range of patients, from the young to the elderly
Doctors use different communication approaches to contact with various patient subgroups to provide appropriate care Donabedian (1988), on the other hand, regards doctor-patient consultation as different phases of doctor-patient encounter, of which both doctors and patients are information givers and providers Ong et al
(1995) assert that doctor-patient interaction at consultations is the application of cure and care systems When the interaction is the cure consultation, doctors use instrumental consultation (task-focused) The aim is to base on doctors’ expertise to solve the patient’s problems Care consultation, in contrast, is an emotional domain that leads doctors to consider the patient as ‘a person’ rather than as ‘a case’
2.1.3 Concepts of doctor-centeredness and patient-centeredness
Studies in various cultures have shown beyond doubt about the two types of medical encounters that can bring about effectiveness in consultation services: doctor-centeredness or patient-centeredness According to Scholl et al (2014, p 1), the existing models of patient-centeredness and doctor-centeredness reveal a lack of conceptual clarity This results in a different use of the terms, unclear measurement dimensions, and inconsistent results regarding the effectiveness of patient-centered or doctor-centered interventions In fact, the two mentioned distinct concepts have been understood variedly among different scholars of linguistics The terms doctor- centeredness and patient-centeredness can be defined with different names: doctor- centered model of communication versus patient-centered model of communication (Graugaard & Finset, 2000; Deveugele et al., 2002)
In particular, doctor-centeredness is a model of doctors asking questions and patient answering (West, 1984; Hein & Wodak, 1987) Aarrons (2005, p 18) even asserts that a doctor-centered model at consultation includes utterances like ‘giving information, asking questions, counseling, giving directions, identifying future treatment or tests, discussing side-effects of tests or treatment, discussing test results with patients, and explaining reasons for treatment or non-treatment and so on.’ Hildebrand (2007) considers a doctor-centered model as a bio-medical model and describes it as a paternalistic model of medical communication as it creates unequal relationship between doctors and patients Freidson (1987), Frankel (1990), Fairclough and Wodak (1997) similarly explain that the term doctor-centeredness was born to emphasize the importance of the doctor’s autonomy which is generated from the doctors’ higher social status, greater scientific knowledge
In contrast, patient-centeredness is a model of interpersonal adoption of consumer-centered care, relationship-centred care and client-centred care (McBrien, 2009; McCarthy et al., 2013; McMillan et al., 2013) In other words, a patient- centered method is defined in terms of doctor’s responses which allow clients to express all their reasons for coming, including symptoms, thoughts, feelings and expectations (Henbest & Steward, 1989) Also, it is the issue of ‘information- sharing’ between physicians and their patients (Fairclough, 1995; Ainsworth- Vaughn, 1998) or an expectation of a more subtle power gained through the language of the doctor (Faiclough & Wodak, 1997; Helman, 1990) Moreover, Illingworth (2002) adds that patient-centeredness requires doctors to expose encouraging, relaxing and friendly utterances to show approval, empathy and intimacy between doctors and patients Similarly, Lazarus (1979) and Garfield
(1980) identify that ‘client-centered’ theory regards patient-centeredness in consultation as an efficacy of medical therapy, born by doctors’ respect, genuineness, unconditional acceptance and warmth Thus, patient-centeredness requires doctors not only to encourage patients to ask questions but also to build rapport to promote patients’ involvement (Epstein, 2000) Even though different authors have defined the concepts of doctor-centeredness and patient-centeredness in different ways, the current thesis supports the ideal medical interview that integrates the patient-centered and physician-centered approaches (Ong et al., 1995, p 2) Here, Smith and Hoppe (1991, p 445) confirm that ‘the patient leads in areas where he is the expert (symptoms, preferences, concerns), the doctor leads in his domain of expertise (details of disease, treatment).’ The mutuality or reconcilement of two agendas enables to facilitate the patient’s participation and exchanges
2.1.4 Concepts of interpersonal communication at consultations
First of all, there should be a thorough definition of interpersonal communication in healthcare context The aim is to show a background of medical communication that the concepts of interpersonal exchanges during doctor-patient consultations, utilized in this current study, are developed In fact, different linguists with interest of doctor-patient interaction have provided numerous definitions regarding interpersonal interaction in medical contexts According to Bach and Grant (2009), interpersonal exchange in healthcare context is the key factor that can bring about the improvement of interpersonal relationships and lead to the improvement of the patient’s care Further, Roter and Hall (1992) consider interpersonal communication in healthcare context as ‘…the main ingredient in medical care and it is the fundamental instrument by which the doctor-patient relationship is crafted and by which therapeutic goals are achieved’ (pp 35-37)
Slade et al (2008, p 1) strongly regard interpersonal communication as the key role of in effective healthcare delivery These authors state that effective interpersonal communication between doctors and patients enables to enhance patient’s satisfaction, treatment compliance and healthcare outcomes As a result, Berengere et al (1997) consider interpersonal communication in medical exchange as a process of acquiring for the medical staff’s skills, sincere intention and understandings of the patient’s feeling and concerns Additionally, as interpersonal communication enables doctors to encourage patients to ‘disclose critical information’ about their health problem (Adam, 2014, p 15), it is described as a hall mark of technical competence that leads to positive rapport between doctor-patient interaction (Donabedian, 1988;
Different approaches to interpersonal communication in doctor talk
The issue of interpersonal communication in doctor talk is highly appreciated in spite of negligible arguments supporting traditional trend of doctors’ autonomy
Thus, a large number of studies have defended that the model of interpersonal exchanges in medical encounters is able to constitute a good doctor-patient rapport, as a result, brings about effective diagnosis and treatment procedures (Heritage &
Stivers, 1999; Heritage & Maynard, 2006; Swinglehurst, 2014; Ochsner, 2010)
Advocates of the alternative methods in medical consultations have studied many different aspects of doctor talk to propose different definition of interpersonal exchanges The fundamental definition is mainly on the equal spoken exchange by both parties Defenders of patient-centeredness, like Fairclough (2001), Monagle and Thomas (1994), Brody (1997), Hyden and Mishler (1999), Steven et al (1999), Pappas and Perlman (2002), Bruce (2009) and so on, all regard interpersonal exchanges in doctor talk as a model that is used to improve patients’ satisfaction, autonomy and treatment outcomes These researchers have generally suggested that medical consultations, particularly those employed in general practice, ‘involve much more than the diagnosis and treatment of physical disease Patients approached doctors for a range of complex reasons located in social and emotional existence’ (Silverman, 1987, p 193)
In fact, the preferable trend of interpersonal exchange at medical consultations has encouraged the shift in doctor talk Correspondingly, a wide range of empirical studies have been conducted to find out pedagogical implications from the complexity of doctor talk’s patterns Notably, numerous recordings of audio, radio as well as video from different approaches of ethnographic investigations at consultation rooms have shown favourite styles of patient-centeredness during doctor-patient encounter (Fairclough, 1995; Ainsworth-Vaughn, 1998; Odebunmi, 2003; Adegbite and Odebunmi, 2006; Matthiessen, 2013; Adam, 2014 and elsewhere) From different theoretical frameworks of linguistics, interpersonal exchanges in doctor talk have been widely scrutinized in various types of languages other than English Thus, a great number of further investigations into this theme have been denoted to many different world-wide contexts of medical consultation
However, these research studies were mostly conducted to investigate doctor talk in a single language A limited number of research studies were implemented to compare doctor talk between English and other languages This current study is hoped to fulfill the gap that meet the demands of numerous linguists with interests of medical language
In Vietnamese medical settings, the changing style of doctor-patient interactions with the insertion of acting toward the patient’s interests has infused a new trend of moral interpersonal perspectives in the hospital environment
Therefore, Vietnamese doctors are generally required to follow a model that limits professional power (Nguyễn Thị Thanh Hà, 2000; Nguyễn Sinh Phúc, 2000; Lê Thị Bình, 2008; Phan Thị Dung et al., 2010; Chu Văn Long, 2010; Nguyễn Khánh Chi et al., 2012; Lê Thu Hòa, 2013; Đỗ Mạnh Hùng, 2014; Phạm Quang Hòa, 2012) In fact, these research investigations have been coincident in finding out the root causes leading to medical staffs’ weak attitudes (Nguyễn Thị Thanh Hà, Ibid: pp 8-
9) and caring performance mostly originate from low income (Đỗ Mạnh Hùng, Ibid.); medical proficiency (Le Thị Binh, Ibid; Lê Thu Hòa, Ibid: pp 13-14); non- desirable age of experience (Trịnh Thị Kim Oanh et al., 2012; Bùi Thị Thủy, 2009)
However, the mentioned Vietnamese research studies into interpersonal communication between healthcare providers and clients only limit their findings at general conclusions of the causes and effects that lead to inefficient treatments or results There has been no thorough research into Vietnamese doctor’s language that may directly affect consultation quality Notably, a research done by Nguyễn Huy Quang (2002) which bases on Systemic theory of mode, tenor and field to investigate the miscommunication amongst health specialists in the Vietnamese health system, has contributed valuable findings to the domain of doctor talk In particular, Quang’s research focuses on the communications between Vietnamese health professionals and foreign partners In Quang’s study, the participants worked in some international health cooperation programs and projects where English is used as a medium of communication The study has not only found out some linguistic problems arising during the communications between Vietnamese healthcare workers and foreign health experts in health cooperation programs, but also contributed a number of linguistic strategies that help to avoid such problems
However, Quang’s research focuses mainly on finding contextual issues that affect communication between Vietnamese and foreign healthcare experts It would be interesting if the study provided more detailed analyses of linguistic patterns exposed by the participants to support evidential effects of cultural matter on the language of doctor talk in medical communication
In general, the above-mentioned studies have noticeably contributed a number of pedagogical suggestions and solutions to improve professional ethics for medical officers However, in Vietnam, a part from Phạm Thị Hồng Nhung (2014)’s research that shares a slightly similar domain of research with the current study, there has been a limited linguistic literature on the language doctors utilize at the time of consultation Nhung’s study focuses on the correlations between linguistic patterns uttered by Vietnamese general practitioners in first encounters with outpatients and cultural constrains The study based on theoretical framework of pragmatics to prove that cultural issues are the major factor constructing the doctor’s discourse at initial phrases of communication Although in Nhung’s research, cultural factors are shown to be able to form choices of words in doctor talk, it would have been beneficial if the author provided more sufficient linguistic evidence supporting the arguments In particular, conclusions of the study are still needed to include much information regarding the lexical uses in the pattern of doctor talks This current thesis has no intention to compare and to deny a mass contribution of exploration to Vietnamese medical professionals’ attitude and behavior In light of SFL, it aims to fulfill the paramount picture of doctors’ communication with the investigation into the language they utilize during their interaction with patients at consultation The following part provides an overview of prominent approaches that use theoretical framework of Conversational Analysis (CA), Critical Discourse Analysis (CDA), Socio-linguistic Analysis (SLA) and Pragmatic Analysis (PA) as guidelines for investigating the interpersonal meanings of doctor talk have shown an enormous contribution to the domain of medical linguistic research
2.2.2 Prominent linguistic approaches 2.2.2.1 Conversational Analysis (CA)
In terms of CA investigation into interpersonal exchanges of doctor talk, a variety of linguistic research used fundamental structures of conversation, established by Schegloff et al (1974) such as turn design, turn allocation or sharing, repair, etc., to set up theoretical framework for analyses Primary linguistic research investigating the language doctors use to communicate with patients using CA methodologies can be found in studies of Frankel (1983), Heath (1982, 1986) and elsewhere CA research into interpersonal exchanges of medical communication benefits linguistic researchers with useful tools that enable to analyze phases and moves (Bowles, 2006: p 49; Anita, 2015; Candlin, 2006, pp 65-86), ‘repair’ (Jack & Tanya, 2013, p 229), interactant assert, contest and defend (Jack & Tanya, Ibid, p 370; Mishler, 1984, p
22), questions (Herritage, 1984, p 378; Raymond, 2010; Anita, 2015; Adam, 2014) and the social action generated through the activity’s discourse However, analyzing tools of CA such as turns, moves, and repairs cannot serve this current study’s aims, which mainly focus on choices of mood and modality
In terms of CDA, a number of research studies into interpersonal exchanges of doctor-patient communication have considered doctor-patient communication as the relationship between discourse and society These studies are mostly based on Fairclough’s theory of language and power (1995, 1989) to regard power and power
‘behind’ discourse as a sort of social practice (Ainsworth-Voughn, 1998; Belder,
2013) They realize that multiple social variables such as age, gender, culture, and so on are the major factors creating power and effect on doctor-patient interactions (Adam, 2014) As a result, these studies struggle for the improvement of interpersonal communication among doctors (Candlin, 2006; Fairclough, 1998, pp
43-68) Thus, CDA literature of doctor-patient interaction mainly shows the power relations existing between doctors and patient (Adam, Ibid.) In fact, CDA considers power is one of the most important elements reflecting interpersonal meanings in the complicated doctor-patient relationship However, using CDA as the main theoretical framework is unable for the current study to focus on its investigation of lexico-grammatical choices of mood and modality Nevertheless, CDA research studies were critically compared and contrasted when the current study attempted to interpret the natural effects of social interaction on the performance of interpersonal meanings in English and Vietnamese doctor talks
An overview of SFL approach to interpersonal communication in doctor talk
Drawing upon SFL theory pioneered by Halliday (1978 and elsewhere), multimodal applications to nurturing the purposes of interpersonal communication among healthcare providers when communicating with clients have been conducted
2.3.1 Interpersonal meaning in doctor talk: The SFL approach
In numerous healthcare contexts, SFL studies prominently reflect the cultural effects on doctors’ language When comparing the different styles of doctor-patient interaction between Western doctors and Asian doctors, Sachiko et al (2003) and
Nant (2016) characterize that Asian doctors generally spend less time and use more Yes/No questions to communicate with patients This finding coincides with what Luo (2015) concluded in a SFL investigation into patients’ choices of mood
Although Luo’s study focuses on the realizations of different types of questions patients utilized, the implications of cultural meaning in doctor talk can be inferred from the high frequency physicians’ responses to patients’ Yes/No interrogatives
Thus, in a Southeast Asian Confucian context of medical communication like Vietnam and China, ‘doctors are considered at a much higher hierarchical level in comparison with patients who are to listen more than ask question or argue.’ (Phạm Thị Hồng Nhung, 2014, p 1130) In this case, doctors’ choices of language have a great influence on their clients’ beliefs which are controlled by a paradigm of doctor- centeredness Although these studies have shown a replication in their findings, more evidence is needed to support the traditional concepts that often prejudice against doctor-centered style Asian doctors often follow The results would be more conclusive if other types of interrogative responses were considered Thus, investigation of Yes/No questions alone are only able to support partially conclusions of cultural effects on doctor’s language at consultations
Another cultural pattern can be found with various meanings in the way of asking pain from different cultural contexts The issue of pains, viewed from SFL’s lens, generally encode with a number of cultural differences occurred in doctor- patient interaction SFL studies of pain like Lascaratou (2003) on Greek, Hori
(2006) on Japanese, Overlach (2008) on German have used corpora of doctor- patient interactions involving patterns of doctor’s asking pains Basically, these studies approach the discourse of doctor-patient interaction to characterize multiple linguistic patterns of pain in terms of context, semantic and lexico-grammar For instance, both Lascaratou (Ibid.) and Hori (Ibid.) show a convincing evidence of verbal construals of pain in Greek and Japanese In fact, the notion of transitivity has helped these SFL scholars shed light on how pain is concealed in doctors’ language Likewise, Overlach (Ibid.) expands a further investigation into cross- linguistic dimension The author adds a further observation on pain asking in German dialect Thus, Wierzbicka (2013, p 307) complains that the concept of asking pain has become an ‘immeasurable’ issue in doctor-patient interaction
While Fermandez and Wasan (2010, p 450) find out that ‘pain’ only ranks as ‘the fifth vital sign’ of language that occurs during doctor-patient interaction, Phạm Thị Hồng Nhung (Ibid, p 1130) reveals the high frequent use of the Vietnamese word
‘đau’, referring to ‘pain’ in doctors’ questions in initial encounters with patients when asking about their patients’ reasons for visiting
Furthermore, in light of SFL theory, politeness and discourse tact in doctor- patient communication have been explored with striking findings In particular, with a synthesis of perspective investigation of CA, SLA, PA and SFL on ‘discourse tact’ in doctor-patient interaction, Adegbite and Odebunmi (2006, pp 508-509) find out that the doctors vary their politeness strategies when communicating with patients In terms of systemic grammatical features, during the interactions, the chosen doctors preferred using clauses of mental process such as feel, think, understand, of material process with modalities such as can or can’t eat/sleep/work, of manners like persistently, seriously, properly, and slowly to describe an illness Adegbite and Odebunmi (Ibid.) conclude that doctors’ utilization of politeness maxims have reflected a cooperative interaction between doctors and patients Here, although the opening moves are initiated by the doctors who often hold topics of communication, the supporting move, in contrast, is dominantly made by the patients who often provide information It can be seen that doctors’ politeness, expressed through linguistic tool of mood and transitivity in SFL, may offer realizations of how patients have chances to engage into the treatment procedure However, either politeness or intimacy alone is not an efficient evidence for a successful consultation Subtle power, combined with a polite interaction device, mentioned in many SFL studies, can be considered as one of the key successes in medical consultation Thus, choices of mood and modality are means of communication that help to shorten the distance between healthcare providers and clients Both Adegbite and Odebunmi (Ibid.) and Adam (2014) realize that in order to do their jobs well, doctors still need to express their power, but in subtle manner Thus, Fowler et al (1979) declare that ‘the need for solidarity undermines clear expression of authority.’ For example, the participant doctors in Adam (Ibid.)’s investigation flexibly use high frequency of declarative mood choices with modalities to negotiate patients’ approval in treatment Similarly, Montgomery (1996, pp 109-110) declares that modal auxiliaries aims to reduce the tension of power expressed by participants and the use of modal auxiliary can be considered as polite ways of communication and negotiation The meaning of adjustable use of mood and modality in different healthcare context can be elicited from Halliday’s original conception of agentive role, social hierarchy and social distance (Annabelle et al., 201, p 199) Since the doctor’s role and the patient’s role are traditionally unequal agentive roles, to make doctor-patient interaction successful, doctors should shift their use of language with polite linguistic devices to get patients involved in ‘relevant context’ (Hasan, 2009)
In fact, there are a number of SFL studies focusing on the role of interpersonal communication in healthcare contexts Slade et al (2008), with thorough analyses on spoken interactions between health care practitioners and their clients from emergency departments in Sydney, Australia, found out linguistic patterns of interpersonal and experiential functions Basing on the mounting evidence of miscommunications, these authors emphasized the roles of professional impact on patient experiences Besides, Moore et al (2010) based on an investigation of verbal and non-verbal signals exposing on intra-professional settings to draw techniques of SFL and encourage cooperation between surgeons and clients
Furthermore, Moore et al (Ibid.) emphasize the important role of language doctors use which enables to mediate the ‘joint action’ in surgery Another investigation on interpersonal interaction between doctors and patients can be found in a Chinese study on doctor’ interrogative choices (Luo, 2015) The study focuses on Chinese expressions of Mood such as declarative, interrogative, imperative and exclamatory clauses From patients’ interrogative choices, Luo concludes that Yes/No interrogatives are employed most of the time by the doctor comparing with wh- interrogatives, and alternative interrogatives Thus, Yes/No interrogatives, closed questions, usually provide patients with little chance to get more information from doctors Responders of Yes/No questions can save time to provide quick replies
Luo concludes that the relationship between the selected doctors and patients is a kind of ‘indifferent and unfriendly’ model The doctors, who are the center of conversations, always lead the topics of communication and treatment
In fact, that discourse of medical communication, viewed from SFL aspects, has been recorded variously However, the comparison of lexico-grammatical proportion and realisations in English and Vietnamese doctor talk that lead to the account of interpersonal meanings has not been found in medical linguistic research As a result, there is a need of a greater contribution to fulfill the picture of complicated diagnostic encounters
2.3.2 Advantages of SFL in finding interpersonal meanings of doctor talk
In contexts of medical discourse, many grammarians have used grammatical features as tools to realize different social issues For example, while Flottum
(2006) shows cultural identities, Leon and Divasson (2006) present the connection between the grammatical features and the rhetorical behavior Moreover, Mungra
(2006) illustrates rhetorical moves of Introduction-Method-Results-Discussion
However, doctor-patient interaction is also an oral communication, therefore, to understand the language of doctors, there should be a consideration of lexical choices of the language utilized in the ‘context of situation’ (Halliday, 1978; Halliday & Hasan, 1989; Halliday et al., 1964; Gregory & Carroll, 1978) However, unlike traditional and formal grammar that focuses on parts of speech to identify word classes, nouns, verbs or formal grammar, and is vigorously impacted by Noam Chomsky who views grammar as a principle rule to classify the correctness or incorrectness of sentence structures (Cope & Kalantzis, 1993, p 139) Functional grammar is more social oriented In other words, while both traditional grammar and formal grammar mainly aim at the relationship between grammar and mind, functional grammar addresses the practical applications of grammar in language of different social contexts (Hayder,
2012, p 181) As a result, Burns et al (1996, p 2) confirm that SFL is able to
highlight the socially functional nature of language;
explain the two-way relationship between the vocabulary and grammatical choices which speakers make and the cultural and social contexts in which the language is used;
Systematically describe the similarities and differences between spoken and written language
Moreover, Martin and White (2005, p 33) propose that interpersonal meanings can be interpreted when basing on a variety of discourse organisations
These authors show that discourse semantics, at text level, can be analyzed through the range of phonological and lexico-grammatical patterns to realize Negotiation, Appraisal, and Involvement In particular, Negotiation focuses on the interactive aspects of discourse like how turns are organized into exchanges to form speech functions; Appraisal focuses on expressions of people’s feelings, behaviours and appreciations; and Involvement focuses on non-gradable resources for negotiating tenor relations, especially solidarity Originally, in Halliday’s work, studies of interpersonal meanings in SFL allow linguistic studies to understand the interaction a focus on the exchanging of information and goods and services (Halliday &
Matthiessen, 2004, p 107) Here, speaker/or writer’s attitudes as well as behaviors can be expressed explicitly and implicitly through language As a result, social relationships between participants can be interpreted through negotiation processes and addressed through deployment of Halliday’s theory of mood and modality
Summary
Again, this thesis does not intend to compare the dominant features of any most relevant approaches thoroughly discussed above In contrast, a critical review of synthetic perspective research into interpersonal communication of doctor talk enables the current study to utilize the most suitable theoretical tool for analyses and discussion In fact, this chapter provides a theoretical background with a critical discussion of the most relevant concepts, definitions and approaches to the issue of interpersonal communication in doctor talk, doctor-patient interaction This chapter prepares a background for setting up an analytical framework that is able to compare English and Vietnamese talks in terms of lexico-grammar By doing this, the chapter is the pre-step to build up a parallel analytical system for discovering interpersonal features of doctor talk at consultations of English and Vietnamese.
THEORETICAL AND METHODOLOGICAL FRAMEWORKS
Theoretical framework
This section reviews the interpersonal metafunction of SFL which is able to find out interpersonal features prompted in doctor talk at the time of consultancy with patients by English and Vietnamese doctors In other words, the current thesis bases itself on sources of lexico-grammar of Systemic functional grammar (SFG) theory to transcribe discourse of doctor talk at semantic level In order to make the task manageable, this thesis aims to answer two questions: (i) How can IRs conceptualized in SFL help to account for the interpersonal meanings of doctor talk? and (ii) Why can lexico-grammatical resources of mood and modality be used to realize the interpersonal features of doctor talk? Due to the scope of the study, question (ii) explains relevant lexico-grammatical factors of mood and modality in system of Mood that help to build up a coding scheme for analyzing interpersonal meanings in English and Vietnamese doctor talk
3.1.1 Notions of interpersonal meanings in SFL
Halliday (1978 and elsewhere) has shown that when exploring the meaning of language, SFL views ‘language as social semiotic’ In terms of interrelated systems, SFL exploits grammar to understand a language’s numerous perspectives, rather than grammatical rules found in the language itself In many cases, SFL linguists attempt to investigate grammatical uses of a language to construct the interpersonal components between the speaker and the listener (Halliday & Hasan, 1989)
So how can the IRs conceptualized in SFL interpret interpersonal meanings in doctor talk? Halliday and Matthiessen (2004) state that whenever language is used with the aim of interaction, there exists a relationship between the interactants Here, social roles and relationships of participants can be observed through turns, moves as well as lexico-grammatical choices As a result, in terms of semantic perspectives, it is possible to decide who is speaking now and who is the next speaker Besides, Butt et al (1995, p 13) express a coincident opinion when stating that interpersonal meanings can be analyzed through grammatical realisations since they occur in processes of social interaction These authors explain that interpersonal meanings can encode communicational interactions by analyzing how interactants express their propositions and proposals Martin and White (2005, p 19) state: ‘investigation of interpersonal meanings in SFL is more strongly oriented to interaction than feeling and the interpersonal component of meaning is the speaker’s ongoing intrusion into the speech situation.’ Matthiessen (1995, p 17) even shows that interpersonal sources not only reflect social roles and relationships among participants but also imply their behaviour, inner thoughts and points of view to the outside world
Why can lexico-grammatical resources of mood and modality be used to realize the interpersonal features of doctor talk? As this study aims to compare interpersonal features found in English and Vietnamese doctor talks, it will firstly investigate the deployment of mood and modality resources Then, it makes an attempt to compare the interpersonal meanings found in English and Vietnamese doctor talks at consultations and constructs similarities and differences of interpersonal components in the doctor’s discourse (Martin & White, 2005, p 164) Thus, from the perspective of interpersonal communication in doctor talk, SFL can be considered as a useful theoretical framework for the current study to develop its investigation However, to understand the IRs and their functions, my choice is to put these resources into the broader context of SFL to revisit the most related concepts to the analytical tool of the current thesis
According to Halliday (1978, 1985, 1994) and Hasan (1993, 1995, 1999), language, a complex semiotic system, is stratified into four different strata: context, semantics, lexico-grammar and phonology As the scope of current study is aimed at exploring lexico-grammatical resources to reflect interpersonal meanings in doctor talk at doctor-patient consultations, phonology is not the concern of this thesis In what follows, I will present briefly the three strata: context, semantics and lexico-grammar to establish the framework for analysis The illustration of strata of the systemic functional model can be seen in Figure 3.1
Figure 3.1: The four strata of SFL language system
At the stratum context, SFL postulates that language has three contextual categories: Field, Tenor and Mode (Halliday & Hasan, 1989; Hasan, 1999) Field, ‘the nature of the social activity’, refers to what is going on through language, to activities and processes that are happening at the time of speech Tenor, ‘the nature of social relations’, refers to who is taking part in the dialogue, particularly to the nature of participants such as the relationship between speaker and listener and the potential for interacting As the current thesis focuses on interpersonal meanings in doctor talk, tenor
- the register variable - is most relevant to the issue Thus, Martin and White (2005, p
29) consider power and solidarity as the two keys of tenor variables (the vertical and horizontal dimensions of interpersonal relations) Mode, ‘the nature of contact’, refers to the role of language itself in a given context of situation In general, categories of context in SFL - field, mode and tenor, classified as register, are used to study communicative behavior within which all of social interactions occur (Halliday, 1994)
At the stratum of semantics, SFL considers this level as a ‘source of meaning’
Halliday categorizes the semantic stratum into three metafunctions such as ideational metafunction, interpersonal metafunction, and textual metafunction Ideational metafunction views grammar of a clause as representation and is realized by the systems of transitivity Meanwhile, interpersonal metafunction considers grammar of a clause as exchange and is realized by the systems of mood and modality Textual metafunction, realized by the system of theme, expresses the grammar of clause as message In particular, the interpersonal metafunction is about social interaction between speaker/or writer and audience It not only constitutes grammatical theory but also reflects social relationship and our personal being Thus, Butts et al (1995, p
13) explain: ‘The interpersonal metafuction uses language to encode interaction and to show how defensible or binding we find our proposition or proposal.’
At the statrum of lexico-grammar, Halliday and other SFL scholars rank this stratum into a resource for wordings and represents language under a set of texts (Halliday, 1994; Matthiessen, 1995; Hoàng Văn Vân, 2012) Lexico-grammar stratum helps us to understand how language is implied through its tool of wording system of lexis (vocabulary) and grammar Precisely, at this stratum, Halliday (Ibid.) indicates that corresponding to the three context-construing strands of meanings – ideational, interpersonal and textual, the lexico-grammar stratum is simultaneously realized as wording through the systems of Transitivity, Mood and Theme At this stratum, the language is represented in the forms of wording based on the grammar of the clause in order to reflex our experience (Transitivity), interaction (Mood) and discourse organization (Theme) In particular, system of Mood, includes mood and modality which are able to reflect participants’ relations, behavior, roles (Hasan & Perrett, 1994, p 183), is used as the main theoretical framework of the current study
Furthermore, there is a connection among the four levels of language system
SFL claims that the relation between these strata is that of realisation The lower stratum realises its next higher one In particular, the lowest level, phonology realises its higher level, lexico-grammar which realizes semantics which realises the highest stratum, context However, the relation of realisation between strata is not the same everywhere The order of abstraction in each stratum of language is exclusively described as a convention or the term that Saussure uses, an arbitrary
Here, the lexico-grammar stratum is located between semantics and phonology
While the systems of meaning, semantics relates upward to context, the systems of sound, phonology concerns downwards to the expression of phonetics In this connection, the relationship between these strata is not only a single direction but also a bi-directional one (Matthiessen, 1995; Halliday, 2012, p 74)
As lexico-grammar stratum can realize interpersonal meaning of its higher linguistic stratum – the semantic stratum of interpersonal metafunction, it is essential to understand how metafunctions work in SFL and what its roles relate to in the current thesis
When a system of language is instantiated into texts, the texts themselves convey simultaneously three meaning potentials in the grammar of the clause
Halliday describes them as ‘metafunctions’ At the stratum of semantics, Halliday and Matthiessen (2004, p 61) categorize three types of metafunctions as ideational, interpersonal and textual metafunctions These metafunctions own different positions in clause column and are in turn, identified by social context (register) and the cultural context (genre) of language use These metafunctions, shown up in the clause column by Halliday, are called as ‘the formalized meaning potential of language’
These three metafunctions are significant because they create three lines of meaning in a clause However, the scope of current thesis only focuses on the interpersonal meanings shown from dialogic analysis of doctor-patient interaction Therefore, the ideational and textual metafunctions are not the concern of the present study The interpersonal metafunction mainly concerns the social roles of addressers and addresses and is realized by its lexico-grammatical systems of mood and modality
The following part reviews system of Mood to denote the choice of mood and modality to interpret the interpersonal meanings in doctor talk
3.1.3 Analytical framework 3.1.3.1 System of Mood
The interpersonal metafunction is able to indicate the roles of participants during interaction and the process of social interaction (Halliday, 2002) This metafunction considers grammar of a clause as exchange and is related to the system of Mood In this connection, Mood is concerned with speaker’s roles on behalf of seeker of information and the listener’s roles on behalf of supplier of the demanded information (Halliday & Matthiessen, 2004, p 106) Halliday (1964,
1978, 1994 and elsewhere) calls this type of ‘interact’ as ‘the role as exchange’ and named it as giving and demanding
Methodological framework
In fact, Vietnamese publication on the issue of language doctors use at the time of consultation investigated basing on the SFL framework has not been found Therefore, based on the Mood framework of English which includes mood and modality, the current study built up an equivalent coding scheme to compare the English data and the Vietnamese data in terms of doctor talk The current thesis was designed as a comparative study using both quantitative and qualitative approaches Since this study compared frequencies of choices of mood and modality instances English and Vietnamese doctors exposed at the time of consultation with patients, it was designed to ensure the comparability by following comparative techniques and principles
(i) In order to review an equivalent domain of literature issue on doctor talks, the current study grounded on rich sources of doctor-patient interaction in English exploited from linguistic theoretical frameworks such as CA, CDA, SLA, PA and SFL, the most related issues of doctor talk in Vietnamese were inspected to compare the correlations in English and Vietnamese
(ii) In order to build a compatible framework and an equivalent coding scheme for a correlative investigation, lexico-grammatical subtypes of mood and modality in English were selected first and considered as an analytical base for coding scheme The comparisons were then designed to find out the similarities and differences in the proportions of mood and modality instances and the range of realisations of interpersonal features in doctor talks in the two compared languages
(iii) In order to establish data corpus to compare the use of mood and modality between the two chosen languages, the data of the thesis were built up in terms of corpus-based approach (henceforth C.B.A) According to Tognini-Bonelli (2001), C.B.A is an approach that uses a source of language data as an evidence to develop a theory In other words, it is an approach that allows a linguistic researcher to base on the data to explain and state assumptions of a pre-existing theory In my study, the tested phenomenon is interpersonal meanings in English and Vietnamese doctor talks
As the corpus in English and Vietnamese doctor-patient interaction at consultation is not available, my choice is to establish a corpus-based study to investigate the variation of doctor talks at consultation The aim of the paper is to base on SFL theory as a foundation to expand more assumptions about doctor talks Therefore, in the current study, C.B.A is designed as a compatible approach by selecting a set of linear categories for comparisons
(iv) Furthermore, as the thesis aims to uses SFL as theoretical framework to investigate interpersonal meanings in doctor talk, it is approached inductively rather than deductively The inductive – deductive divide is one generally associated with qualitative research to exploring new phenomena of theory emerging from the data
Meanwhile, a deductive approach begins with a hypothesis to emphasize on causality The current dissertation bases itself on the data of English and Vietnamese doctor talks to investigate mood and modality resources chosen by the selected doctors to prove interpersonal meanings In other words, the thesis considers SFL theory as a starting point to examine lexico-grammatical choices that indicate interpersonal meanings in doctor talk
In general, this thesis was designed as a corpus-based study and conducted comparatively, quantitatively, qualitatively and inductively to investigate the interpersonal meanings in doctor talks It contributes illustrations and evidence to support and expand SFL theory of mood and modality
3.2.2 Research methods 3.2.2.1 Qualitative, quantitative and comparative methods
The current study chooses triangulation of qualitative, quantitative and comparative research methods as a guideline to answer the research questions In particular, this comparative thesis uses systemic functional approach to implement descriptive and qualitative methods Thus, triangulation has been commended by a number of linguistic researchers because it is an eclectic use of multiple methods for a research issue (Denzin & Lincoln, 1998; Wolfram-Cox & Hassard, 2005) As every method has its own advantages and disadvantages, the use of multiple methods can help researchers synthesize the strong points from different methods and realize more sophisticated aspects of social issue (Gillham, 2000, p 12)
Litosseliti (2010, p 33) suggests that qualitative and quantitative methods should be combined as they allow a better understanding of a phenomenon from different perspectives Thus, while qualitative method provides the current researcher with in-depth and rich data, quantitative methods presents numerous quantity of data embedding with statistic features, preliminary interpretation This study takes a large qualitative research, which is complimented by descriptive analysis The qualitative analysis deals with a real content of consultation which is analyzed by means of written transcripts (Cilliers, 2014, p 102) A quantitative analysis uses computerized system to quantify the frequency of choices of lexico-grammar of mood and modality resources Then, basing on the statistical findings found in each data corpus, with reference to the objectives, the current study is designed as a comparative investigation
The coding scheme is set up basing on English system of Mood which is established by Halliday’s matrix of connections Also, the analytical approach of comparative method is used to compare the shared and unshared lexico-grammatical signs of doctor talk in the two languages and their meanings Besides, synthetic method of qualitative and quantitative is implemented to support the comparative processes The descriptive and comparative methods are utilized to analyze, interpret and realize the similarities and differences
The utilization of triangulation is aimed to ensure the reliability and validity for the current comparative study Also, this eclectic method is expected to provide readers with rich descriptions and interpretation since ‘triangulation is able to enrich understanding of an experience or issue through confirmation of conclusions, extension of knowledge’ (Bazeley, 2004, p 9)
This study reports interpersonal features in doctor talk not only through proportions, percentages and instances of the coded data but also through realisations of specific linguistic evidence When constructing methodologies of qualitative content analysis, Hsieh and Shannon (2005, pp 1278-1279) state that this analytic method is constructed by hypothetical studies which relate closely to the area of ‘end-of-life’ care These authors have developed the theoretical background of content analysis from health area that aims to enhance ‘the End-of- life Experience for Patients and Their Families’ One of the advantages in using content analysis is the subjective account of text data can go beyond merely counting frequent choice of words Additionally, this method is able to examine language intensely through different coding categories and identify linguistic themes emerging from the data Thus, content analysis enables to ‘provide knowledge and understanding of the phenomenon under study’ (Downe-Wamboldt,
1992, p 314) The current study, therefore, chooses qualitative content analysis as the method of coding process to analyze text data in terms of both proportions and realisations In other words, lexico-grammatical choices of interpersonal categories in doctor talk are reported by both instances and specific linguistic evidence This present study adopts three types of qualitative content analysis that Hsieh and Shannon (Ibid, pp 1279-1285) have introduced They are conventional, directed and summative content analyses
In this study, conventional qualitative content analysis is used to describe different phenomena of interpersonal features extracted from lexico-grammatical resources of mood and modality This type of design is usually appropriate when the existing theory or research literature on a phenomenon is limited (Kondracki &
Summary
This chapter presents theoretical and methodological platforms on which this study conducts its investigation into English and Vietnamese doctor talks In light of SFL, the theoretical framework of lexico-grammar of mood and modality is discussed and specified In Vietnam, studies on the language doctors use when interacting with patients, viewed from SFL perspective, are not found The analytical framework in terms of lexico-grammar that serves to investigate interpersonal features in doctor talk is not available Therefore, an equivalent coding scheme has been built up as a compatible framework to compare mood and modality in English and in Vietnamese doctor talk This chapter also introduces the application, adjustment of mood and modality coding processes The aim is to make the analyses of interpersonal meanings occurring in doctor talk in the English and Vietnamese data the most compatible Also, this chapter has provided methodological parameters which show attempts to justify research designs, research methods, data collection, and data analysis.
DEPLOYMENT OF INTERPERSONAL RESOURCES
Summary of the English and Vietnamese data corpus
This section provides a general description of the two compatible data resources of English and Vietnamese doctor talk It describes the number of words, clauses and the average number of words in a clause
4.1.1 Summary of the English data corpus
Figure 4.1: General summary of the English data corpus
Figure 4.1 describes the distribution of words and the average number of words in a clause employed by English doctors and patients in six selected groups of diseases (more details in Appendix 4.1) The left-hand vertical axes represent information of word number English doctors and patients uttered during the interaction The right-hand vertical axes represent the average number of words in each clause The horizontal axis of the bar chart represents six selected group of diseases
In the English data, it is revealed that of over 55 thousand words of consultation, the number of words in doctor utterance accounted for 10% higher than that of patient’s (55% amount of words used by doctors compared with 45% employed by patients) In fact, the total number of words used by English doctors and patients during the endocrinology and neurology consultations indicates the highest amount, accounting for around 20% By contrast, the number of words employed in the field of cardiology ranks at the lowest proportion, accounting for approximately 9% The middle-range amount of words and clauses is equally distributed in three types of diseases: gastroenterology, oncology and otorhinolaryngology Apparently, there is a higher average number of words in a clause in patient’s discourse (over 8.0) compared with that of the average amount in doctor’s utterance (approximately 6.0)
As can be seen from Figure 4.1, doctor utterance accounts a higher percentage of word numbers compared with that of patient’s However, apart from the cardiology data that register a higher doctor’s average number of words in a clause (5.5) compared with that of patient’s (4.2), patient’s utterance from the rest type of diseases experiences a dramatically higher number In particular, there is a greater percentage of word use in patient’s speech (approximately 9%) compared with that of doctor’s (7%) during the oncological consultation
Overall, in terms of verbal engagement, Figure 4.1 shows a general degree of doctor-patient engagement in six selected groups of diseases Although English doctors are more active during consultations, patients with nervous and respiratory problems spend much amount of speech interacting with their doctors Indeed, doctors coming from departments of oncology and otorhinolaryngology spoke less than their clients in most conversations, resulting fewer total words and clauses used by the doctors compared with that of the patient’s However, patients with heart and digestive problems seemed to engage less during the consultation This result reflects a fact that English doctors spend much more word amount with shorter clauses when talking to patients about acute diseases such as heart stroke, high blood pressure, peripheral artery diseases, stomachache, nausea, gastrointestinal disorder, constipation and so on However, for chronic diseases relating to Neurology and Oncology, doctors tended to offer patients more opportunities to get involved into consultation To some extent, the gap of verbal engagement degree between English doctors and patients seems to be modest and marginal The involvement distance depends on types and the danger level of diseases
4.1.2 Summary of the Vietnamese data corpus
Corresponding with the description of the English data corpus, Figure 4.2 below shows the background information of the Vietnamese data corpus (more details in Appendix 4.2) The left-hand vertical axis of the figures represents the percentages of word number Vietnamese doctor and patient uttered during the interaction The right-hand vertical axes represent the average number of words in clauses The horizontal axis of the bar chart shows percentages of word uttered by doctors and patients from the six selected groups of diseases
In general, in terms of verbal involvement, the doctor employed much amount of words than the patient Of nearly 42 thousand words found in Vietnamese doctor- patient recordings, the word amount used by the doctor (over 25000 words) accounted for approximately a double percentage than the locution proportion the client exploited to communicate during consultations (over 15000 words) Also, the
Figure 4.2: General summary of the Vietnamese data corpus doctor much verbally engaged than the patient when the amount of words the doctor used in the six selected groups of diseases was wholly higher than that of the patient’s Although the average number of words in a clause in the Vietnamese data shows a relatively low level of word distribution (6.7), the doctor’s utterance underwent a marginally condensed expression (over 7.0) compared with the patient’s (6.0) Here, the average rate of word distribution in a clause of neurological and oncological diseases ranked equally at the highest level (7.5) Whereas, the consultations, recorded the smallest quantities of words in a clause, belonged to heart and respiratory diseases, identically accounting for around 6.0
Another point to note is the higher percentage of word consultation aggregated in diseases that related to heart and nerve Thus, there was up to 20% of the total amount of word used in these types of consultations Meanwhile, doctor-patient consultations from gastroenterology and otorhinolaryngology data underwent the lowest percentage of word distribution, recording about 13% The middle-range fell into the diseases of endocrinology and oncology data that owned the word location fluctuated between 14% and 16% Another striking feature is that although the doctor was apparently involved much more in every selected disease, the patient’s participation seemed to be more verbally active in consultations relating to heart and nervous diseases As a result, the corresponding rate of clauses used in these types of disease is comparatively equal between the doctor and the patient On the contrary, there was an inverse ratio of word amount existing between utterances of the doctor and the patient who come from consultations of hormonal and cancer diseases Here, the word proportion used by the doctor is shown with more than half of word quantity compared with the patient Accordingly, compared with the rest of selected diseases, endocrine and cancer doctors offer their clients less chance to engage in the consultations
Overall, the aggregated Vietnamese data revealed that the doctor’s verbal involvement into consultations recorded higher proportion than that of the patient’s
Consultations of heart and nervous systems indicated a higher verbal interaction between doctors and patients since both of the doctor and the patient participated into conversations with a high proportion of word amount However, doctor talks of Endocrinology and Oncology are expected to be more sharing because there is a gap in number of words between the two speakers Actually, cancer patients with the highest mortality rate got the least chance to get involved into consultations although the total percentage of word ranks at the third level Overall, the high rate of doctor talk in departments of endocrinology, neurology and oncology well reflects the fact that Vietnamese doctors preferred talking much more than their clients when guiding them to follow steps of treatment, e.g physical exercises for arthropathia patients to improve joints, muscles and nerves In fact, endocrinologists and oncologists often hold the floor during consultations of life-threatening diseases such as renal failure, leukemia, diabetes, and so on The reason comes from the fact that doctors often spend much time warning dangers of such serious diseases and informing present status of patients’ diseases In general, the statistics shows that the discourse is centered on the doctor
4.1.3 Summary of the English and Vietnamese data corpus
Extracting illustrations from Figure 4.1 and Figure 4.2, Figure 4.3 synthesizes the general information of the English and Vietnamese data corpus
Figure 4.3: The English and Vietnamese data corpus
As can be seen from Figure 4.3, while the amount of utterance of English doctor talk accounts equally as that of the patient talk, Vietnamese doctor talk is found to be more dominant in terms of engagement in all the categories of diseases
It is seemingly presumed that English doctor-patient interaction shows a more patient-centered orientation, whereas Vietnamese doctor-patient communication witnesses a preferable trend of doctor-centeredness
Overall, from the proportion of doctor talk, the number of clauses and the average number of words in a clause, an equal proportion of talk between the doctor and the patient is found more frequent in English Obviously, at this stage, no possible interpretation of the result of the analysis of interpersonal meanings of doctor talk in
25% percentage of words in English patient talk percentage of words in English doctor talk
25% percentage of words in Vietnamese patient talk percentage of words in Vietnamese doctor talk
English and Vietnamese could be made However, to some extent, this section is based on the proportion of talk between the doctor and the patient to reflect a preliminary picture of doctor talk in six selected groups of diseases It is expected that this section is able to pave a concrete foundation for the interpretation of interpersonal meanings in doctor talk The analyses of the deployment of mood and modality resources that construct interpersonal meanings in the English and Vietnamese doctor talks are presented in the sections below.
Deployment of IRs in English and Vietnamese doctor talks
The deployment of IRs in the English and Vietnamese doctor talks was analyzed and reported respectively from the two perspectives of the Mood system of SFL: mood and modality Thus, this section primarily reports and explains the results of the analysis of mood and modality resources in the discourse of English and Vietnamese doctors In general, from the data corpus, this part will demonstrate from the results of the analysis (1) proportions of mood and modality and (2) the range of realisations of mood and modality in terms of lexico-grammar This part answers the first research question:
1 What interpersonal resources that construct interpersonal meanings do
English and Vietnamese doctors employ to talk to their patients at doctor- patient consultations?
1.1 What mood resources are employed in English and Vietnamese doctor talks?
1.2 What modality resources are employed in English and Vietnamese doctor talks?
The following sections, Sections 4.2.1 and 4.2.2, respectively present proportions and realisations of mood and modality resources that perform interpersonal meanings in a particular doctor talk The proportions of mood and modality resources were illustrated basing on percentage choices of types and subtypes of mood and modality
Precisely, the proportions of different aspects of mood resources (including types of (i) subjects, (ii) declaratives, (iii) interrogatives and (iv) imperatives) and modality resources (including types of (i) congruents and (ii) incongruents) were reported To make the analysis more thorough and precise, comparisons of percentage of mood resources deployed by the patient were somehow provided for the later discussion The aim was to put the doctor’s language in contexts of doctor- patient interaction This part provides a fundamental background that enables the comparison task of the research question two much more meticulous and precise
4.2.1 Deployment of Mood resources in English doctor talk
Deployment of Mood resources in doctor talk was investigated from two perspectives: (1) the proportions and realisations of mood resources; and (2) the proportions and realisations of modality resources
4.2.1.1 Proportions and realisations of mood resources in English doctor talk
Of the four main aspects of mood analyses which include (i) subject, (ii) declarative, (iii) interrogative and (iv) imperative, types of subject uses comprising subject explicit, subject implicit, subject interactant and subject non-interactant were analyzed before the three others
4.2.1.1.1 Proportions and realisations of subject uses in English doctor talk a Proportions of subject uses
Instances of subject uses of English doctors in six selected groups of diseases can be viewed from Figure 4.4 below (more in details in Appendix 4.3)
Figure 4.4: Proportions of subject uses of English doctors and patients
Figure 4.4 shows the general information of subject used by English doctors and patients in four selected types: (1) subject explicit (subj.expli.), (2) subject implicit (subj.impli.), (3) subject interactant (subj.inter.), (4) subject non-interactant (subj.non- inter.) In all types of subject, the doctor uses a greater number of subjects compared with the patient, accounting for a double use in total (approximately 70%)
In terms of subject explicit and subject implicit, there was a bigger gap in the proportion of subject uses between the doctor and the patient Comparing with the patient, the doctor took up 13%, accounting for nearly 80% in the use of subject explicit and over six times in the use of subject implicit, accounting for 5%
Regarding to the choice of subject interactant and subject non-interactant, although
Pt. these types of subject witnessed a double use by the doctor, there was a relatively large number of these subject patterns chosen by the patient The dominant use of subject interactants showed a preferable trend of interaction between the doctor and the patient and indicated an active involvement into conversations by both parties
In terms of six compared groups of diseases, cardiologist employed only half proportion of subject uses compared with endocrinologists, neurologists and gastroenterologists who all deployed more than 14% of the subjects (5978 instances)
Meanwhile, doctors from oncology and otorhinolaryngology utilized a slightly lower percentage of subject uses, accounting for nearly 10% in total The following section shows the range of realisations of subject used by the doctor extracted from the English data corpus b Realisations of subject uses
Obviously, a great number of realisations of subject uses in doctor’s utterances can be found in the English corpus Table 4.1 exemplifies only typical illustrations for each type of subject deployment
Table 4.1: Realisations of subject (subj.) uses in English doctor talk
Functions Realisations of subject uses in English doctor talk
Grammar Lexico subj.expli Noun your risk factors
- ||Ok |||you have a history of thumb ||and your risk factors appear such as high cholesterol, high blood pressure, diabetes (Cardiology, Dr.04) subj.impli pronoun (you) -||| (you) just tell me a little bit about ||what’s happened! (Endocrinology, Dr.05) subj.inter pronoun I, you, we - |||so just tell me a little bit about ||what symptoms || you’ve been having them!
|||But we do have a scan result here today ||and there are some things to discuss on it, right ||| I just like to make sure ||that I know ||what’s been happening to you first of all ||and then we’ll go into a detail it (Oncology, Dr.08) vocative Mr Young,
-Hi, Jane Smith ||It’s nice to meet you my name is Dr Guda (Endocrinology, Dr.01)
- ||On lungs exam, take some deep breaths for me, Mr Young! (Cardio, Dr.06)
Let + objective let’s, let me - So, |||let’s go ahead ||and get a urinalysis and a cat scan of the lumbar area no contrast! (Neurology, Dr.01) -||So … let me keep …||keep them on the monitor ||and keep checking you the vital signs!
[subj.non- inter.] pronoun, relative pronoun it, which -|||I was running for your vital signs this morning ||and your heart rate is significantly better || [It]’s in the 90s which is good ||| [It]’s still a regular ||but
[It]’s much slower (Cardiology, Dr.06) -|||And… there’s a vector marker Liberty || [which] you showed us yesterday
4.2.1.1.2 Proportions and realisations of declarative mood in English doctor talk a Proportions of declarative mood
Proportions of declarative mood in English doctor talk are represented in Figure 4.5 (more details in Appendix 4.4) The marked line chart illustrates the percentages of three declarative subtypes The column bar chart summarizes the declarative instances used by both the doctor and the patient in six selected diseases
Figure 4.5: Proportion of declarative (decl.) mood used by English doctors & patients
The line chart shows a relatively equal use of declarative mood between doctors and patients Both English doctors and patients are in favour of using declarative mood in their talk as this mood type was seen to be used mostly during consultation The doctor uses a slightly higher percentage of declarative mood, accounting for 57% The allocation of three declarative types places full declaratives in the first rank and elliptical declaratives in the lowest rank of use
Summary
In summary, this chapter has addressed the first research question It examines the deployment of IRs that constructs interpersonal meanings in English and Vietnamese doctor talk by reporting the data analysis from the two lexico- grammatical perspectives: mood and modality Although the focus of the study is on interpersonal meanings in doctor talk, it is clearly noticeable that this chapter’s analyses have also included the patients’ data information and their frequent choices of mood and modality resources The main aim is to examine how interpersonal meanings doctors employed in their talks at consultation are formed when interacting with different types of patients
The findings from the general introduction of the data have preliminarily shown a different trend of engagement between English and Vietnamese doctors
Although doctors from the two compared languages engage into consultation more actively than their patients, English consultations involve both doctors and patients more freedom to talk Besides, the findings of proportions and realisations of mood and modality in the two languages of doctor talk have indicated lexico-grammatical distinctions in each language This chapter is a fundamental background and the first step of comparisons of interpersonal meanings found in English and Vietnamese doctor talks.
COMPARISONS OF INTERPERSONAL MEANINGS
Comparison of mood resources
The comparison is a combination of analyses of proportions and realisations of four main aspects of mood resources (i) subject, (ii) declarative, (iii) interrogative and (iv) imperative The results of comparisons of mood resources are then discussed and argued to find out the similarities and differences of interpersonal meanings in the two languages
The comparisons of proportions and lexico-grammatical realisations of subject uses in the two languages are revealed in this section The similarities and differences are illustrated in Figure 5.1
Figure 5.1: Proportions of subject types in English and Vietnamese doctor talks
As can be seen from Figure 5.1, in both English and Vietnamese doctor talks, doctors exploited a great number of subjects A similar feature can be found that both English and Vietnamese doctors utilized subject interactants to involve in interactions much more frequently than the patients (see Figures 4.4 & 4.10) In fact, subject interactants function as signals of participation of the doctor and the patient during doctor-patient consultations In other words, subject interactants indicate the speaker when taking up his/her position (Chinwe, 2013, p 8) In this current thesis, since the recording consultations occur between doctors and patients, subject interactants apparently refer to these two speakers, the doctor and the patient The highest proportion of subject interactants well reflects the fact that, the roles of the doctor and the patient during consultations are centered in both languages In fact, the largest proportion of subject uses in the neurology data has indicated not only the active involvement of both doctors and patients but also shown an effective model of consultation when the role of the participants is highly concentrated
The first striking difference can be found in the percentage of subject instances distributed in the two languages In general, a part from the dominant exploitation of subject implicits in Vietnamese doctor talk, English doctor talk used the rest of subjects more frequent In fact, subject implicits were hidden mostly in Vietnamese imperative clauses when doctors demand the patient to implement actions
Moreover, Figure 5.1 above illustrates different trends of exploiting subjects in the two languages First of all, despite the fact that the proportion of subject interactants reported in English and Vietnamese doctor talk was identically used the most frequent, English doctors exploited this type of subject approximately double higher Not only that, English doctor talk was found with many consultation strategies that offered English patients more chance to expose positions to engage into interaction, resulting a higher percentage of using subject interactants in English patient talk Moreover, while the second most favourite deployment of subjects in English doctor talk skewed towards subject explicit, in Vietnamese doctor talk, however, subject implicit was largely used
5.1.1.2 Comparison of lexico-grammatical realisations
The similarities and differences of lexico-grammatical realisations of subject uses in English and Vietnamese doctor talks are respectively displayed in terms of four types of compared subjects: explicit, implicit, interactant and non-interactant
In both English and Vietnamese doctor talks, realisations of four subject types can be seen in Table 5.1 below
Table 5.1: Lexico-grammatical realisations of subject uses in English and Vietnamese doctor talks
Functions Realisations of subject uses in English doctor talk
Functions Realisations of subject uses in Vietnamese doctor talk
Grammar Lexico Grammar Lexico subj.expli Noun your risk factors
-||Ok |||you have a history of thumb
||and your risk factors appear such as high cholesterol, high blood pressure, diabetes (Cardiology, Dr.04)
- ||| Các bác sĩ sẽ cho làm tiếp những xét nghiệm ||và điều trị nhé
(Cardiology, Dr.03) subj.impli pronoun (you) - ||| (you) just tell me a little bit about ||what’s happened!
(Endocrinology, Dr.05) pronoun (chị) - |||Bây giờ thì ||chị không có thiếu máu nhiều, ||nhưng (chị) cũng còn thiếu máu chút xíu thôi
(Endocrinology, Dr.01) subj.inter pronoun I, you, we
- |||so just tell me a little bit about
||what symptoms || you’ve been having them! |||But we do have a scan result here today ||and there are some things to discuss on it, right ||| I just like to make sure ||that
I know ||what’s been happening to you first of all ||and then we’ll go into a detail it (Oncology, Dr.08) pronoun tụi em - Tụi em cần ||những cái người mà tuân thủ quá trình điều trị || Chị biết cái tình trạng bệnh ngay từ đầu đó
||Như là tụi em cho chị Trang biết đó (Endocrinology, Dr.01) vocative Mr
- Hi, Jane Smith ||It’s nice to meet you my name is Dr Guda
- ||On lungs exam, take some deep breaths for me, Mr Young!
(Cardio, Dr.06) vocative Thảo ơi - Thảo bị bao lâu rồi mới đi khám bệnh đây ||Đưa đưa đơn đây!
|| Thảo ơi || dậy khám bệnh! ||Trước giờ cháu bị bệnh gì vậy? ||trước giờ con bị bệnh gì vậy?(
Let + objective let’s, let me
- So, |||let’s go ahead ||and get a urinalysis and a cat scan of the lumbar area no contrast!
- ||So … let me keep …||keep them on the monitor ||and keep checking you the vital signs!
Let + objective Để tôi - || Để tôi làm hết cái cao huyết áp, nhồi máu cơ tim, tiểu đường cho anh nhé! (Cardiology, Dr.02)
[subj.non- inter.] pronoun, relative pronoun it, which
- |||I was running for your vital signs this morning ||and your heart rate is significantly better || [It]’s in the
90s which is good ||| [It]’s still a regular ||but [It]’s much slower
- |||And… there’s a vector marker Liberty || [which] you showed us yesterday (Cardiology, Dr.10) pronoun, relative pronoun bệnh đó
- |||Nói thực chị chịu đựng cái tác dụng phụ của bệnh đái tháo đường tuýp 2 đó, ||[ bệnh đó ] cũng vất vả
As can be seen from Table 5.1, despite the diversity of lexical realisations, grammatical realisations of subject uses are relatively similar In both languages, subject explicit includes nominal groups; subject implicit, is omitted, but carries the same grammatical functions as the nominal group mentioned earlier in conversation; subject interactant illustrates direct engagement of the doctor and the patient; subject non-interactant functions as a pronoun or a pronoun + relative pronoun restored from a nominal group that mentioned earlier in conversation
English doctors did not tend to limit interaction between subject framework of the doctor and the patient; Conversely, English doctors used much subject explicit to expand discourse to outside things that directly relate to consultations
(16) Dr: ||Okay |||and so diabetes is a condition ||where the blood doesn't appear to handle sugar very well ||and so your blood gets a bit stickier and a bit more syrupy and ||there's more sugar hanging around in it (Endocrinology, Dr.02)
Although subject implicit does not exist in the participants’ discourse, it functions as an indicator of pointing who is projected to take actions In Vietnamese doctor-patient interaction, the doctor used many subject implicits in interrogative clauses of unmarked person when exploiting information from the patient and imperative clauses when listing actions that need to be done by the patient In other words, subject implicit in Vietnamese doctor talk was mostly used as a replacement of subject interactants which imply the patient’s position The following examples, examples 17 and 18, respectively illustrate the highest frequencies of use of subject implicit in Vietnamese doctor talk As subject implicits do not appear in clauses, they are parenthesized in the following examples Firstly, subject implicits were used typically in interrogative clauses
(17) Dr: ||Anh Ba bị đau sao anh Ba?(||Brother Ba, how is your pain, brother Ba?) Pt: ||Cao huyết áp nó gây đau (||High blood pressure, it causes pain)
Dr: ||(anh) ||Cao huyết áp lâu chưa? [(you) ||high blood pressure for how long?]
Pt: ||Lâu rồi, còn bị tai biến nữa (||for so long, also having seizures) Dr: ||(anh) Tai biến à? ||(anh) Tai biến lâu chưa?[||(you) have seizures? ||Since when did
Pt: ||Lần nhất rồi lại lần sau (||The first time and the following time) Dr: ||(anh) Tai biến cách đây bao lâu?[||Since when did (you) have seizures?]
Pt: ||Khoảng 2 năm hay 3 năm (||about 2 or 3 years) Dr: ||(anh) Cao huyết áp bao nhiêu năm? [||How long have (you) been high blood pressure?]
Pt: Khoảng 2 năm nay rồi.(||For about 2 years)
Dr: |||(Anh) Cao huyết áp hai năm nay ||(Anh) có uống thuốc gì hông? [||(you) have had high blood pressure for two years ||Have (you) taken any medicine?]
Pt: ||Uống thuốc tây đó (||Taking western medicine)
As can be seen, apart from the initial move that the doctor used subject interactants to indicate the patient, the rest of the conversation, subject implicits with unmarked person were used in the doctor’s questions Similarly, Vietnamese doctor used subject implicits mostly in imperative clauses
(18) Dr: |||Còn bây giờ thì, thứ nhất là đang trong cái giai đoạn viêm cấp thế này ||thì em đi lại hạn chế! ||(em) Còn có thể mua thêm băng chun để quấn cái khớp gối vào nhé! ||(em) Cuốn cái khớp gối vào để cho nó đỡ sưng! ||(em) Đi lại vận động nhiều để nó đỡ sưng!
(|||And now, firstly it is in period of acute inflammation, ||you limit travelling! ||(you) buy some more elastic band to tie the knee joints to protect it from swelling! ||(you) do more physical movement to avoid it from swelling!) (Neurology, Dr.04)
Again, it was only the initial move that the doctor used subject interactant ‘em’
(you) to refer the patient, in the rest of imperative clauses, subject implicits were omitted This well reflects the fact that Vietnamese doctors could avoid repetition of subject-interactants and saved more time for consultations by using a dominant proportion of subject implicit
Comparison of modality resources
However, there exists a wide range of distinct uses of mood resources to perform different interpersonal meanings in a particular language Thus, different deployments of mood resources in each language have created its own language of consultation with private meanings of interpersonal flavor In general, English doctor talk was shown with much active employment in every mood element The results show that English doctor talk is equal and friendly with high uses of subject interactants I, you, we and inclusive imperative let us; to be informative with preferred choices of how-questions Besides, Vietnamese doctor talk is shown to be hierarchical with complicated and sophisticated uses of subject interactants (con, cô, bà, bạn, mình, em, tụi em, chị, chú, cháu, anh, ông, tôi, chúng tôi, chúng cháu, etc.); to be respectful with polite markers ạ, nhé; to be authorized with high deployment of inclusive imperatives để tôi (let me)
Comparisons of proportions and realisations of modality are depicted by the main aspects of modality resources (i) congruent, (ii) incongruent The results of comparisons are then discussed to compare the interpersonal meanings performed in the two languages
The similarities and differences of proportions and lexico-grammatical realisations of congruent modality in the two languages are represented in this section The similarities and differences are discussed basing on the demonstration of congruent modality illustrated in Figure 5.5
Figure 5.5: Proportions of congruent modality in English and Vietnamese doctor talks
As can be seen from Figure 5.5 on the previous page, in both of the English and Vietnamese data, there is a higher percentage of modality uses in modalisation which includes probability (e.g will/may/might) and usuality (e.g always/usually/sometimes) than in modulation which includes obligation (e.g have to) and inclination (e.g need/will/would/should/can) Both English and Vietnamese doctors recorded around a double frequency of choice of modalisation modality compared with the patient This may be suggestive that both English and Vietnamese doctors prefer using modal operators to provide information rather than to exchange goods-&-services Moreover, both English and Vietnamese doctors exploited greater amount of modal auxiliary verbs [e.g will (sẽ), can (có thể), may/might (có lẽ)] than modal adjuncts [e.g willingly (sẵn sàng), probably (có thể là), possibly (có khả năng là)] Particularly, modal auxiliary verbs at medium value
[e.g should (nên), will/would (sẽ)] were exploited much in modality of probability than low [e.g can/could (có thể), may/might (có khả năng)) and high (e.g must/have to (phải), need (cần)] values In both corpora, there is a higher percentage in the use of congruent modality in the endocrinology and neurology data
A number of striking differences of imperative distribution between the two languages can be found in Figure 5.5 In general, more instances of congruent modality were found in English doctor talk than in Vietnamese doctor talk, accounting for a remarkable use of modality in probability and inclination Particularly, while Vietnamese doctors dominated the patient in using modality for exchanging goods-&- services, English doctors only recorded an equal use of these modal operators compared with the patient Moreover, while modal auxiliary verbs in English were exploited largely at low value in probability and usuality, those in Vietnamese were used mainly at high value Especially, a paradoxical example of modality high and low values can be found in the oncology data of the two corpora Precisely, while low value modalities were preferred in English doctor talk, high value ones were found much frequent in Vietnamese doctor talk in the oncology consultations Moreover, the least choice of congruent modality in English doctor talk fell into the obligation type, meanwhile those in Vietnamese doctor talk belonged to the inclination type
The different uses of congruent modality can show that Vietnamese doctors, with the dominant use of modality at high value, were able to express a strong discourse of consultation Meanwhile, English doctors, with the favourable use of modality at low value, showed a mild voice of authority with interpersonal flavour
5.2.1.2 Comparison of lexico-grammatical realisations
The similarities and differences of lexico-grammatical realisations of congruent modality in English and Vietnamese doctor talks are respectively displayed in terms of four types of compared modality: probability, usuality, obligation and inclination In both English and Vietnamese doctor talks, four types of congruent modality can be summarized in Table 5.5 on the next page
Table 5.5: Lexico-grammatical realisations of congruent modality in English and Vietnamese doctor talks
T y p es Functions Realisations of congruent modality in English doctor talk Functions Realisations of congruent modality in Vietnamese doctor talk value Grammar Lexico Grammar Lexico
M od ali sa tion ( in for m a tio n ) P rob a b il it y
H modal auxiliary must |||It must have scared you a bit ||and you have the right thing by coming to the hospital (Otorhinolaryngology, Dr.04) modal auxiliary phải ||Tự nhiên chị biết mình ngoại tâm thu à? ||Nó phải có biểu hiện gì khác chứ? (Cardiology, Dr.09)
Will |||I just hope pretty short of breath ||and your oxygenation will be exactly normal (Cardiology, Dr.05) modal auxiliary nên |||Bệnh tật thì có khi cũng nên quan tâm ||vì nông thôn thì thế thôi
||Bây giờ người ta … đời sống người ta cũng cao rồi (Cardiology, Dr.05)
L modal auxiliary may, may not ||Alright, |||I 'm just going to ask you some other questions ||that may ||or may not be really related to that any any other sometimes like a headache testing out a vision change? (Neurology, Dr.01) modal auxiliary có thể ||Tiểu đường, tăng huyết áp, tăng mỡ máu, các bệnh liên quan đến tim mạch, có thể gây tắc mạch, động mạch ở tim (Cardiology, Dr.04) modal adjunct probably |||It probably is good for you in certain circumstances like ||after you run the marathon (Endocrinology, Dr.03) modal adjunct có khi là…
||Vâng ạ, ||thì sau này có khi là phải uống thêm những cái thuốc chống thoái hóa, glucosamine (Neurology, Dr.06)
H modal adjunct always ||And nutrition labels are always how you the serving size
(Endocrinology, Dr.09) modal adjunct hoài |||Chứ không cứ thấy điều trị hoài mà khổng bớt, || rồi lại bỏ trị hoặc
||điều trị bằng phương pháp khác thì ||nó rất là nguy hiểm (Endocrinology, Dr.01)
M modal adjunct usually ||you're usually compressing your owner nerve right here ||and when you're laying your hand down (Neurology, Dr.08) modal adjunct thường thường || Thường thường là lúc đói.(Gastrology, Dr.01)
L modal adjunct sometimes ||Does it sometimes transform into a migraine? (Neurology,
Dr.04) modal adjunct thỉnh thoảng
|||À tức là không liên tục, || thỉnh thoảng mới đau (Cardiology, Dr.04) modal adjunct recently || Recently, have you had a cough sore throat? (Cardiology, Dr.04) modal adjunct gần đây |||Nó đau lâu thì ||nó xuất hiện gần đây hay là lâu rồi?(Cardiology,
M od u la tio n ( goo d s- & -s er vice s) Ob li g at io n
H modal auxiliary must ||So we had to do further investigation like cat scan (Oncology,
Dr.05) modal adjunct phải ||Nhưng mà chị phải đi cái tất chân! tất áp lực í, ||thì nó sẽ bớt đi áp lực (Cardiology, Dr.05)
- Well ||right ||now your heart’s going really fast ||and so we need to get that slowed down (Cardiology, Dr.01)
- ||you're supposed to hear a little bit of dullness over your organs(Gastroenterology, Dr.10)
- modal auxiliary không cần - ||Soi chứ tội gì mà không soi! ||Soi là cho thấy vi trùng luôn không cần phải thử máu! ||Muốn soi thì soi lại! (Gastroenterology, Dr.04)
- ||Definitely, I think you should be quitting smoking ||What have you tried that so far (Endocrinology, Dr.07)
- The whole idea is to actually kill those cells ||and you are allowed to have new skin to reduce cancer to grow back
Modal auxiliary nên |||Nếu mà phải ăn đồ xào rán ||thì cô nên ăn với dầu thực vật nhé!
(Oncology Dr.03) modal adjunct unavoidably ||Oh, we unavoidably will just keep working on that (Cardiology,
Dr 08) modal adjunct tất nhiên là… ||thế … thế tất nhiên là bà không phải rượu bia gì cả rồi ||Như vậy lại loét hoặc có nhiều vấn đề khác.(Gastrology, Dr.06)
Summary
In general, this chapter bases on the results of Research Question One to address the Research Question Two Precisely, this chapter compares the deployment of IRs to perform the similarities and differences of interpersonal meanings in English and Vietnamese doctor talks The comparisons are mainly on the two dimensions, namely proportions and realisations of mood and modality resources
The comparisons have reported more distinct results of lexico-grammatical realisations than that of proportions between the two compared languages In terms of proportions, similar frequencies of choices of mood and modality have reported a nature feature of doctor talk that characterized the doctor as a more active speaker during consultations However, the different proportions of mood and modality uses between the two languages have proved a more preferable style of patient- centeredness in English doctor talk In terms of lexico-grammar, although many grammatical characteristics are identical in the two languages, a number of distinctions of lexical resources have evidenced a remarkable difference of interpersonal meanings between English and Vietnamese doctor talk.
CONCLUSION
Summarizing conclusions
In this paper, I have been concerned with the comparisons of interpersonal meanings found in English and Vietnamese doctor talks I raised two questions for my research One concerns the types of IRs and how they are used in a particular language of doctor talk The other is about the comparisons of uses of IRs to perform common and distinct interpersonal meanings in the two languages
Through the analytical device of IRs mood and modality of SFL, the current thesis answered the two research questions respectively The data of the study were collected from the six groups of diseases: Cardiology, Endocrinology, Neurology, Gastroenterology, Oncology, and Otorhinolaryngology The aim is to make the data sources more reliable for analyses and discussion The research methods and techniques that were used to address the research questions were comparative, quantitative and qualitative Moreover, methods of content analyses, used for presenting discussions and showing evidence, were also exploited Also, the current study used Microsoft Word 2010 and Excel Programs to calculate the data statistics
The followings summarize and discuss in accordance with the two research questions above
In regards to Research Question One, this research question, in fact, based on comparisons of choices of mood and modality recorded by the doctor and the patient to make a detailed description of doctor talk from the angle of proportions and realisations Although the study focuses only on the language doctors exploit at the time of consultation, the doctor-patient interactions are put into context of different diseases to make the analyses more diversified and feasible Precisely, from quantitative examinations on proportions and realizations of IRs: mood and modality, this question respectively unveiled frequencies of choices of these lexico-grammatical sources deployed in the English and Vietnamese data In both of the English and Vietnamese data, sub-categories of mood and modality were exploited variously In regards to English data, English doctors and patients have their own habits of using categories of mood and modality English doctors offered their patients much time and opportunities to engage into consultation and to show ideas, opinions and to express emotion In regards to the Vietnamese data, Vietnamese doctors and patients also recored a high use of subject interactants that were able to show active engagements between the two parties However, a more frequent use of elliptical declaratives in Vietnamese patient talk is able to reflect a traditional consultation when the doctor always raises questions and the patient replies with short responses
In general, the first research question preliminarily showed a different trend of engagement between English and Vietnamese doctors Although both English and Vietnamese doctors verbally engaged into consultation more actively than their patients, English consultations involve both doctors and patients more freedom to talk
In regards to Research Question Two, quantitative and qualitative comparisons were reported and discussed based on the results of Research Question One: the deployment of lexico-grammatical resources of mood and modality in English and Vietnamese doctor and patient talks At this stage, methods of content analyses were utilized to help the researcher plunge into comparisons of interpersonal meanings in English and Vietnamese doctor talks However, patient talks of both languages were somehow taken into account to explain the use of doctor talks In terms of comparisons of uses of IRs, the comparisons focused on the two selected dimensions: proportions and realisations of mood and modality found in English and Vietnamese doctor talks
Both English and Vietnamese doctor talk were seen with many evidences of active deployment of interactant subjects, full declaratives, implicit imperatives, modality of probability Thus, identical results of proportions in both doctor talks well reflect the natural instinct of doctor-patient consultation Doctors always play active roles in eliciting and conveying information, advising, commanding, and making decision during doctor-patient consultations As a result, the doctor often has more chances to express their emotions and behaviour through the more frequent uses of imperatives and modality However, the different proportions of subject implicits and explicits, interrogatives, exclusive and inclusive imperatives as well as modality uses have constructed a distinct style of consultation in each language Precisely, English doctor talk has been found with higher percentages of evidence supporting for patient- centeredness such as the more frequent uses of explicit subjects to expand consultation discourses; of wh-questions to exploit manners; of inclusive imperatives to share responsibility and authority Meanwhile, Vietnamese doctor talk has been prone to doctor-centeredness with more choices of subject implicits that omit personal pronouns in clauses; of oriented questions such as alternative, tag and elliptical ones; of explicit imperatives that presses burden on the patient’s role and authority These findings are suggestive of the possibility that English doctor talk is inclined to politeness, equality, friendliness and informativeness since the talk was scripted for educational purposes; the language used by the doctors can be idealized From the analyses of the similarities and differences of IRs used in English and Vietnamese doctor talks, Research Question Two mainly performed qualitative comparisons of interpersonal meanings embedded in the two languages This question is answered with a number of lexico-grammatical evidences indicating how interpersonal features in doctor talks are displayed commonly and distinctly
As regards similarities, the findings confirm the habitual dominance of role authority and responsibility of the doctor over the patient in both of two languages
The discussion relies not only on the factual evidence of the study but also on identical results of previous studies Precisely, lexico-grammatical devices justifying the common flavours of interpersonal meanings are the high uses of subject interactants, polar questions, full declaratives, imperatives of unmarked person and probability modality This phenomenon indicates that in equivalent settings of doctor-patient interaction – medical consultation, doctors with their professionalism, medical knowledge and skills are inclined to interact with their client in the same manner (Eggins & Slade, 1997; Bramley, 2001; O’Keeffe, 2006;
Adam, 2014; Phạm Thị Hồng Nhung, 2014)
As regards differences, English and Vietnamese doctors have their own ways of expressing interpersonal features in their discourses A set of lexical-grammatical evidence of the current study proves that English doctor talk is characterized by subtle power, politeness, solidarity and intimacy Meanwhile, Vietnamese doctor talk is characterized by direct, straightforward, complicated and hierarchical choices of lexical grammar in discourse In terms of mood uses, English doctors owned a large number of strategies that skew towards consultation style of patient-centeredness
Thus, English doctors showed a more flexible exploitation of subject types that consider as the ‘anchor’ of proposition and proposal (Chinwe, 2013, p 53), particularly the subject interactants that involve the doctor and the patient directly into conversations In contrast, although Vietnamese doctors owned a various particles of polite markers positioning at the end of an implicit imperative clauses and intimate kin-terms for demonstrating close relationships, Vietnamese doctors did not employ these IRs effectively to build up interpersonal rapports with the patient
Moreover, English doctors exploited a larger number of wh-questions, especially question of how that brings about much more beneficial effects in exploiting information Vietnamese doctors’ large amount of elliptical questions with unmarked for person leads the discourse to be less friendly and intimate This habit creates a distance between the doctor and the patient In terms of modality uses, a large number of modalities skewing towards implicit subjectivity imply English doctors’ attempt to focus on improving the patient’s democratic arguments and autonomy In contrast, frequent use of explicitly objective assessment of obligation and high value modal auxiliaries in Vietnamese doctor talk indicates an interest of expressing authority, responsibility and dominance over the patient.
Implications
This current study compares the interpersonal meanings constructed in the language doctors exploit at the time of consulting the patient Investigation into doctor talk at consultation is not new, especially in Western countries where a large number of terms supporting for patient-centeredness or subtle power have long been received much applause Also, in Vietnam, intimate consultations have been highly appreciated and acclaimed among public However, linguistic studies investigating into the scope of doctor talk, particularly Vietnamese doctor talk is limited As a result, literature domain of doctor talk at consultation is unable to meet emergency requests from healthcare providers, educators, researchers and so on Therefore, the current study is hoped to provide some theoretical and practical implications as follows
In the field of theoretical implications, as the current study uses IRs of mood and modality of SFL to compare interpersonal meanings found in English and Vietnamese doctor talks, it so far justifies how IRs, deployed in English, are distinctive to the Vietnamese language Moreover, although the scope of the current study only focuses on the language of doctor and its interpersonal meanings, IRs of lexico-grammar of mood and modality in the Vietnamese language greatly benefits from the findings of the study Although the present study limits itself to distinguish lexical realisations of word components between English and Vietnamese (e.g reduplicate and compound words), it provides a large number of lexical choices realized in mood clauses that are able to inspire further studies on other languages
In the field of pedagogical implications, the current study has made a great contribution to the realisations of interpersonal meanings in doctor talks at consultations Thus, the findings of the study are expected to help the doctor to consider their discourse when interacting with patients Interactive performance of interpersonal flavour in the doctor’s discourse is able to encourage the patient’s confidence and self-control (Brody, 1997; Hyden & Mishler, 1999; Bruce, 2009) In contrast, if interpersonal exchanges are introduced in a direct and authorized way, it probably makes patients easily fail to engage in consultations; consequently doctors may be unsuccessful in their consultation because they are unable to exploit the patients’ emotional position (Fairclough, 1995; Ainsworth-Vaughn, 1998) The purpose of the current study is not only to unveil interpersonal meanings in doctor talks of the two languages but also to reinforce the preferable concept of medical consultation – patient-centeredness From pedagogical perspectives, it is expected that the results of the current study enable doctors to be aware of benefits of the move towards the trend of patient-centeredness in which they can consult patients in a polite way This study not only confirms the necessity of change in medical discourse, but also proposes evidence of benefits may bring to the movement in the Vietnamese doctor talk The study appreciates the doctor’s interpersonal discourse in reciprocal consultations that takes the patients’ concerns and expectations into account Thus, the language of doctors has always been expressed very powerfully through their discourse (Ainsworth, 1992; Fairclough, 2001; Frankel 1990;
Heritage, 1984; Heath, 1992; Ong et al., 1995; Robinson & Heritage, 2006;
Ruusuvori, 2000) This has now been changed to become much more subtle
According to Aitchison (2000, p 3) ‘language, like everything else is joining in the general flux’ That means there has never been a moment where a ‘true standstill in language’ exists The language of doctors should also move towards increasing informality and solidarity because it underlies the system of general language (Nguyễn Thanh Nga, 2018a) It is hoped that the findings of the interpersonal meanings used in English and Vietnamese doctor talk of the current study will supplement the trend of patient-centeredness in which the politeness, solidarity and intimateness in the doctor’s discourse will be maximized to create a friendlier environment, and to increase the patient’s autonomy as well
This study has enlightened medical educators, myself included, to be more aware of the insufficiencies and limitations of training and experience In other words, this study has provided linguistic teachers a new insight into the teaching of medical students and how to interact with their patients Precisely, linguistic educators of medical languages can take advantages of theoretical background of mood and modality of IRs to instruct student doctors to practise a polite and intimate language of communication with patients Thus, the increasing trend towards informality in medical discourse will enable medical students to establish solidarity and intimacy in the doctor-patient relationship This pivotal factor not only encourages patients to be more open with their doctors but also provides the doctor with useful information to assist themselves with diagnose work Hence, if medical students wish to be successful with their medical consultations, it is extremely important for them to establish a rapport with their clients As a result, the medical students will be able to elicit much more information and be able to make a more effective and accurate diagnosis
The current study has contributed richly authentic teaching materials relating to communicative language teaching of medical consultation Thus, a mixed syllabus of text-based and authentic-based approaches provides much practical knowledge of doctor-patient interactions Lessons of morality introduced with evidence of real-life consultations will help medical students overcome the linguistic and strategic challenges of interaction with patients Thus, these difficulties are normally caused by the differences between what students are taught and what they witness in real-life situations The study has raised the issue of the need for preparing medical leaners with effective communication outside classroom Medical language teachers in Vietnam, myself included, should take advantages of authentic discourse from internet sources, from real-life contexts to provide students with vivid illustrations, evidences and suggestions of an effective model of consultation.
Limitations of the study
This research is an attempt at comparing the similarities and differences of interpersonal meanings found in English and Vietnamese doctor talks in terms of lexico-grammar In light of SFL, it utilizes IRs of the Mood system including mood and modality resources as the theoretical framework for describing, comparing and discussing In fact, at analytical levels of interpersonal meanings, the analyses are able to concern with a variety of discourse organizations such as turns, non-gradable resources such as solidarity, and people’s feelings, judgments and behaviours (Martin & White, 2005, p 33) However, the current study has limited to the lexico- grammatical choices of mood and modality resources analyzed throughout doctor- patient consultations Therefore, the current study, in no ways, can capture participants’ intonation and nonverbal behaviors which significantly contribute to social research (Jewitt, 2013) In other words, the current research only focuses on lexical choices apparently occurred in doctor talk Thus, to some extent, this study should have involved further discussions on the issue of conversational interactions like moves, turns, pairs and repairs Multimodality is suitable for media data of live interaction (Baldry & Thibault, 2006; Bateman, 2008) However, unlike the Vietnamese data, the English data of this study is unable to recruit live records from real doctor-patient consultations Therefore, the present study cannot compare multiple modes of doctor talk in the two languages, particularly non-verbal resources which is considered as an important mean of interpreting politeness, power and authority in doctor talk In other words, the current study excludes paralinguistic and extralinguistic factors from the research data though they are of vital importance in the expression of the ‘how’ in interpersonal communication
In addition, the current study has limited to practical evidence of the English data As the English data sources were dramatized to serve educational purposes, the current study’s corpora of English doctor talk was partially diminished its natural characteristics To obtain a more valid result, this study should have been supplemented with primary evidences of English doctor talk from previous studies
Furthermore, because of the time constrain, the study could only conduct its investigation on a small size of population Therefore, the results are unable to generate and to include a close look into different variables such as genders, social relations, and social positions and so on.
Suggestions for further research
Because of the limited scope of the study, many more areas in relation to the deployment of interpersonal meanings in English and Vietnamese remain untouched Therefore, some recommendations for future studies can be shown as follows First of all, as the current study only uses mood and modality resources of the mood system to interpret interpersonal meanings in doctor talk Hence, it would be more interesting if other issues relating to lexico-grammatical choices reflecting interpersonal meanings would be supplemented A study could use the untouched issues in this study such as verbal groups of transitivity system to understand doctor’s registers that create interpersonal features Another recommendation for the further study is to investigate non-verbal communications such as gestures, facial expressions, body languages found in doctor talk at consultation because they are exponentially crucial for research studies of oral communication
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