giao tiếp của bác sĩ trong tư vấn khám bệnh trong tiếng anh và tiếng việt so sánh từ bình diện liên nhân

VIETNAM NATIONAL UNIVERSITY, HANOI UNIVERSITY OF LANGUAGES AND INTERNATIONAL STUDIES ***** FACULTY OF POST–GRADUATE STUDIES NGUYEN THANH NGA DOCTOR TALK AT CONSULTANCY IN ENGLISH AND VIETNAMESE: AN INTERPERSONAL COMPARISON (Giao tiếp bác sĩ tư vấn khám bệnh tiếng Anh tiếng Việt: So sánh từ bình diện liên nhân) MAJOR: ENGLISH LINGUISTICS CODE: 9220201.01 A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Linguistics Supervisor: Prof Dr Hoang Van Van HANOI – 2018 i DECLARATION I certify my authority of the study project report submitted entitled DOCTOR TALK AT CONSULTANCY IN ENGLISH AND VIETNAMESE: AN INTERPERSONAL COMPARISON In fulfillment of the requirements for the degree of Doctor of Philosophy in Linguistics at Vietnam National University, Hanoi Except where the reference is indicated, no other person’s work has been used without due acknowledgement in the text of the dissertation Nguyen Thanh Nga, HANOI, 2018 ii ACKNOWLEDGMENTS I would like to express my sincere gratitude to many people who have supported and helped me a great deal to complete this dissertation I am especially grateful to all of the patients and the doctors who were generous enough to allow me to record their consultations To my supervisor, Prof Dr Hoang Van Van, I wish to thank him sincerely for his thorough and conscientious supervision that enlightened my inspiration in Systemic Functional Linguistics I have benefited not only from his generosities of providing me with valuable materials, giving me edifying feedback as well as advice with regard to this dissertation but also from his patience, gentle and loving personality to encourage me to overcome my limited knowledge of systemic theory I extend my warm thanks to all the lecturers and examiners for their enthusiasm and scholar knowledge, whose teachings and lectures I benefited from I am particularly indebted to Prof Dr Nguyen Hoa, Prof Dr Nguyen Quang, Assoc Prof Dr Le Hung Tien, and Dr Huynh Anh Tuan who generously helped me by giving materials, feedbacks, critical comments, discussions and valuable advice with regard to this study I would also like to thank all the staffs of VNU journal of foreign studies who provided me with invaluable feedback on my journal articles I must not fail to express my sincere gratitude to Dr Qasim Adam who provided me with rare materials and his dissertation copy I surely got much benefit and inspiration to complete this dissertation from his priceless academic resources I wish particularly to thank all the personnel departments, administrators and military officers of Vietnam Military Medical University for their generosity of providing me time, financial supports, and permission to conduct this research I take this opportunity to thank all the lecturers and my doctor students for their whole-hearted support, guidance and advice Also, my great thanks to all of my friends and colleagues who have encouraged me to finish this study Last but not least, my special thanks and love go to my parents, my husband, Nguyen Đoan Ngoc and my two sons: Nguyen An Nguyen and Nguyen Khang Ninh who are certainly my greatest source of motivation to go through many hardships during my PhD study I owe a debt of care to all of my family members as I had been very busy and spent less time taking care of them Above all, I would like to say a great thank-you and wish you all good health and great success in your life iii ABSTRACT The language that doctors use during their consultations with patients has been the focus of increasing interest for many years A large number of contributors to this field of medicine, which include linguistic researchers, have explored this domain in various perspectives and in different languages This thesis examined the issue of doctor talk, a subject that has been discussed by a large literature of medical communication This thesis employed Systemic Functional Linguistics (hereafter SFL) as the theoretical and analytical framework In particular, the study adopted the Mood system that includes two lexico-grammatical resources: mood and modality to compare proportions and realisations of interpersonal meanings as found in English and Vietnamese doctor talks at the time of consultations with patients The data of the study were collected and categorized into six groups of diseases: Cardiology, Endocrinology, Neurology, Gastroenterology, Oncology, and Otorhinolaryngology Since the scope of this study is majorly on comparing interpersonal meanings between the two languages, it is unnecessary for the study to compare doctor talks across the selected diseases However, comparisons of different patterns of interpersonal meanings in doctor talks across six selected groups of diseases were somehow provided The aim is only to diversify the data source, to prove more cross-sectioned analyses and to ensure the current study’s reliability Descriptions, comparisons and interpretations of interpersonal meanings found in the two languages of consultation have been conducted by qualitative and quantitative processes and methods of content analysis Research findings of this thesis showed that the use of mood and modality resources in English and Vietnamese corpora was remarkably different in the range of realisations compared with that of proportions As regards proportions, doctors from the two corpora were seen to be more active in employing subtypes of mood and modality resources These identical results of proportions in both doctor talks well reflect the natural instinct of doctor-patient consultation where the doctor always plays an active role As regards lexico-grammatical realisations, from a wide range of spontaneous patterns of doctor talks, this research shows that while English doctor talk is inclined to politeness, equality, friendliness and informativeness, Vietnamese doctor talk is prone to hierarchy, complexity and sophistication, directness and firmness Comparisons of interpersonal features found in the two language of consultation indicate remarkable evidence supporting model of patient-centeredness in the English iv consultations and a model of doctor-centeredness in the Vietnamese ones This is suggestive of the possibility that English doctor talk was skewed towards patientcenteredness since the talk was scripted for educational purposes; the language used by the doctors can be idealized In particular, this study is an attempt to make some pedagogical suggestions that enable medical educators to be more aware of the insufficiencies of healthcare communication training and of language teaching methods Moreover, the study confirms a necessity of change towards a polite manner in doctor talk that helps student doctors establish solidarity, intimacy, and rapport in the doctor-patient relationship v TABLE OF CONTENTS Table of contents Abbreviations List of tables List of figures CHAPTER 1: INTRODUCTION 1.1 Statement of the problem 1.2 Aims and objectives of the study 1.3 Significance of the study 1.4 Scope of the study 1.5 Research questions 1.6 Research design and methodology 1.6.1 Research design 1.6.2 Research methods 1.7 Research data 1.8 Structure of the thesis CHAPTER 2: LITERATURE REVIEW 2.1 Conceptual background of doctor talk at doctor-patient consultations 2.1.1 Concepts of doctor talk 2.1.2 Concepts of doctor-patient consultation 11 2.1.3 Concepts of doctor-centeredness and patient-centeredness 11 2.1.4 Concepts of interpersonal communication at consultations 12 2.2 Different approaches to interpersonal communication in doctor talk: 14 2.2.1 Interpersonal communication in doctor talk 14 2.2.2 Prominent linguistic approaches 16 2.3 An overview of SFL approach to interpersonal communication in doctor talk 19 2.3.1 Interpersonal meaning in doctor talk: The SFL approach 19 2.3.2 Advantages of SFL in finding interpersonal meanings of doctor talk 22 2.4 Summary 23 CHAPTER 3: THEORETICAL AND METHODOLOGICAL FRAMEWORKS 24 3.1 Theoretical framework 24 3.1.1 Notions of interpersonal meanings in SFL 25 3.1.2 Reviewed concepts 26 3.1.3 Analytical framework 28 3.2 Methodological framework 42 3.2.1 Research designs 42 3.2.2 Research methods 43 3.2.3 The pilot study – remarks 46 3.2.4 Descriptions of the corpus 47 vi 3.2.5 Data collection 52 3.2.6 Data analysis 56 3.3 Summary 61 CHAPTER 4: DEPLOYMENT OF INTERPERSONAL RESOURCES 62 4.1 Summary of the English and Vietnamese data corpus 62 4.1.1 Summary of the English data corpus 62 4.1.2 Summary of the Vietnamese data corpus 64 4.1.3 Summary of the English and Vietnamese data corpus 66 4.2 Deployment of IRs in English and Vietnamese doctor talks 67 4.2.1 Deployment of Mood resources in English doctor talk 68 4.2.2 Deployment of mood resources in Vietnamese doctor talk 83 4.3 Summary 100 CHAPTER 5: COMPARISONS OF INTERPERSONAL MEANINGS 101 5.1 Comparison of mood resources 101 5.1.1 Comparison of subject uses 101 5.1.2 Comparison of declarative uses 108 5.1.3 Comparison of interrogative uses 113 5.1.4 Comparison of imperative uses 123 5.1.5 Comparison of interpersonal meanings of mood resources 129 5.1.6 Concluding remarks of comparisons of mood 139 5.2 Comparison of modality resources 140 5.2.1 Comparison of congruent modality 140 5.2.2 Comparison of incongruent modality 149 5.2.3 Comparison of interpersonal meanings of modality 153 5.2.4 Concluding remarks of comparisons of modality 157 5.3 Summary 157 CHAPTER 6: CONCLUSION 159 6.1 Summarizing conclusions 159 6.2 Implications 162 6.3 Limitations of the study 164 6.4 Suggestions for further research 165 REFERENCES 166 APPENDIX 185 vii ABBREVIATIONS CA - Conversational Analysis C.B.A - corpus-based approach CDA - Critical Discourse Analysis Dr - Doctor decl - declarative IRs - Interpersonal resources interro - interrogative impe - imperative PA - Pragmatic Analysis Pt - Patient SFL - Systemic Functional Linguistics SFG - Systemic Functional Grammar SLA - Socio-linguistic Analysis Subj - Subject VMMU - Vietnam Military Medical University viii LISTS OF TABLES Table 3.1: Summary of the Vietnamese participants 47 Table 3.2: Summary of the English participants 50 Table 3.3: Grouping of English and Vietnamese doctor-patient pairs 50 Table 4.1: Realisations of subject uses in English doctor talk 69 Table 4.2: Realisations of declarative mood in English doctor talk 71 Table 4.3: Realisations of interrogative mood in English doctor talk 73 Table 4.4: Realisations of imperative mood in English doctor talk 75 Table 4.5: Proportions of congruent modality used by English doctors & patients 76 Table 4.6: Realisations of congruent modality uses in English doctor talk 79 Table 4.7: Realisations of incongruent modality uses in English doctor talk 81 Table 4.8: Realisations of subject uses in Vietnamese doctor talk 85 Table 4.9: Realisations of declarative mood in Vietnamese doctor talk 87 Table 4.10: Realisations of interrogative mood in Vietnamese doctor talk 89 Table 4.11: Realisations of imperative mood in Vietnamese doctor talk 91 Table 4.12: Proportions of congruent modality used by Vietnamese doctors & patients 92 Table 4.13: Realisations of congruent modality uses in Vietnamese doctor talk 95 Table 4.14: Realisations of incongruent modality uses in Vietnamese doctor talk 97 Table 4.15: Modality Orientation and Manifestation used in Vietnamese doctor talk 98 Table 5.1: Lexico-grammatical realisations of subject uses in English and Vietnamese doctor talks 103 Table 5.2: Lexico-grammatical realisations of declarative uses in English and Vietnamese doctor talks 110 Table 5.3: Lexico-grammatical realisations of interrogative uses in English and Vietnamese doctor talks 113 Table 5.4: Lexico-grammatical realisations of imperative uses in English and Vietnamese doctor talks 126 Table 5.5: Lexico-grammatical realisations of congruent modality in English and Vietnamese doctor talks 143 Table 5.6: Lexico-grammatical realisations of incongruent modality in English and Vietnamese doctor talks 151 ix LISTS OF FIGURES Figure 3.1: The four strata of SFL language system 26 Figure 3.2: The Mood system network 29 Figure 3.3: Components of mood in clauses of English and Vietnamese doctor talks 31 Figure 3.4: Modal adjuncts found in Mood adjuncts of the Mood system 33 Figure 3.5: Relation of modality to polarity and mood 34 Figure 3.6: Types of modality 35 Figure 3.7: Three values of modality in English 35 Figure 3.8: Summary of the coding scheme 40 Figure 3.9: Types and subtypes of mood and modality in English and Vietnamese 42 Figure 3.10: The comparability of the corpora 52 Figure 3.11: Equivalence of the English and Vietnamese corpus 52 Figure 4.1: General summary of the English data corpus 62 Figure 4.2: General summary of the Vietnamese data corpus 64 Figure 4.3: The English and Vietnamese data corpus 66 Figure 4.4: Proportions of subject uses of English doctors and patient 68 Figure 4.5: Proportion of declarative mood used by English doctors & patients 70 Figure 4.6: Proportion of interrogative mood used by English doctors & patients 72 Figure 4.7: Proportion of imperative mood used by English doctors & patients 74 Figure 4.8: Proportions of modal auxiliaries and modal adjuncts in English doctor talk 77 Figure 4.9: Proportions of incongruent modality used by English doctors& patients 80 Figure 4.10: Proportions of subject uses of Vietnamese doctors and patients 84 Figure 4.11: Proportion of declarative mood used by Vietnamese doctors & patients 86 Figure 4.12: Proportion of interrogative mood used by Vietnamese doctors & patients 88 Figure 4.13: Proportion of imperative mood used by Vietnamese doctors & patients 90 Figure 4.14: Proportions of modal auxiliaries and modal adjuncts in Vietnamese doctor talk 93 Figure 4.15: Proportions of incongruent modality used by Vietnamese doctors& patients 96 Figure 5.1: Proportions of subject types in English and Vietnamese doctor talks 101 Figure 5.2: Proportions of declarative types in English and Vietnamese doctor talks 108 Figure 5.3: Proportions of interrogative types in English and Vietnamese doctor talks 113 Figure 5.4: Proportions of imperative types in English and Vietnamese doctor talks 124 Figure 5.5: Proportions of congruent modality in English and Vietnamese doctor talks 140 Figure 5.6: Proportion of incongruent modality in English and Vietnamese doctor talks 150 x Khoa Sau đại học - Trường Đại học Ngoại ngữ - ĐHQGHN Đường Phạm Văn Đồng - Quận Cầu Giấy - Hà Nội Email: sdh_dhnn@vnu.edu.vn Website: http://www.ulis.vnu.edu.vn BÁO CÁO VỀ VIỆC CHỈNH SỬA LUẬN ÁN TIẾN SĨ SAU BẢO VỆ CẤP ĐẠI HỌC QUỐC GIA Hà Nội, ngày tháng năm 2018 I TĨM TẮT MỘT SỐ THƠNG TIN NGHIÊN CỨU SINH: Họ tên NCS: Nguyễn Thanh Nga Khóa: QHF 2014 Mã số NCS: 14048002 Đề tài: Doctor talk at consultancy in English and Vietnamese: An interpersonal comparison (Giao tiếp bác sĩ tư vấn khám bệnh tiếng Anh tiếng Việt: So sánh từ bình diện liên nhân) Chuyên ngành: Ngôn ngữ Anh Mã số: 9220201.01 II NỘI DUNG CHỈNH SỬA: Sau hội đồng góp ý sửa chữa luận án, nghiên cứu sinh cán hướng dẫn nghiên cứu ý kiến Hội đồng đối chiếu với nội dung luận án, nghiên cứu sinh xin trình bày chi tiết nội dung sửa chữa ý kiến bảo lưu với lý giải, bổ sung vào vấn đề chưa rõ nhằm làm sáng tỏ kết nghiên cứu sau: Phần/ Chương Technical mistakes /errors Yêu cầu chỉnh sửa Nội dung chỉnh sửa - The use of the simple present tense in Further proof-reading is provided to the abstract is inappropriate because this avoid spelling, punctuation, grammar part briefly reports what has been done in mistakes/errors the research - Small Arab numbers should be used for numbering the chapters, not the Roman ones Chapter - Typos and errors in grammar, word choice, collocation which scatter all over the dissertation and its summaries (both English and Vietnamese) should be rectified before the final versions are sent to the library for reference - The frequent use of absolute Personal expressions or statements that expressions like “Obviously” (p 1, 4, sound more impartial and formal have 16…), “It cannot be denied” (p 3), been replaced “exceedingly (p 7), makes the researcher’s remarks subjective and not very convincing Some examples of Vietnamese doctor The examples have been checked and talk sound strange, for example: “Không, transcribed originally from the ngược lại í.” (p 32), “có thể tập thể Vietnamese corpus dục thể thao chút || tăng lượng can-xi.”, “có phải uống thêm thuốc chống thối hóa” (p 38) Some paragraphs should be broken into These technical errors have been checked smaller paragraphs (e.g the one on pages and changed and 10, the one on pages 19 and 20, the one on pages 131, 132, 133 some of them are two page long.) - Word choice in many places is problematic, which may cause confusion and misunderstanding (e.g page 7, 47, 48, 62, 63, 64, general percentage on page 92, shift of choice on page 93, identical on page 103, double on page 109, proportion on page 109, percentage on page 114, remaining on many pages) - Grammatical mistakes and expression issues here and there should be fixed (e.g page 47, page 72, page 75, page 81, page 82, 83, 86, 89, 130) LITERATURE REVIEW The literature review could include more This section was supplemented with previous studies on doctor talk in English some references (e.g the one by Belder and probably in Vietnamese, if there has (2013) on Power and Discourse of doctor been any The author could have added talk, the one by Ochsner (2010) Chapter Chapter review on previous studies relating to reviewing doctor-patient communication doctor-patient communication in English Other past research on the linguistic features of doctor-patient talk, for example, Swinglehurst (2014) that carried out a linguistic ethnographic analysis of patient record to assess authority display in the clinical consultation In reviewing previous studies related to More critical comments were provided to the research, the doctoral candidate rarely emphasize what has not been explored in commented on the gap in the field left by the reviewed study and what is the ‘gap’ the authors reviewed although the critical that the current study needs to thinking is a requirement for any doctoral contribution to the topic of interpersonal candidate communication in doctor talk THEORETICAL AND METHODOLOGICAL FRAMEWORKS The audio files of English and Some sample audio files have been Vietnamese recordings should be provided with the link addresses (see attached to the dissertation to show the more details in Appendices 3.1 and 3.2) real data to the reader in case they would As the data recordings are needed to be like to check something relating to the kept confidentially, the author of the corpora dissertation is not allowed to attach the files to the dissertation However, the audio files of the data corpus will be available to be examined under any inspection after research inspector(s) approve to sign the ethical commitment in research (see Appendix 3.4 for more details of the Ethical Commitment) DEPLOYMENT OF INTERPERSONAL RESOURCES Several figures (e.g Figure 4.1) show This figure is a combination of the bar line graphs indicating the number of graph and the line graph to describe words/clauses in English and doctor talk different units of comparison The bar and English patient talk This may cause chart is illustrated by percentages; confusion as line graphs are appropriate meanwhile the line graph is demonstrated for trends and changes of the same thing by numbers In order to combine the over time In this case, bar graphs would comparison, the researcher has to merge be a better choice these two issues of comparison into one figure As a result, it is impossible to mix two units of comparison into one with the bar graph only The explanation of most of the figures, As mentioned in the scope of the study, especially figure 4.1 should be clearer the current dissertation only focuses on lexico-grammatical resources of mood and modality to investigate the interpersonal features of the language doctors utilize at consultations in English and Vietnamese It narrows down the investigation of interpersonal meanings found 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 doctorpatient interaction Therefore, in most of the selected figures, the author of the current study only selects remarkable figures, instances and percentages that serve the comparisons of proportions and realisations of lexico-grammatical resources of mood and modality in English and Vietnamese More details of the figures were illustrated in appendices of chapter 4, from appendix 4.1 to 4.23 Especially, section 4.1 – Summary of the English and Vietnamese data corpus only provides the general information of the data corpus In particular, it shows how the balanced corpus is built up by the same criteria of six medical specializations It summarizes the number of words, clauses and the average number of words in a clause distributed in both of the doctor and the patient talk At this stage, the main aim is to provide the panorama picture of data corpus, not to Chapter Chapter compare the proportion or engagement of doctor and patient talk between the two languages Therefore, the information should be brief and coincide The aim is to prepare foundation for the detailed analyses of mood and modality resources that construct interpersonal meanings in the English and Vietnamese doctor talks presented in sections of the dissertation COMPARISONS OF INTERPERSONAL MEANINGS More discussions should be made to the The aim, the scope and the methodology impacts of the culture on doctor talks of the study serve well to show precise justifications In particular, to control the unbalance of the data corpus and to improve the validity and comparability of the data, the present study leaves out multiple modes of doctor talk in the two languages, particularly non-verbal resources which are considered as an important mean of interpreting politeness, power and authority in doctor talk The findings of the current study have avoided discussing on evidence of the cultural issues that create interpersonal meanings in doctor talk Also, it does not capture participants’ intonation and nonverbal behaviors which significantly contribute to research studies of natural communication It only focuses on lexical choices apparently occurred in doctor talk, especially comparing interpersonal meanings in English and Vietnamese doctor talks from two lexico-grammatical perspectives of mood and modality resources CONCLUSION In the conclusion section, implications of Some conclusions and implications imply the fact that lead to the differences that English doctor talk is inclined to between English and Vietnamese doctor politeness, equality, friendliness and talks informativeness might be down to the fact that these talks are scripted for educational purposes; the language used by the doctors can be idealized Chúng xin cam kết nội dung chỉnh sửa thực đầy đủ Cán hướng dẫn Chữ kí học viên GS Hồng Văn Vân Nguyễn Thanh Nga Thư ký Hội đồng Chủ tịch Hội đồng TS Huỳnh Anh Tuấn GS Nguyễn Quang ... Comparison of imperative uses 123 5.1.5 Comparison of interpersonal meanings of mood resources 129 5.1.6 Concluding remarks of comparisons of mood 139 5.2 Comparison of modality... MEANINGS 101 5.1 Comparison of mood resources 101 5.1.1 Comparison of subject uses 101 5.1.2 Comparison of declarative uses 108 5.1.3 Comparison of interrogative uses... Comparison of modality resources 140 5.2.1 Comparison of congruent modality 140 5.2.2 Comparison of incongruent modality 149 5.2.3 Comparison of interpersonal meanings of