Page 266 - Handbooks of Applied Linguistics Communication Competence Language and Communication Problems Practical Solutions

244 Celia Roberts

care practitioners or psychologists (Ong, DeHaes, Hoos and Lammes 1995). In
comparison, the output from linguistics has been small. Candlin and Candlin
(2003: 135) with reference to the major applied and sociolinguistic journals re-
mark that “one finds the occasional paper, but no real sense of ongoing commit-
ment to the health care communication field”. Only a very small fraction of
these thousands of articles are focused on intercultural communication (Skel-
ton, Kai and Loudon 2001).

3. Difference as “cultural”

The research traditions of medical sociology and sociolinguistics, although not
focused on ethnic notions of interculturality, conceptualize the health profes-
sional–patient encounter as one of difference in which the medical system is
characterized as “a cultural system” (Kleinman 1988). The different perspectives
and knowledge structures about, for example, AIDS or genetics, and managing
social relations are broadly intercultural in that professionals and clients/patients
are seen as voicing different world views (Mishler 1984). The sociolinguistic lit-
erature on healthcare settings has looked at inequalities in medical discourse
(Freeman and Heller 1987), and healthcare generally (McKay and Pittam 2002)
asymmetrical power relations (Ainsworth-Vaughn 1998, Wadak 1997) and how
they are co-constructed in consultations (ten Have 1995) and, in particular, the
gendered nature of such relations (Fisher 1995; West 1984), as well as social
class (Todd 1984), the discursive representation of health and illness (Fisher and
Todd 1983; Fleischman 2001; Hyden and Mishler 1999); and how different
medical conditions shape the discourse of the consultation (Hamilton 2004).
The sociologically based studies of the consultation share with intercultural
communication studies a concern with inferential processes and the potential
for miscommunication which can feed into more structured social inequalities
in healthcare. Cicourel (1983) examines the miscommunication when doctor
and patient have different belief structures about the cause of an illness (see also
Tannen and Wallet 1986). He argues that much of the misunderstanding that
arises out of diagnostic reasoning stems from tacit clinical experience and from
everyday understanding that is presumed to be shared knowledge. Similarly,
Atkinson (1995) and Silverman (1987) drawing on seminal work on the ritual
aspects of the consultation, analyse the powerful discourses that determine the
patients’ treatment.
As well as the cultural differences between health professional discourse
and the lifeworld discourses of the patient, there are increasing tensions and
instabilities between professional discourses and the wider institutional dis-
courses of healthcare organization, as new types of communicative genres come
into being (Iedema and Scheeres 2003; Cook-Gumperz and Messerman 1999).