Page 271 - Handbooks of Applied Linguistics Communication Competence Language and Communication Problems Practical Solutions

Intercultural communication in healthcare settings 249

tail of how conversational inferences are made and conversational involvement
is sustained in ethnically and linguistically heterogeneous communities. Differ-
ences in communicative background enter into talk and affect how interpre-
tations are made. Ways of talking are not separated from the socio-cultural
knowledge that is brought along and brought about in the interaction or how so-
cial identity leaks out into the interaction through talk; for example, how to
manage the moral self in consultations, what are allowable topics, how to struc-
ture an illness narrative; how direct to be in self-presentation or how to manage
turns at talk with the professional. At a micro level, language and socio-cultural
knowledge influence choice of words and idioms and a range of prosodic fea-
tures, including intonation and rhythm. These are the “contextualization cues”
(Gumperz 1982) which help to frame each phase of the consultation and channel
the interpretive message of either professional or patient. Where these styles of
speaking and conventions for interpreting the other’s talk are not shared, mis-
understandings frequently occur. Differences in communicative style can not
only lead to overt misunderstandings but also to difficult or uncomfortable mo-
ments and to some of the small tragedies of everyday life (Levinson 1997); for
example, if patients do not get access to scarce resources. Patients may be any-
where on a continuum of language ability in terms of lexico-grammatical accu-
racy, pragmatics and discursive strategies (Ali 2003). Patterns of language dif-
ference are situated and contingent rather than absolute and systematic, so:
“We need to be able to deal with degrees of differentiation and … learn to explore
how such differentiation affects individuals’ ability to sustain social interaction and
have their goals and motives understood.” (Gumperz 1982: 7).

7. Patients with limited English and doctors in general practice

This final section is based on a series of studies drawn from a research project
based at King’s College London. The video data illustrated below form part of a
corpus gathered for a programme of research on patient–family doctor interac-
tions: Patients with Limited English and Doctors in General Practice: Education
issues (the PLEDGE project), which used interactional sociolinguistic methods
to explore how general practitioners (GPs) and patients negotiate meaning and
collaborate to manage, repair or prevent understanding problems. 20% of the
232 video-recorded consultations were with patients from non-English speak-
ing backgrounds or patients with a culturally specific style of communicating
and featured frequent and profound misunderstandings.
Patients from these backgrounds ranged from those who had considerable
difficulty conveying even their literal meaning, while others were more fluent,
but have culturally different styles of communicating, influenced by their first
languages.