Page 272 - Handbooks of Applied Linguistics Communication Competence Language and Communication Problems Practical Solutions

250 Celia Roberts

The research looked at the potential for, and occasions of misunderstandings
and awkward moments where the conditions for shared interpretation between
patients and doctors cannot be created. The studies include: misunderstandings
which occur when doctors fail to understand patients (Roberts et al. 2005),
when the misunderstandings are caused by doctors and when both sides try to
prevent and repair misunderstandings (Moss and Roberts 2005). We have also
looked at phases in the consultation, for example, the opening phase (Roberts,
Sarangi and Moss 2004) when differences in self-presentation can set the con-
sultation off on the wrong footing.
Intercultural consultations challenge much of the received wisdom about
good communication skills in the healthcare literature. The topsy-turvy, “look-
ing glass” world of such consultations suggests that “patient-centred” models
(“patients want their feelings elicited”) and the idea that more talk is likely to
mean less misunderstanding (“ask open questions”) often do not work and even
cause more confusion when talk itself is the problem. Communications research
and textbooks argue that doctors should engage more with patients but in the
PLEDGE data attempts to do so by the doctors through social chat and extended
explanations were often closed down by the patients (Roberts, Moss, Wass, Sar-
angi and Jones 2005).

7.1. Problems with patient-centredness
Data example one
In the following example, a young mother from Somalia has brought her baby
daughter to see the family doctor because she has been suffering from diarrhoea.
At this stage in the consultation, the doctor has already taken a brief history
from the patient’s mother and, before examining the baby, has asked her some
initial questions about breast feeding her:

1 D little bit (.) right so you’re virtually stopped (.)
2 so what sort of questions have you got in your mind for me today (.)
3 what do you want me to do
4 (ı)
5 P mm no: =she say=
6 D =today=
7 P eh: the lady she say if you want to contacting doctor eh:
you want eh: talk him
8 D yeah= =
9 P = =I say yes I am happy with e- with =you=
10 D =right= right ok= =
11 P = =because (.) definitely when I am coming with you
12 when I go back I will go back happy