Page 273 - Handbooks of Applied Linguistics Communication Competence Language and Communication Problems Practical Solutions

Intercultural communication in healthcare settings 251

13 D ((laughs)) I hope so
14 P because I will look to see you and your doctor K (.)
15 I like it
16 D good= =
17 P = =[cos] when when I come in will come in the you know ((tut))
18 when I go back my home I’m happy
19 D right
20 P ((laughs))
21 D so you want me to- (.) check her over

At line one the doctor uses a number of contextualization cues to show that she
is about to shift topic from discussing breast feeding. She pauses, uses the dis-
course marker “right” and sums up the patient’s contribution. She then moves to
a new frame, at line 2, to eliciting patient’s concerns in classic patient-centred
mode. The mother may well have missed the lexical and prosodic contextualiz-
ation cues which mark the shift in topic and this exacerbates the difficulty in
processing the questions in lines two and three. But the main difficulty seems to
be that she cannot interpret the shift in frame marked by these open questions.
She responds with a negative and then refers to the “lady” (probably the recep-
tionist) and how she is happy to see this particular doctor. This is the beginning
of a narrative account about coming in to see the doctor rather than an analytical
account of her concerns. She then reformulates her perception of the doctor
twice more. This repetition of how she likes this doctor and her colleague seems
to shift the topic from the question she asked the receptionist (about seeing the
doctor) to some general display of satisfaction. This may be because she is un-
certain how to take the doctor’s elicitation and/or because she sees it as cul-
turally appropriate to praise her. This is not the footing which the doctor had an-
ticipated in which the patient is offered a more equal social relationship with the
doctor in indicating her concerns. The doctor’s responses at lines 10, 16 and 19
are markers of possible change of frame rather than receipt tokens, particularly
“right”. However, the patient orients to them as the latter and on three occasions
reiterates her positive evaluation of the doctor. When there is again a minimal
response from the doctor at line 19 “right”, the mother gives up on her praise
and laughs, marking the closure of this unsuccessful attempt at patient-centred-
ness. The doctor then speaks for the patient in line 21, thus undermining her
original attempt to be patient-centred and shifting back to a more orthodox
frame in which she pushes on with the next phase of the consultation (Roberts,
Sarangi and Moss 2004).
Misunderstandings, as this example shows, are multi-causal and jointly ac-
complished: contextualization cues fail to be read; socio-cultural knowledge
about patient roles is not shared and neither side has the appropriate linguistic
resources to repair the misunderstanding. The origin of the problem may lie