Page 274 - Handbooks of Applied Linguistics Communication Competence Language and Communication Problems Practical Solutions

252 Celia Roberts

with the patient or with the doctor but together they either talk past each other
or, in some cases, find other resources to repair and manage the interaction. Un-
surprisingly, doctors had difficulties with patients’ phonological differences,
prosodic features, particularly contrastive stress and assessing speaker stance,
and with grammatical and syntactical means of contextualizing. But the greatest
difficulties were with patients’ overall rhetorical style: with low self-display,
with structuring their information and with two inter-related features of topic
overload and overlapping/interrupting talk (Roberts, Moss, Wass, Sarangi and
Jones 2005).
Topic management was also one of the elements of doctor talk which, on dif-
ferent occasions, either produced or prevented misunderstandings (see also
Erickson and Rittenberg 1987). Rapid topic shift was a major cause of interac-
tional difficulties. By contrast strategies for topic involvement and fostering
chances of participation in which the patient could initiate the topic tended to
prevent or help repair misunderstandings (Moss and Roberts 2005).

7.2. Presentation of self and symptoms

It is a commonplace in the intercultural literature to find evidence of the illusion
of understanding and of awkward moments where there is no overt breakdown
but the sense of orderliness and the underlying rhythm of a typical institutional
encounter fails to be established or maintained. This is illustrated in the opening
phases of symptom telling where local English styles of self and symptom pres-
entation contrast with those used by patients whose dominant language is not
English. These issues and the next two examples are discussed in more detail in
Roberts, Sarangi and Moss (2004). There are three aspects to the initial self-re-
porting by patients: the description of symptoms, the context in which the symp-
toms occurred and the patient’s stance. By stance here we include both “affec-
tive stance” and “epistemic stance” (Ochs 1996).

Data example two
A young white woman who speaks a standard variety of English has brought her
toddler to the surgery to have his infected eye checked out.

01 D right so how can I help =you=
02 M =o:h= =erm=
03 D =I’m sorry= you’ve had to come
04 M oh it’s ok / (ı) I think he’s got conjuncti*vitis but =I’m not= sure
(.) hes had
05 D =oh dear=
06 M it since la:st (0.5) he had a *gummy eye this side but {[ac]when he was
born that was quite *gummy so I tolerated it}(.) then it *travelled to this