Page 275 - Handbooks of Applied Linguistics Communication Competence Language and Communication Problems Practical Solutions

Intercultural communication in healthcare settings 253

one and got {[dc]progressively worse (0.5) over the weekend we were in
Germany for a wedding so }= =
07 D = =oh right (nice time)
08 M yeah it was good
09 D ok
10 M erm it went *red underneath *there and *red just a*bove
11 D right
12 M {[dc]and it’s been very *gunky}
13 D mm= =
14 M = = {[ac] [lo]as you can see I’ve sort of left it (.) erm }= =
15 D = =so this is for how many days now

Through her use of prosodic features, the mother focuses on the symptom and
puts in the background the child’s history of such infection. She does this by
putting emphatic stress on key syllables “conjunctiVITis”, “GUMmy”, “RED”
and so on and by speeding up her utterance at 6 when giving some of the back-
ground detail and then slowing down when she returns to the symptoms later in
turn 6 and 12. The repetition “red” and the rhythmic stress in this turn and the
next when she refers to the “gunky” eye reinforces the display of symptoms as
the most important information. This enables the doctor to attend to the presen-
tation of symptoms, and the rest can be put in the background.
By making the child’s symptoms the focus of her opening turns, and the con-
text and stance the background, this patient aligns herself with the GP and the
medical model which she expects the GP to be working with. Since both doctor
and patient share the same cultural resources for making meaning, in this case
the same use of prosodic features to contextualise this phase of the consultation,
the indirect messages conveyed in these contextualisation cues are readily inter-
pretable by the GP.
The mother’s epistemic stance is a subtle blend of the agentive – she “toler-
ated” the gummy eye but also somewhat deferential – “I’ve sort of left it”. The
patient’s mother presents her “moral self” as a caring but not overly anxious
mother who does not want to over treat her child and she interweaves this moral
self with the medical model of symptom giving. As shown above, this is partly
accomplished through her prosodic management of the opening report.
Patients whose expert language is not English face linguistic, pragmatic and
rhetorical problems. Pragmatic and linguistic difficulties do not necessarily pre-
vent such patients from managing the rhetoric of routine self-presentations.
However, many patients talk about their problems with resources which are
both linguistically and rhetorically different from those of the doctor.
In the next example, the patient focuses not on her symptoms but her inabil-
ity to cope with them. She is an elderly woman of South Asian origin whose first
language is Gujarati.