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Intercultural communication in healthcare settings 255

opposite them. As a result openings become protracted and harder work inter-
actionally. Doctors may make judgements about patients based on a style of
self-reporting that does not meet the doctor’s expectations. Patients become
labelled as “difficult” or “passive” and these labels become social facts. These
facts constructed out of the discourse of patient–healthcare professionals, can
also lead to generalisations and stereotypes in the backstage work of healthcare
encounters (Roberts,Sarangi and Moss 2004).

8. Backstage work

As with the health professional–patient communication, the relatively little
work by socio- and applied linguistics on backstage work has not focused on in-
tercultural communication. Meetings (Cook-Gumperz and Messerman 1999),
doctors’ rounds (Atkinson 1995), interaction in operating theatres (Pettinari
1988) as well as talk, for example, in medical laboratories are all backstage
work where the teams reflect the diverse multilingual nature of western urban
societies. However, linguistic and ethnic diversity is rarely the focus of attention
except in educational and selection processes where issues of disadvantage, lan-
guage and indirect racial discrimination are increasingly matters of concern.
These issues can manifest themselves in subtle ways. For example, Erickson’s
case study of an African-American inexperienced doctor presenting a case to his
white preceptor (experienced attending doctor) shows how “racial” tension is an
implicit resource which the young doctor uses to distance himself from the
black “street” patient. But in so doing he uses a more formal medical register
than is expected between two medical colleagues and so may come across as in-
sufficiently socialized (Erickson 1999).
The preparation, training and assessment of ethnic minority healthcare pro-
fessionals, particularly those educated and/or trained overseas, raises questions
about the adequacy and fairness of these high-stake intercultural encounters. A
recurrent theme is the gap between medical knowledge and socio-cultural
knowledge. Both aspiring healthcare professionals and their educators and as-
sessors tend to overemphasize medical knowledge and down-play or remain un-
aware of the socio-cultural knowledge which constructs these encounters. This
is the case with healthcare workers in Canada (Duff, Wong and Early 2000),
with professionals subjected to language testing in Australia (McNamara 1997)
and in the London-based research projects which end this paper.