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Статья поступила в редакцию 02.11.24
УДК 8.81
Asadchaya M.A., student, Kazan State Medical University (Kazan, Russia), E-mail: [email protected]
Gorbunova D.V., senior teacher, Kazan State Medical University (Kazan, Russia), E-mail: [email protected]
THE COMMUNICATIVE PATTERNS FOR ESTABLISHING RAPPORT IN DOCTOR-PATIENT INTERACTION. The paper presents results of a study of professional medical discourse in doctor-patient interaction. The purpose of the study lies in the identification of communicative patterns relevant for a doctor to establish rapport with a patient at the medical appointment. The research materials are represented by educational videos in English illustrating the doctor's appointment, taken by the accredited medical schools. The performed analysis has shown that one of the key non-verbal means of establishing rapport is active listening. Verbal means are expressed by open-ended questions, leading questions, encouraging phrases, expressions of acceptance and understanding, as well as paraphrasing and clarification. The phrases extracted from the video materials are subdivided into four groups according to the stages of the patient-orientated communication model: establishing contact, orientation, argumentation, and correction. The research materials may be of use for researchers addressing the issues of professional medical discourse, medical practitioners, and medical students aspiring to improve the level of professional foreign language communicative competence.
Key words: professional communication, medical discourse, interpersonal interaction, communicative competence, empathy, speech strategies of doctor, medical rhetoric, dialogical communication
М.А. Асадчая, студентка, Казанский государственный медицинский университет, г. Казань, E-mail: [email protected]
Д.В. Горбунова, ст. преп., Казанский государственный медицинский университет, г. Казань, E-mail: [email protected]
КОММУНИКАТИВНЫЕ ПАТТЕРНЫ ДЛЯ УСТАНОВЛЕНИЯ РАППОРТА ВО ВЗАИМОДЕЙСТВИИ ВРАЧА И ПАЦИЕНТА
В статье представлены результаты исследования профессионального медицинского дискурса на материале коммуникации в диаде врач - пациент. Цель исследования заключается в выявлении коммуникативных паттернов, значимых для установления раппорта во взаимодействии врача и пациента. Материалом исследования послужили англоязычные обучающие видеоматериалы, иллюстрирующие приём у врача. Проведённый анализ показал, что основным невербальным средством установления взаимопонимания является активное эмпатическое слушание. Вербальные средства выражены вопросами открытого типа, наводящими вопросами, поощрениями, выражениями принятия и понимания, парафразированием и уточнением. Фразы, извлечённые из видеоматериалов, были распределены на четыре подгруппы, согласно этапам пациент-ориентированной коммуникативной модели: установление контакта, ориентировка, аргументация и корректировка. Материалы исследования могут быть полезны исследователям, занимающимся вопросами профессионального медицинского дискурса, практикующим медицинским работникам и студентам медицинских вузов, желающим повысить уровень профессиональной иноязычной коммуникативной компетентности.
Ключевые слова: профессиональная коммуникация, медицинский дискурс, межличностное взаимодействие, коммуникативная компетенция, эмпатия, речевые стратегии врача, речевое поведение врача, диалогическое общение
The relevance of the study lies in the fact that doctor-patient communication is the core of the therapy. The proper approach to communication ensures increasing the integrity of outpatient and inpatient care, correlating with patient satisfaction, which has a direct impact on their well-being. The communication barrier was shown to be the major cause of misunderstandings, complicating interpersonal interaction and leading to medical errors [1].
The purpose of the study is identification of communicative patterns in doctor-patient communication as the rapport-building means, which can be used by medical professionals when interacting with English-speaking patients.
The aims of the study: (1) to consider the nature and role of effective communication at the medical encounter as the foundation of the doctor-patient relationship; (2) to review the professional communication phases based on the Calgary-Cambridge model; (3) to identify verbal and non-verbal communication means used by doctors to develop rapport with patients and demonstrate empathy.
The study materials are represented by the scripts of educational video materials from accredited medical schools. A set of methods was applied, namely, deduction and induction, contextual analysis, conversation analysis, generalisation, and structuring.
The scientific novelty of the study lies in the doctor-patient conversation analysis based on the video materials illustrating the Calgary-Cambridge model of the medical interview.
The scientific and practical significance of the study consists in clarifying the verbal and non-verbal communication means aimed at creating rapport with a patient at the medical encounter and presenting the structured set of phrases, which can be of help for the medical professionals when communicating with the English-speaking patients.
According to the Calgary-Cambridge model for structuring the medical interview, there are several phases ensuring doctor-patient communication to be effective, namely the contact phase, orientation, argumentation, and correction. [2].
Contact phase. Interaction begins immediately from the moment the doctor enters the office or ward. At this stage, a doctor greets a patient, offers to take a seat, and identifies patient's complaints. At the same time, the patient begins to evaluate the doctor not only through open dialogue but also through the nonverbal signals and cues (i.e. appearance; body language and posture; kinesics - gestures; proxemics - the use of space in interpersonal communication; paralinguistics - the tone and pitch of voice, intonation, etc.). Therefore, the humanistic personality traits, the good manners, and professional demeanour agreeable to ethical standards are of vital importance. These factors contribute to creating a comfortable environment for the patient in order to facilitate further communication.
The orientation phase. At this stage, the doctor takes the medical history. It is important to focus on listening to the patient's complaints, worries, and expectations without judging or interrupting them. it is recommended to apply the active listening techniques and encourage the patient to continue talking. It pursues two purposes: to express the doctor's care and empathy, and to gain as much information as possible to ensure the correct diagnosis. In other words, the focus of this stage is on understanding the patient, rather than on responding.
The argumentation phase. It involves an open dialogue between the doctor and the patient. The doctor may ask clarifying questions in order to gather necessary details, analyze, and hypothesize for planning further treatment. When interacting with patients, it is essential to maintain a polite and sensitive approach, ensuring that questions are framed correctly in order to prevent misunderstandings. It is important to keep a balance between formal and informal communication style taking into account personal factors and the communicative context.
Correction phase is final and includes making a diagnosis, prescribing medications, giving recommendations, and explaining the course of treatment as well as some aspects of his condition to the patient. At this stage, the doctor needs to express confidence and to ensure that the patient fully understands the information provided and is ready to follow recommendations. It is done by getting the feedback from the patient and by answering any questions that may arise, reformulating, and then explaining again.
Thus, to ensure the doctor-patient relationships are based on trust, professional communicative competence of a doctor ought to be at the highest level. Trust-based relationship in doctor-patient dyad are known to be essential for successful treatment and rehabilitation, and minimization of the occurrence of medical errors. Psychological support and empathy, which means the ability of the physician to understand the patient's inner experiences and perspective, a capability to communicate this understanding, are ones of the core factors of establishing trust. Body language and para-linguistic features run like a red thread through all the communication phases at the medical appointment. As regards verbalization of psychological support, the forms are also quite diverse [3; 4].
At the second research stage, educational video materials by the accredited medical schools were chosen and the video scripts were analysed [5-8]. The analysis allowed us to summarize the communicative patterns in therapeutic interaction, and to identify the key expressions and phrases used for establishing rapport with a patient. The results were categorsed according to the Calgary-Cambridge model communication phases, described above.
The contact phase. The analysis of the video has shown that the first stage of medical interview follows in two general sub-stages: greeting and identification of the request.
At the greeting sub-stage, the physician welcomes the patient, introduces himself clarifying his role, and invites the patient to take a seat in case it is an outpatient appointment. Talking with the inpatient or providing that the patient is already sitting when the physician comes in, the latest should ensure they are on the same height and sit beside them to establish eye-contact. It is also important to determine the appropriate form of address, even if the patient's name is already noted in the medical card.
In terms of language, the following patterns appear to be universal:
- Greeting. [formal]Goodmorning/afternoon/evening; [informal]Hi...
- Introduction and clarification. My name is... I'll be/1 am your doctor today.
- Invitation. Please, take a seat.
- Addressing a patient. It must be (patient's name), is that right? Would you prefer Mr/Ms/Mrs (second name) or can I call you (first name)? it's nice to meet you.
Identification of the request. Before the doctor starts collecting anamnesis, it is essential to identify the main patient's concerns and to clarify any other relevant issues. So that, the doctor's goal is to encourage the patient to focus on the reason of his/her visit and formulate the complaints. It is done by asking the open-ended questions:
- How can I help you today?
- What's brought you in today?
- Can you tell me why you're here today?
- Anything else besides ... that you want to address here?
The orientation phase is aimed at history taking. Whether it is the admission to the hospital or the outpatient appointment, the hospital environment is generally associated with stress and worries, what has an impact on the psychological state of patients. The polite and empathetic manner of a doctor is a must in decreasing the level of unease at the appointment.
At this stage, the doctor's speech contains indirect questions with modal verbs. It represents respect for the patient's autonomy. Moreover, the topic of conversation might be sensitive, or the patients might not like to disclose some information, not seeing the direct link between their health issue and the question the doctor asks. Indirect questions help to redirect the patient to the necessary details. The examples include the following:
- Would it be okay if I took some notes?
- Can/May I ask a few questions...
- Could you tell me...
- I would like to talk a little bit more about...
Active listening is at the heart of history taking, as it gives the patient a sense of feedback from the doctor, encouraging to share the concerns and expectations. Active listening is expressed through both verbal and non-verbal communication means. In the video under analysis, the following body language and paralinguistic features are applied: non-verbal affirmations like keeping an eye contact, nodding or using facial expressions, etc; avoiding distractions; producing non-lexical conversation sounds or interjections like 'uh', 'um', 'ah ha', 'yeah'. The verbal means of active listening represent the patient-centred responses:
- Encouraging: (1). It's okay. (2) That's fine/great.
- Expressing understanding: (1) I understand you. (2) I see what you mean.
- Acknowledging feelings: (l) That sounds really bad. (2) It sounds like it's really impacting your life.
The argumentation phase suggests the doctor checks his hypotheses related to the patient's condition and makes an initial diagnosis. The communicative patterns revealed in our analysis are represented by clarifying questions, eliciting the patient's perspective, summarizing and paraphrasing.
While at the orientation stage, the doctor should avoid domination in conversation, at the argumentation stage it's reasonable to reroute the dialogue to the aspects the specialist finds significant to make an accurate diagnosis. Moreover, there is the possibility that patients may by chance miss out information that is why clarifying questions prevail at this stage.
- Tell me, please, are you allergic to anything?
- Do you have any medical conditions I should be aware of?
- If I can just ask a little bit more about when the pain started?
- Do your symptoms get worse when.?
- Can you tell me anything that makes it better?
- If you had to rate on a Pain Scale where zero being no pain and 10 being the worst pain you ever had.
Active listening remains to be at the core of conversation. Recognising that patients may experience discomfort when answering certain questions, it is necessary to provide a supportive and understanding environment.
- Acknowledging emotions: I know it's a bit embarrassing to talk about...
- Encouraging elaboration: (1) Don't worry, it's okay. (2) You can tell me everything that bothers you.
- Gratitude statements: (1) Thank you for telling me that. (2) I'm glad you told me that.
To maintain a cooperative model of the doctor-patient interaction, it is worthwhile to enquire about the patient's thoughts on what is happening. For this purpose, general and special questions are used, as well as an invitation to speak up.
- Do you know what it's due to?
- What do you think could be the cause?
Tell me, what you think, the problem is?
- I'd like to get your perception of what you think is going on.
To avoid mistakes when taking medical history, it is of key importance to check the patient's comprehension of the diagnosis and some diagnostic aspects, the treatment and management of their condition, the administration and prescriptions given by the doctor. Verbally, it is done by:
- Paraphrasing: (1) Let's make sure I'm hearing you correctly. (2) So, going back into the history again, have you said...?
- Summarizing: (1) Let me summarize to make sure I've got everything straight. (2) Let me just summarize what's been happening...
The correction phase implies the doctor explains the patient the next steps for diagnosis and discusses the treatment options. It is important to ensure that the patient understands everything clearly and to address any questions or concerns they may have. The doctor should also deal with any misunderstandings in order to prevent mistakes in treatment.
- I think initially we'll [probably run some blood tests]...
- It will be okay if our next step in a diagnostic will be...
- I understand your concerns, but this procedure is important for us because..
- Don't worry, I'll explain...
- Do you have any questions about the treatment?
- It is important for me to make sure that you understand everything clearly.
After discussing the options, it is crucial to conclude the conversation by providing the patient with clear instructions and expressing gratitude for their time. This will help to ensure that the patient feels supported and informed throughout the therapy process.
- I'm grateful for the trust you placed in me.
Библиографический список
- Thank you for your time. If you have any further questions, please do not hesitate to contact us.
- I'm sorry, I have to go. I'll be there if you need a help.
In the conclusion, it is important to emphasise that the medical practitioner should always take into account the vulnerability of the person dealing with the condition and seeking medical attention. The state of patients may vary depending on the severity of the symptoms and the condition, but generally, each medical appointment or admission to the hospital is associated with stress and worries to some degree. It is indisputable that both mental and physical states influence the process of recovery and overall wellbeing. Ethically and humanistically, the profession of a doctor does not tolerate a mechanical approach to treatment, which prioritises the condition first. It is the interpersonal interaction that is the heart of medicine. That is why the personal qualities of the medical practitioners are an integral part of their professional competence and expertise.
Communication between the doctor and patient is essential for successful medical history taking, accurate diagnosis, and treatment. As the patient's trust in a doctor is a core of effective professional communication, building rapport with a patient is one of the key initial aims. The interaction based on the patient-orientated communication model focuses on avoiding mistakes, increasing patient satisfaction, and enhancing their experience in the hospital despite feeling unwell.
The research allowed us to clarify the professional communication strategy at the medical encounter and to identify verbal and non-verbal communication means and conversation patterns, which can be of use for the medical practitioners working with the English-speaking patients, medical students learning English for professional communication, lecturers and researchers exploring the issues of the professional medical discourse.
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Статья поступила в редакцию 05.11.24
УДК 8Г272.12
Istomina E.M., senior teacher, postgraduate, South Ural State University (Chelyabinsk, Russia), E-mail: [email protected]
NATIONAL AND CULTURAL SPECIFICICS OF THE RUSSIAN-LANGUAGE POPULAR PSYCHOLOGY DISCOURSE. The article studies a concept of discourse and various approaches to its comprehension, and also states some features that characterize the discourse of popular psychology as the discourse of a social institution. The objective of the study is to identify the national and cultural specificity of the Russian-language discourse of popular psychology via identifying precedent phenomena specific to the Russian culture. The linguistic and cognitive approach, a continuous sample method and discourse analysis method are used in the research. The study reveals that therapists tend to turn to precedent phenomena of all types in their texts which demonstrates that the discourse of popular psychology has acquired some specificity of the Russian culture. Most of the identified precedent phenomena relate to the field of fiction. This fact indicates the literature-centrism of the popular psychology discourse and, consequently, the literature-centrism of the national worldview.
Key words: discourse of popular psychology, therapeutic turn, institutional discourse, country-specific component, presupposition, precedent phenomenon, national precedent phenomenon, literature-centrism
Е.М. Истомина, ст. преп., аспирант, Южно-Уральский государственный университет (НИУ), г. Челябинск, E-mail: [email protected]
НАЦИОНАЛЬНО-КУЛЬТУРНАЯ СПЕЦИФИКА РУССКОЯЗЫЧНОГО ДИСКУРСА ПОПУЛЯРНОЙ ПСИХОЛОГИИ
В статье рассматривается понятие дискурса и различные подходы к его пониманию, а также отмечается ряд особенностей, характеризующих дискурс популярной психологии как дискурс социального института. Целью исследования является выявление национально-культурной специфики русскоязычного дискурса популярной психологии через специфические для отечественной культуры прецедентные феномены. Исследование проводилось с позиции лингвокогнитивного подхода методом сплошной выборки из корпуса текстов онлайн-журнала и последующего дискурсивного анализа. Проведенное иссле-
