Tag: Institutional talk

By Carrie Chan

As citizens, we must have had certain experience in medical encounters or interactions in our daily lives. In institutional talks like business meetings, doctor-patient talks and political interviews, ‘institution’, ‘discourse’ (language) and ‘power’ are interconnected and language serves as the ‘principal means by which organizational members create a coherent social reality that frames their sense of who they are’ (Fairclough & Wodak, 1997, p. 181). Besides, every participant in institutional talks possesses specific goal orientations in order to match with their social roles. However, we might not be aware of the fact that power asymmetry does exist during the interactions since linguistic resources are employed in the process to make the power differences seem ‘pre-inscribed’. In that case, we as patients are usually at a more ‘inferior’ position while the doctors are more powerful since they possess the professional knowledge in medical science.

In fact, in the realm of language and power, a combination of Conversation Analysis (CA) which studies talk-in interactions at a micro-level as well as Critical Discourse Analysis (CDA) which places the emphasis on describing, detailing and analysing linguistic features during talks could be used to help unfold the ‘generally hidden determinants’ during social interactions (Simpson et al., 2018). With these two methods, some common linguistic features that demonstrate the power asymmetry are found in doctor-patient interactions. They are ‘Topic control’, ‘Enforcing explicitness’, ‘Interruption’ suggested by Fairclough (1989, pp. 135-137) and a rhetorical device called ‘hedging’.

Topic Control

During the consultation, the doctor is usually the one controlling the sequences using a cycle of questions to elicit responses from the patient and the patients are bound to answer them. When answering these ‘closed’ questions asked by the doctors, the patients’ contributions are restrained since they are limited to say ‘Yes’ or ‘No’ or give brief responses.

Enforcing Explicitness

Patients as the less powerful speakers are usually asked to disambiguate the responses, explain with further details and make the ‘vague’ answers explicit. In order to cooperate and meet the social goals, the patients have to provide a clarification and be enforced to describe their conditions as requested by the doctors.

Interruption Interruption indicated by speech overlaps is also commonly found in everyday talks as well as doctor-patient interactions and it is somehow regarded as ‘normal’ and ‘natural’. For example, when a patient is making his turn or answering the doctor’s question, the doctor may interrupt without allowing him or her to finish the turn since the doctor knows what might be an ‘adequate’ answer for him to do the diagnosis.

Hedging

Apart from the above three devices, ‘Hedging’ is a linguistic device used by the patient where a mitigating word is used in the utterance to soften the tone or certainty (Brown & Levinson, 1987). Sometimes when patients are describing their conditions, words such as “I think” or “like” are used to hedge their speeches. Even though the patients possess the ‘superior knowledge’ about how they feel, they still choose to hedge the speech by uncertainty markers to downplay the certainty without ‘challenging’ the doctor whom they think possess professional knowledge in giving diagnosis.

From the above devices identified in doctor-patient interactions, it is shown that they serve as good examples that illustrate how power asymmetry is being ‘naturalized’ in institutional talks. Even patients possess ‘superior knowledge’ of how they feel, they would still align with the mainstream thinking that doctors are the more powerful figure during the interactions since they have professional recognition in medical science. Through critically picking out details from the above talk-in interactions, asymmetrical speaking rights, obligations and power differences in institutional talks could be brought to light.