A Pragmatic Study Of Doctor-Patient Oral Interaction In Outpatient Departments Of Chinese Hospitals

Based on the Corpus of Chinese Doctor-patient Clinical Interviews in Outpatient Departments under construction by the author, this dissertation adopts a pragmatic approach in the study of the various macro-aspects and micro-linguistic phenomena in doctor-patient oral interaction in the outpatient departments of Chinese hospitals, aiming firstly to explore the influence of doctor-patient role relationship, power relationship and other extra-linguistic factors upon doctor-patient oral interaction, and secondly to work out constructive proposals concerning the improvement of doctor-patient interaction, which will be expected to counteract upon the status quo of doctor-patient oral interaction and to contribute to the establishment of a new doctor-patient relationship characterized by equality, interactivity, and cooperativeness.The 4 general research questions of the dissertation include: what is the pragmatic status quo of the various macro-aspects and micro linguistic phenomena of Chinese doctor-patient oral interaction in outpatient departments? To what extent and how do doctor-patient role relationship and power relationship influence the pragmatic status quo of the various macro-aspects and micro-linguistic phenomena? What constructive suggestions can we make for doctor-patient oral interaction and doctor-patient relationship? What implications do the answers to the above 3 questions have for the various related linguistic theories?To elaborate on the above 4 general questions, we focus on 3 macro-aspects and 3 micro-linguistic phenomena of doctor-patient oral interaction in outpatient departments, the former including cooperation, politeness, and exchange structure in doctor-patient oral interaction in the outpatient departments, and the latter comprising confirmation-seeking questions used to elicit information in patient discourse, ao at the clausal end in doctor discourse, and interruptions in doctor-patient oral interaction.The dissertation is divided into 8 chapters.Chapter 1 first does a review of the contemporary research done on doctor-patient oral interaction both home and abroad, and then it gives a general introduction to the study in the following terms: the object of search and the language material, the specific research questions, a static analysis of doctor-patient role relationship and power relationship in China, the organization of the dissertation and the research procedure, and the significance of the research.Chapters 2 to 4 each focus upon one of the 3 macro-aspects of cooperation, politeness, and exchange structure in doctor-patient oral interaction in outpatient departments, and Chapters 5 to 7 each dwell on one of the 3 micro-linguistic phenomena of confirmation-seeking questions used to elicit information in patient discourse, ao at the clausal end in doctor discourse, and interruptions in doctor-patient oral interaction. The research in individual chapters follows a 4-step procedure: first, the research topic is put forward; secondly, a description and characterization is conducted of the macro-aspect or micro-linguistic phenomenon; thirdly, based on the asymmetrical role and power relationship between doctor and patient a tenable explanation is proposed for the result of the description and characterization; fourthly, based upon the conclusions reached at the second and third phases, proposals are worked out in terms of language for the improvement of doctor-patient interaction and medical practice, and the proposals are expected to counteract upon the asymmetrical doctor-patient relationship and the present medical practice, and ultimately to facilitate the establishment of a new doctor-patient relationship characterized by equality, interactivity, and cooperativeness. At the fourth phase, implications are put forward concerning various relevant linguistic theories.Chapter 8, as the concluding part of the dissertation, summarizes the conclusions from Chapters 2 to 7 from the following 5 aspects:Firstly, in terms of doctor-patient role and power relationship, we hold that the present asymmetrical role and power relationship is one of the major factors influencing doctor-patient interaction, and that doctors and patients not only adapt themselves to the asymmetry of role and power relationship but also are engaged in dynamic struggles for dominance and power, only that the adaptation is the mainstream and the struggles are merely the branches;Secondly, as to the influence of goal relationship upon doctor-patient oral interaction, we have found that the consistency of general goals between the doctor and the patient to some extent determines the overall adaptation of the two parties to the present asymmetrical role and power relationship, while the conflict resulting from the difference in minor goals between the doctors and the patient in a degree leads to the struggles for dominance and power;Thirdly, as an implication of the present research for doctor-patient interaction and doctor-patient relationship, we think that doctors should do their utmost to meet the patients' demand of telling about the disease and the symptoms and their need for core medical information, and respect the patients' right of relating to the disease and the symptoms and the right of informed consent, and that doctors should adopt various linguistic and non-linguistic strategies to invisiblize and weaken their vantage point in asymmetrical role and power relationship;Fourthly, for various related linguistic theories, this dissertation has the following implications: (1) The theory of linguistic hierarchy in Halliday's systemic functional grammar should be revised by including language structures over clause and clause complex in the part of language structure. To realize this, we first divide the 3 metafunctions each into an intra-clausal semantic component and a hyper-clausal semantic component, each semantic component being broken further into various semantic systems; then we decompose the part of language structure into 2 levels: the level of clausal syntax and the level of sentence groups (for written discourse or monologues) or transactions (for oral interaction), the former level realizing the intra-clausal semantic component of the metafunctions and the latter realizing the hyper-clausal semantic component. (2) Another insight put forward is the cancelability of primary illocutionary act by the addressee. (3) Revision is also done upon Labov's theory of A-,B- and AB Event.Fifthly, reflection is conducted upon the wide applicability of power analysis in pragmatic studies.At the end of Chapter 8 limitations of the dissertation are also pointed out.