| This thesis is intended to carry out a systemic functional research on the interpersonal meaning realized in Chinese doctor-patient conversations from the perspective of Mood system. Doctor-patient conversations refer to the dialogue between doctors and outpatients or outpatients’ families in the course of diagnosis and treatments. They are regarded as one of the two important approaches to treatment. Actually, they not only help to build good doctor-patient relationship but also help to treat disease.Byrne and Long started the research on doctor-patient relationship in the 1970 s. They published a book entitled Doctors Talking to Patients based on audio recording of 2,500 conversations between doctors and patients, in which they analyzed every phase of medical diagnosis and treatment in detail, and analyzed doctors’ behaviors thoroughly. Since then doctor-patient conversations as one kind of institutional conversation have attracted more and more attention, and a great deal of research on them have been done.Researches on doctor-patient conversations in foreign countries are plentiful. They are mainly carried out in descriptive and empirical ways from the perspective of sociology(especially conversation analysis) and linguistics. However, researches on doctor-patient conversations in China started late and up to now there only have appeared a few studies, concerning language skills, the influence of doctor-patient relationship on conversations and their language features, so lack in empirical studies is obvious.Doctor-patient conversations proceed information exchanges. Doctors’ questioning is the main mode to exchange information. They choose different modes of questioning in terms of different information acquirement, judgement on patients’ response and assessment of patients’ ability to reply. Systemic functional grammar embraces three meaning systems: ideational meaning, interpersonal meaning and textual meaning, which can be applied to discourse analysis, unveiling language features. Based on the theory of Mood system of systemic functional grammar, this study focuses on the construction of interpersonal meaning in doctor-patient conversations via the choices of Mood, especially the choice of interrogative Mood, modal particles and interpersonal metaphor. This research is expected to help to improve the doctor-patient relationship, and makes pertinent suggestions regarding how to achieve better communication between them.This study provides no account of factors such as gender, nationality, age, education. Data were randomly collected from conversations between doctors and outpatients in one hospital in China, which involve 11 clinical departments: four medical departments(neurology Department, Department of respiration, Department of gastroenterology, and cardiovascular Department), three surgical departments(hepatobiliary surgery, general surgery, and orthopedics Department), three specialist departments(dermatology Department, gynecology Department, and oncology Department), and the Department of Traditional Chinese Medicine. Altogether, 120 conversations(62,000 words) were recorded with a digital voice recorder, transcribed and analyzed thoroughly.The major findings of this study are as follows:As an institutional conversation,the doctor-patient conversations’discrepancy in Mood choice was obvious.(i)Declarative mood was doctors’favorite,especially unmarked declarative clauses.For marked declarative clauses,doctors were likely to use a modal particle such as“了(liao),哈(ha),吧(ba),啊(a),嘛(ma),呢(ne),噢(ao),''(sa),呃(e),哟(yo)”at the end of clauses,which could express their personal emotion and feelings.However,marked declarative clauses often expressed negative emotion and feelings,which resulted in the disharmonious conversations and bad communication.For patients,they mainly chose declarative mood in conversations,especially unmarked declarative clauses which resulted from patients’lower status.(ii)Although imperative mood was not mostly used in doctor-patient conversations,it displayed various pragmatic functions.The data show that unmarked positive imperative clauses were used far more frequently than other types of imperative clauses,moreover they were usually chosen at the phase of doctors’treatment(move 3).By contrast,marked negative imperative clauses were least chosen by doctors.Modal particle used at the end of the imperative clause included“了(liao),嘛(ma),啊(a),哈(ha),吧(ba),呃(e),噢(ao),哟(yo),呢(ne),好吗(hao ma)”.We also found that the frequency of using modal particles with strong tone was higher than that of using modal particles with mild tone.(iii)In this study,imperative clauses were classified as two main types:positive imperative clauses and negative imperative clauses.In addition,according to the strength of tone,positive imperative clauses were sub-classified as“commanding–requiring–suggesting–exhorting–asking-begging”,while negative imperative clauses were sub-classified as“forbidding–blaming–dissuading–reminding–comforting–begging”.The data unveil that the imperative clauses that doctors used most frequently were clauses expressing requiring and then came clauses expressing suggesting.(iv)Exclamatory mood was rarely chosen by both doctors and patients,because there were few chances for them to express their strong feelings with exaggeration in the course of exchange of information.The data reveal that it is a distinctive feature of doctor-patient conversations that the total frequency of using interrogatives is higher than that of using declaratives.(i) Yes/no interrogatives were mostly chosen by doctors regardless of medical department and phase of diagnosis. For the three major clinical departments including medical departments, surgical departments, and specialist departments, there was no obvious discrepancy among the choice of the three types of interrogatives, namely yes/no interrogatives, wh-interrogatives and alternative interrogatives. However, an obvious discrepancy existed in the Department of Traditional Chinese Medicine, where doctors favored the yes/no interrogative.(ii) Among the three subtypes of yes/no interrogative, namely interjection interrogatives(II), additional interrogatives(AI), and declarative interrogatives, that is, declarative clause with rising tone(DR), interjection interrogatives were mostly chosen by doctors, especially at the phase of doctors’ diagnosis(move 2); additional interrogative having the function of negotiation and softening mood were seldom chosen by doctors. As a kind of closed question, yes/no interrogatives narrowed patients’ chances of questioning or providing additional new information. The high frequency of using yes/no interrogatives makes the conversation cold, indifferent, and lacking of compassion.(iii) Wh-interrogatives were chosen mostly by doctors at the phase of diagnosis(move 2).(iv) The frequency of choosing any type of alternative interrogatives was a little low, and compound alternatives in particular. Comparatively speaking, doctors preferred to choose A-not-A interrogatives/repeating interrogatives, because the answers to A-not-A interrogatives /repeating interrogatives were more direct.(v) From the perspective of phase of diagnosis, doctors’ power was strongly embodied in the phase of treatment(move 3) when doctors rarely chose open-ended questions, and patients’ replies were narrowed.(vi) The frequency of patients’ choosing interrogatives was much lower than that of doctors’ choices. However, similarly patients mostly preferred to choose yes/no interrogatives while talking to doctors, and least to choose alternative interrogatives. That meant patients in doctor-patient conversations were powerless.An interrogative particle is not a necessary condition for interrogative mood but it is very important because it is one of the important means to realize interrogative mood.(i) In Chinese doctor-patient conversations, interrogative particles included typical interrogative particles “啊(a), 吧(ba), 呢(ne), 吗(ma)” and untypical interrogative particles “哈(ha), 噢(ao), 噻(sai), 哟(yo), 嘛(ma)”. Interrogatives with particle took almost half ratio of interrogatives chosen by doctors.(ii) Among all medical departments, the frequency of choosing interjection interrogatives was highest, which meant doctors were not willing to express their personal feelings but just asking for information. That resulted in the indifference between doctors and patients.(iii) Interrogative particles “呢(ne)” and “啊(a)” were chosen least by doctors in the phase of doctors’ treatment(move 3). Although interrogative particles can express certain feelings, the data as a whole show Chinese doctor-patient conversations sounded indifferent, rigid and impassive.Grammar metaphor is one important part in systemic functional grammar.(i) In Chinese doctor-patient conversations, tag questions performed four pragmatic functions: information reconfirmation, information inquiry, information emphasis and suggestion/requirement reduction. In order to confirm information, doctors chose tag questions to efficiently testify the validity of information. That was a polite way to confirm information. Doctors usually chose tag questions to acquire information at the phase of seeking for social-historical information(move 1) and phase of diagnosis(move 2). Tag questions with function of suggestion/requirement reduction were chosen by doctors to weaken the strength of tone and make conversations negotiable. In general, tag questions in doctor-patient conversations had the functions of making information inquiry in a mild way, emphasizing information and reminding patients.(ii) Rhetorical questions were rarely chosen by doctors and patients, for they often expressed negative feelings and would break good communication.Projection is also one significant approach to expressing interpersonal meaning. In Chinese doctor-patient conversations projection was not often chosen. However, when doctors chose projection in conversations, advice or proposition was subjectivized, which would enhance the force of negotiation between doctors and patients, and provided more opportunities for patients to give new information. Unluckily, doctors usually objectivized advice or proposition, which caused conversations to be inflexible, and sometimes caused patients to have to accept advice or proposal.To sum up, this dissertation has investigated on the construction of interpersonal meaning in Chinese doctor-patient conversations based on Mood system of systemic functional grammar. We found that doctors were in the leading position and possessed more power in conversations, but patients were usually passive and powerless, and played a supporting role in conversations. In order to enhance the efficiency of treatment and decrease medical disputes caused by bad communications, doctors must consider patients’ feelings and their psychological needs and learn appropriate language skills to achieve better communication. |
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