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Effective communication and interpersonal skills have long been recognized as fundamental to the delivery of quality health care. However, there is mounting evidence that the pressures of communication in high stress work areas such as hospital emergency departments (EDs) present particular challenges to the delivery of quality care. A recent report on incident management in the Australian health care system (NSW Health, 2005a) cites the main cause of critical incidents (that is, adverse events such as an incorrect procedure leading to patient harm), as being poor and inadequate communication between clinicians and patients. This article presents research that describes and analyses spoken interactions between health care practitioners and patients in one ED of a large, public teaching hospital in Sydney, Australia. The research aimed to address the challenges and critical incidents caused by breakdowns in communication that occur between health practitioners and patients and by refining and extending knowledge of discourse structures, to identify ways in which health care practitioners can enhance their communicative practices thereby improving the quality of the patient journey through the ED. The research used a qualitative ethnographic approach combined with discourse analysis of audio-recorded interactions. Some key findings from the analysis of data are outlined including how the absence of information about processes, the pressure of time within the ED, divergent goals of clinicians and patients, the delivery of diagnoses and professional roles impact on patient experiences. Finally, the article presents an in-depth linguistic analysis on interpersonal and experiential patterns in the discursive practices of patients, nurses and doctors.

This study was designed to establish the specific communicative function of both low (L*) and high (H*) pitch accent onsets with high rising tunes (HRTs), earlier established as a feature of Australian English. The data consisted of the dialogues of four female and four male adolescent speakers who were recorded while participating in the Map task. The discourse analysis involved the application of Pierrehumbert & Hirschberg's compositional theory of tune meaning. The study appears to support key aspects of Pierrehumbert & Hirschberg's theory: the results show overwhelmingly that the speakers used high (H*) pitch accents with new information and low (L*) pitch accents with information that was already part of the speaker and hearer's mutual beliefs. The findings suggest that the individual tones in a HRT each contribute to the overall meaning of an intonation contour, and that a close examination of intonation features within a developing communication context is crucial to understanding intonational meaning.

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There is an increasing recognition internationally of the critical impact of communication within healthcare. The link between ineffective communication, patient dissatisfaction and critical incidents is well established. Family Planning New South Wales (FPNSW) has sought to address patient-centred care and communication in its policy platform. This article reports on research conducted within FPNSW, which analysed the discourse features that constituted effective doctor-patient 1 communication in sexual and reproductive health consultations. The principal aim of the research was to understand how effectively messages were conveyed and received and to what degree patients were active participants in their own sexual healthcare. Analysed consultations were characterised by extremely high levels of communicative competence on the part of the doctors who integrated medical expertise with the development of interpersonal relationships with patients, thus positioning patients as active contributors to the consultations and to decisions about their ongoing treatment. The detailed linguistic analysis identified characteristic features of patient-centred communication that are essential to patient-centred care. These interactions demonstrate that communicating care is just as important as delivering care and involves a drawing together of the medical and the interpersonal in consultations. The article details strategies for interweaving medical knowledge and establishing rapport that can inform practitioner communication practices across different healthcare contexts. KeywordsClinical consultations, communication strategies, discourse of sexual health, family planning discourse, healthcare communication, linguistic analysis, medical discourse, patient-centred healthcare, reproductive and sexual health, research Discourse & Communication 9(3)information sessions to clinic staff, outlining the aims and methods of the project. These were followed by three days of non-participant observations of the clinic at work, over a range of shifts.Ultimately, interviews of between 30 minutes and one hour were conducted with eight doctors, six senior management staff, one clinical nurse and the head receptionist. Focus groups were also conducted with five doctors, four senior managerial staff and one clinical nurse. Both interviews and focus groups asked participants to reflect on the role of communication in FP consultations and on how they incorporated the FPNSW model of patient-centred care into their interactions with patients. All interviews and focus groups were audio-recorded and transcribed.Twenty doctor-patient consultations were filmed and transcribed. Nurse consultations were not included in this research, nor were consultations where a trainee health professional was present. Post-consultation interviews were conducted with participating doctors and patients. Patients were also given a short take-away questionnaire that invited them to add additional comments after later reflection. Participating doctors were also offered t...