A Study of Politeness Strategies Adopted in Pediatric Clinics in Taiwan

Abstract

Drawing on Brown and Levinson's (1987) politeness theory, this study investigates the communicative interaction behaviors of physicians, patients, and patients' parents in pediatrics in Taiwan. Thirty outpatients and six senior physicians from three different levels of hospital participated in the study. The analysis results indicate that most of the communicative politeness strategies used in pediatrics are bald-on-record, direct, and non-redressed. In addition, physicians adopt a higher percentage of bald-on-record and negative politeness strategies than patients. In contrast, patients' parents use more positive politeness and off-record strategies. These results indicate that while physicians display lower levels of politeness and often communicate directly, patients' parents express more supportive opinions and adopt more indirect communication strategies. The results reveal a preference for efficiency in pediatric clinics, with physicians adopting a dominant role in the communication process. These results also demonstrate an inherently asymmetric power balance between physician and patient. Our findings indicate the presence of several commonly seen politeness strategies and dialogue patterns that encourage greater self-awareness and self-observation for physicians and patients, leading to more effective communication in the clinical context. Finally, also discussed are the possible influences of Chinese culture such as face work, harmony, and power.

Experiences and perspectives related to shared decision-making among outpatients with degenerative joint disease in Taiwan: a qualitative study

“…Patients showing respect to physicians was noted to be a common reaction during the interviews in this study. This characteristic of Taiwanese communication has been described in a relevant study: valuing harmony, avoidance of conflict, and respect for professionals and authority 43. In Asian culture, physicians warrant respect because of their high socioeconomic status and authority; respect toward physicians may also be extended to the treatment options they recommend.…”

“…This characteristic of Taiwanese communication has been described in a relevant study: valuing harmony, avoidance of conflict, and respect for professionals and authority. 43 In Asian culture, physicians warrant respect because of their high socioeconomic status and authority; respect toward physicians may also be extended to the treatment options they recommend. This is the reason that patients and their families do not challenge the decisions of physicians.…”

“Is there any way I can get something for my pain?” Patient strategies for requesting analgesics

“…Patients in our study were typically meeting their providers for the first time, but patients may be more or less motivated to employ face-saving politeness strategies with providers with whom they have a long-term relationship; plausible arguments can be made in both directions. Although politeness theory has been mobilized to analyze a variety of clinical interactions, 37,38,51,52 further work is necessary to elucidate the application of our findings to pain encounters outside of the ED. Second, patients who declined to be in the study may have been more likely to request analgesics directly than those who agreed to be recorded.…”

“…For example, in a Taiwanese pediatric setting, parents adopted more off-record strategies and commonly demonstrated support for physicians' statements before raising a concern of their own. 34 …”