Confrontation and politeness strategies in physician-patient interactions

Abstract

The therapeutic success of physician-patient interactions depends in large part on how physicians interpret and respond to patients' implicit and explicit messages. Using a hypothetical vignette, in which a patient refuses to comply with a recommended therapeutic regimen, we found that first-year medical students with no classroom training in medical interviewing implicitly recognized that the situation called for face preserving or polite linguistic behavior. Ninety percent of them used culturally sanctioned politeness forms to repair the conversational breakdown depicted in the vignette. They responded to this clinical scenario, however, with linguistic behaviors borrowed from their everyday interactions, some of which were culturally appropriate, but not necessarily therapeutic. We suggest that students can learn to adapt their culturally appropriate behaviors and engage in therapeutic communication as physicians if they are given the necessary conceptual tools. We discuss how Brown and Levinson's theories of politeness and strategic language usage can (1) provide a framework for interpreting communication in general and physician-patient interaction in particular, (2) illuminate some of the problems inherent in doctor-patient encounters, and (3) be used prescriptively for teaching students and health professionals how to avoid some communication difficulties.

The management of embarrassment and sexuality in health care

“…This could be done, for example, by using vignettes in which students are asked to rate their degree of embarrassment, and to explore the imputed feelings of the different participants in the situation portrayed. As Robins & Wolf (1988 p. 218) state, attention to politeness and other theories borrowed from disciplines such as anthropology and linguistics, may help students to understand and modify their existing patterns of interaction, and learn new ones.…”

The management of embarrassment and sexuality in health care

“…This could be done, for example, by using vignettes in which students are asked to rate their degree of embarrassment, and to explore the imputed feelings of the different participants in the situation portrayed. As Robins & Wolf (1988 p. 218) state, attention to politeness and other theories borrowed from disciplines such as anthropology and linguistics, may help students to understand and modify their existing patterns of interaction, and learn new ones.…”

The Palgrave Handbook of Linguistic (Im)politeness

“…As Mullany (2009) points out in her introduction to the special issue on health and (im)politeness in the Journal of Politeness Research, "applying politeness research to health care communication" is a fairly recent but rewarding area of research within applied linguistics. Even when we include the studies she points to (Robins & Wolf, 1988;Lambert, 1995Lambert, , 1996Speirs, 1998;Grainger 2002Grainger , 2004Jameson, 2003;Norris & Rowsell, 2003;Delbene, 2004;Woolhead et al, 2006), add the six contributions in her 2009 special issue (Backhaus; Brown & Crawford; Graham; Harrison & Barlow; Mullany; Zayts & Kang), and take further sources into account, we can still concur with Mullany that "overall there is a real necessity for empirical investigations to be produced in a wide variety of health care contexts" (p. 1). In this chapter, we review some of the issues that transpire in the current research field and add observations of our own.…”

(Im)politeness in Health Settings

“…As Mullany (2009) points out in her introduction to the special issue on health and (im)politeness in the Journal of Politeness Research, 'applying politeness research to health care communication' is a fairly recent but rewarding area of research within applied linguistics. Even when we include the studies she points to (Robins and Wolf 1988;Lambert 1995Lambert , 1996Speirs 1998;Grainger 2002Grainger , 2004Jameson 2003;Norris and Rowsell 2003;Delbene 2004;Woolhead et al 2006), add the six contributions in her 2009 special issue (Backhaus; Brown and Crawford; Graham; Harrison and Barlow; Mullany; Zayts and Kang), and take further sources into account, we can still concur with Mullany that 'overall there is a real necessity for empirical investigations to be produced in a wide variety of health care contexts' (p. 1). In this chapter, we review some of the issues that transpire in the current research field and add observations of our own.…”

The management of embarrassment and sexuality in health care

“…This could be done, for example, by using vignettes in which students are asked to rate their degree of embarrassment, and to explore the imputed feelings of the different participants in the situation portrayed. As Robins & Wolf (1988 p. 218) state, attention to politeness and other theories borrowed from disciplines such as anthropology and linguistics, may help students to understand and modify their existing patterns of interaction, and learn new ones.…”

The Palgrave Handbook of Linguistic (Im)politeness

“…As Mullany (2009) points out in her introduction to the special issue on health and (im)politeness in the Journal of Politeness Research, "applying politeness research to health care communication" is a fairly recent but rewarding area of research within applied linguistics. Even when we include the studies she points to (Robins & Wolf, 1988;Lambert, 1995Lambert, , 1996Speirs, 1998;Grainger 2002Grainger , 2004Jameson, 2003;Norris & Rowsell, 2003;Delbene, 2004;Woolhead et al, 2006), add the six contributions in her 2009 special issue (Backhaus; Brown & Crawford; Graham; Harrison & Barlow; Mullany; Zayts & Kang), and take further sources into account, we can still concur with Mullany that "overall there is a real necessity for empirical investigations to be produced in a wide variety of health care contexts" (p. 1). In this chapter, we review some of the issues that transpire in the current research field and add observations of our own.…”

(Im)politeness in Health Settings

“…As Mullany (2009) points out in her introduction to the special issue on health and (im)politeness in the Journal of Politeness Research, 'applying politeness research to health care communication' is a fairly recent but rewarding area of research within applied linguistics. Even when we include the studies she points to (Robins and Wolf 1988;Lambert 1995Lambert , 1996Speirs 1998;Grainger 2002Grainger , 2004Jameson 2003;Norris and Rowsell 2003;Delbene 2004;Woolhead et al 2006), add the six contributions in her 2009 special issue (Backhaus; Brown and Crawford; Graham; Harrison and Barlow; Mullany; Zayts and Kang), and take further sources into account, we can still concur with Mullany that 'overall there is a real necessity for empirical investigations to be produced in a wide variety of health care contexts' (p. 1). In this chapter, we review some of the issues that transpire in the current research field and add observations of our own.…”

The management of embarrassment and sexuality in health care

“…This could be done, for example, by using vignettes in which students are asked to rate their degree of embarrassment, and to explore the imputed feelings of the different participants in the situation portrayed. As Robins & Wolf (1988 p. 218) state, attention to politeness and other theories borrowed from disciplines such as anthropology and linguistics, may help students to understand and modify their existing patterns of interaction, and learn new ones.…”

The Palgrave Handbook of Linguistic (Im)politeness

“…As Mullany (2009) points out in her introduction to the special issue on health and (im)politeness in the Journal of Politeness Research, "applying politeness research to health care communication" is a fairly recent but rewarding area of research within applied linguistics. Even when we include the studies she points to (Robins & Wolf, 1988;Lambert, 1995Lambert, , 1996Speirs, 1998;Grainger 2002Grainger , 2004Jameson, 2003;Norris & Rowsell, 2003;Delbene, 2004;Woolhead et al, 2006), add the six contributions in her 2009 special issue (Backhaus; Brown & Crawford; Graham; Harrison & Barlow; Mullany; Zayts & Kang), and take further sources into account, we can still concur with Mullany that "overall there is a real necessity for empirical investigations to be produced in a wide variety of health care contexts" (p. 1). In this chapter, we review some of the issues that transpire in the current research field and add observations of our own.…”

(Im)politeness in Health Settings

“…As Mullany (2009) points out in her introduction to the special issue on health and (im)politeness in the Journal of Politeness Research, 'applying politeness research to health care communication' is a fairly recent but rewarding area of research within applied linguistics. Even when we include the studies she points to (Robins and Wolf 1988;Lambert 1995Lambert , 1996Speirs 1998;Grainger 2002Grainger , 2004Jameson 2003;Norris and Rowsell 2003;Delbene 2004;Woolhead et al 2006), add the six contributions in her 2009 special issue (Backhaus; Brown and Crawford; Graham; Harrison and Barlow; Mullany; Zayts and Kang), and take further sources into account, we can still concur with Mullany that 'overall there is a real necessity for empirical investigations to be produced in a wide variety of health care contexts' (p. 1). In this chapter, we review some of the issues that transpire in the current research field and add observations of our own.…”