This section highlights doctors’ strategies for enhancing rapport from four interrelated domain of RMM and uncovers pragmatic effects achieved through the doctors’ speeches. The performance of speech acts, including a range of various components, can be rapport-enhancing or rapport-threatening[53]. An patient who refuses to follow the doctors’ advice with excuses posed a challenge or threat for the doctor-patient consultation process and treatment results. In the face of such rapport-threatening behaviour, a doctor often adopts rapport management strategies along with rapport-enhancing behaviour to promote health care delivery. In this connection, the study first extends this line of research by analyzing the doctor-patient rapport in these four domains and explores their rapport management strategies for effective communication and better health outcomes.
5.1 Illocutionary Domain
Compared with other domains, most research space is devoted to the illocutionary domain[49]. The illocutionary domain, first drawn heavily by Brown and Levinson[53], concerns the rapport-threatening or rapport-enhancing implications of performing speech acts. The illocutionary domain covers widely, such as apologies, requests, compliments, gratitude and so on[46]. The appropriate handling of speech acts is crucial for the establishment of harmonious communication relations[54]. In typical health-care settings involving a doctor, a patient, and their utterance, there are many kinds of acts in various domains of RMM. Doctors in our study show a preference to construct rapport through compliments and joking. According to previous studies, compliments typically have a positive effect on interpersonal relations by offering support or approval[55]. For instance, as indicated in Extract 1, the doctor gave his compliments on the patient’s physical fitness in a general health check.
Except 1
|
1．
|
D:
|
平时这个走路啊腿酸麻胀痛吗?
Do you feel painful or aching and tingling or numb when you walk?
|
|
2．
|
|
(1.5)
|
|
3．
|
P:
|
不疼
No, not really.
|
|
4．
|
D:
|
不疼吭现在还能出去遛弯吗?
Um. Can you still go out for a walk now?
|
|
5．
|
|
就这八十多了=
Since you are over eighty=
|
|
6．
|
P:
|
=还能溜这溜啊还能太极呢
=I often stroll around the neighborhood and play tai-chi.
|
|
7．
|
|
啥事没有不用拐杖
I’m fine without crutches.
|
|
8．
|
D:
|
=那那那很好啊(hhenhh)
=It’s cool(hhenhh)
|
|
9．
|
|
您这是宝刀未老啊
You are really a treasure knife which does not age.
|
|
10．
|
|
行行啊没事
Okay, okay. It’s all right.
|
|
11．
|
P:
|
好啊
Yippee.
|
|
12．
|
D:
|
昂
Well.
|
|
13．
|
|
(0.3)
|
|
14．
|
|
你现在现在整体状况整体状况很好啊
Your overall situation is really good.
|
|
15．
|
C:
|
°是吧 °
°I think so°
|
|
16．
|
D:
|
他现在呢就是主要就是这个就是到了这个年龄啊↑
Now, he has aged into eighty.
|
|
17．
|
|
就是出去遛弯:
So, it is especially important to take care of him while out for walks:
|
|
18．
|
|
(1.0)
|
|
19．
|
|
注意防止摔倒.
Look out for falls and fall prevention.
|
|
20．
|
|
以后出去啊一定拿着呃拿着拐杖=
Never leave home without a waking aid, a crutch=
|
|
21．
|
P:
|
=拐杖(hhenhh) =
=The crutch (hhenhh)=
|
|
22．
|
D:
|
=对对对
=Exactly! No doubt about it!
|
|
23．
|
|
一定拿着拐杖
Make sure to take a crutch
|
|
24．
|
|
(1.0)
|
|
25．
|
P:
|
那拐着怕丢人
I am afraid of losing face and embarrassing myself
|
|
26．
|
|
(.)
|
|
27．
|
D:
|
呃#你这八十多了呵呵:你这八十多岁了你:
Um#You are over eighty:come on, you are over eighty years old!
|
|
28．
|
|
要是腿磕一下
If got a nasty crack on the leg
|
|
29．
|
|
还敢不拿拐杖吗(hhenhh)
Dare you not take a crutch(hhenhh)
|
|
30．
|
|
虽然还有另外一条腿呢
Although you still have another strong leg
|
|
31．
|
|
但是咱也不能学丹顶鹤啊(hhenhh)
You can't live like a red-crowned crane(hhenhh)
|
|
32．
|
P:
|
哈哈哈(hhenhh)
Ha ha ha(hhenhh)
|
|
33．
|
|
放心吧一定照做=
Don’t worry. I will do that.
|
|
34．
|
D:
|
=哈哈哈(hhenhh)
Ha ha ha(hhenhh)
|
Compliments in medical consultation are frequently used to enhance the mutual understanding among participants and strengthen emotional exchanges for the preparation of further communication[56]. In Extract 1, the patient has a regular health check and the medical report shows that he is in the better physical state compared with older adults of same ages. Here, the doctor responds by first affirming the patient’s fitness at this age, and second, by expressing his compliments to the patient’s statement that he still plays tai-chi (an internal Chinese martial art) despite being over eighty and there is no need to use the crutch, and then by producing an assessment of his capability to walk (‘It’s cool(hhenhh)’;line 7). In the opinion of the patient, he wants to be want to be appreciated by such a physical condition, which marks the need of respectability face. In terms of the patient’s extrovert personality and desires, the doctor soon responds with an idiom (‘You are really a treasure knife which does not age’;line 8) as a way of compliment. This idiom, derived from the Chinese ancient literature called Romance of Three Kingdoms, refers to the old people who still have the stimulus and capability of participating in activities like they did in the past. It is prevalent in the Chinese society and has seen ages of constant use[57]. This idiom not only play a social function of improving the patient’s confidence but show consideration for the patient’s respectability face. Note, in line 10, the patient immediately exhibits an acceptance of physicians’ words (‘Yippee’), indicating a good mood and his preference to receive the doctor’ further affirmation rather than concoct excuses. As a continuation of the conversation, the doctor repeats compliments using different expressions (‘Your overall situation is really good’; line 13). At this time, the patient also provides a positive assessment about his own health as illustrated in line 14. In Extract 1, It becomes evident that the patient takes equal part in the relationship and maintains rapport in the follow-up consultation. As Wolfson stated, one of the function of compliments is to encourage the desired behavior[58]. Older patients are expected to be occupied with their improved mental and physical state. The calling for respectability face from this patient extends to the degree of congruence between judgments of his condition, including his physical fitness. Since compliments can be identified as face-threatening, the doctor performs appropriate words instead of the highly exaggerated compliment content to establish the common ground with this stubborn patient and reach the rapport goal.
Another related sub-category of rapport-enhancing behavior is joking. Joking, as a part of humor, finds a natural home in conversation. The joking activity, a double-edged sword, plays an important role in rapport management. Joking is expressed in specific terms that refers to specific people[59], such as doctors, nurses and patients and their identifies in the medical setting. Hospitals are shrouded with constant pains and complaining, increasing the likelihood of exhaustion[60]among healthcare workers and patients. Therefore, medical consultations are in great need of joking strategies to enliven patients and create a joyful atmosphere. Except 1 exemplifies a sequence of talk with a joke. Upon seeing the patient’s embarrassment upon using a crutch and excuses(line 25), the doctor realizes that he should help the patient to feel at ease and assure the patient that crutches are not stupid (line 27). In accordance with earlier studies, on similar occasions, many physicians prefer to perform rapport-sensitive speech acts, including requests or orders[61], to encourage better communication. However, the doctors’ orders are usually laded with power and position[62], which might threaten equity rights and even arouse irritation or annoyance. In this particular case, the physician in Extract 1 presents the importance of using crutches in a humorous and relaxing way by joking, which is rarely discussed in the past. The breadth of usage of joking is demonstrated in many ways, including greeting or leaving-taking, introducing new topics or participants, relieving tension, covering embarrassment, and filling in awkward moments[63]. Since the patient feels embarrassed and has no actual recourse to handle these feelings, the aim of a joker, that is, the physician here, is to produce positive reactions, burst the embarrassment bubble, dissolve excuses, and establish the positive rapport. For the physician in Extract 1, powerless in the face of his obdurate patient, humor, like joking, might be one of rapport-building ways to cope. Generally speaking, patients are less often the target of jokes than symptoms; if jokes are about patients, it is more often those who have “brought on their own medical problems”[64]. The joking targets at the high risk of crack on the patient’s legs and patient’s resistance against crunches. The physician first points out that the the serious consequence is the lost of one leg with laughing in line 28. The laughing could be interpreted as a way to release the built-up tension. After that, the physician makes exaggerations that the patient would possibly become “a red-crowned crane” (line 30) which often stands on only one leg if he falls down and still refuses to use crunches. Through this act the doctor hands the decision-making power to the patient himself, which is the equity placement. ,The patient is subsequently shrieking with laughter, and further confirms that he follows the physician’s advice to use crunches in line 32. To respond with patient’s feedback, the physician laughs with cohesion (see equals sign in line 32 and line 33). They have joint laughing since they finally get a release from this talk and manage the rapport appropriately without frustration and annoyance. In this extract, the doctor and the patient who carry out different acts have different degrees of “cost and benefit”. Equilibrium has been calibrated through joking and laughter in a light-hearted way. As a result, the achievement of equality rights and a good rapport comes naturally. Overall, the doctor uses compliments or joking to help the patient feel confident that he would not lose face if he walks with a crutch. The impromptu use of an idiom leads to a change of the patient’s attitude towards crunches, and laughter also helps to decrease the patient’s anxiety. Both compliments and joking in the illocutionary domain have an underappreciated benefit of resolving communication problems, carrying implications for interpersonal relations and offer helpful insights into rapport management strategies.
5.2 Discourse Domain
The production and understanding of the discourse domain derives from discourse structures[65], such as topic choice and management, the sequence organization of information. Among studies the sequence organization is of primary importance because social interactions are characterized by a sequential occurrence of social actions[46]. In medical settings, the sequence organization flows from the concern with the doctors’ strategies towards the patient’s feedback. Analyses of sequences in this study indicate that storytelling is commonly used in consultations, serving as the rapport-building “lubricant”. In new patient visits, when patients display their own understanding of symptoms, the floor is yielded allowing physicians to check diagnostic x-rays and other factors that may contribute to the symptoms. However, patients are least cooperative with treatment recommendations[66]when they desire more treatments than they receive from physicians and often make excuses to stick to their earlier life styles. In Extract 2, a patient adopts the active resistance to negotiate for a new treatment that is in line with her own thoughts.
|
1．
|
D:
|
血压高啊你看都160了
Your blood pressure is up to 160 now.
|
|
2．
|
|
(1.5)
|
|
3．
|
P:
|
不高啊就是偶尔才160
It’s as high as 160 only sometimes.
|
|
4．
|
D:
|
hh.你走路的时候脚疼不疼啊=
hh. Feet hurt when walking?
|
|
5．
|
P:
|
=而且我早上起来、午睡后、晚上睡前测得都正常啊
Numbers are normal when I checked in the morning, at noon and before bedtime.
|
|
6．
|
|
就是看到白大褂紧张了
It is you in the white coat that leads to the higher number.
|
|
7．
|
D:
|
哈哈哈哈
(laughing)
|
|
8．
|
|
(4.0)
|
|
9．
|
P:
|
我脚::我脚上贴着膏药.
Feet::Plaster cast on my feet.
|
|
10．
|
D:
|
哦贴着膏药哈,因为我一看你的膝盖好像有点变形啊
Whoa, plaster cast. It seems that the knee shape has changed.
|
|
11．
|
P:
|
我感觉还行啊
I feel good.
|
|
12．
|
D:
|
你这个大姨就是说-如果啥的话想治的话:
Aunt, I mean-if you want to heal the knee injury:
|
|
13．
|
|
你得查一下,
It’s better to check the cause in detail.
|
|
14．
|
|
我妈也是这样=
My mom had the same condition=
|
|
15．
|
|
=后来拖着就不行了哎
=It dragged on and finally did not pull through.
|
|
16．
|
|
孩子是疼在心里也是没辙了
My heart aches but there is really no way.
|
|
17．
|
P:
|
哎
So sorry.
|
|
18．
|
D:
|
我作为孩子辈实在见太多这种例子了
I have seen too many cases as a child and doctor.
|
|
19．
|
|
吭::就特别你这个膝盖,我因为我-你一进来-我看到膝盖变形了.
ow::your knees are particularly..because I see its crooked shape as soon as you walked in.
|
|
20．
|
|
还是尽快做个核磁共振看看吧
It’s better to have MRI as soon as possible.
|
|
21．
|
|
你看前面几个身体不如你都好了
Several are not as good as you, and all fully restore to health.
|
|
22．
|
|
身子骨能好得更快
You will recover sooner.
|
|
23．
|
|
医保也能报销啊
The health insurance also covers it.
|
|
24．
|
P:
|
行吧
Okay.
|
|
25．
|
D:
|
提前治.不然到后期啊你要再变形再-然后再厉害了
Early intervention works. Otherwise, it will become more serious later.
|
|
26．
|
|
你难受孩子也心疼啊
Your child also feel distressed when you are sick.
|
|
27．
|
|
到时候就得-换-换膝盖了
knee replacement is the choice when it is far worse=
|
|
28．
|
P:
|
=吓人啊那肯定很疼啊
That's so scary and painful.
|
|
29．
|
|
行我就听你的！
Fine, I follow your treatment plan.
|
As illustrated in line 5, the patient begins her explanation by a gentle presentation of her normal blood pressure, and then proceeds to ascribe her irregular blood pressure to the doctor’s white coat (line 6), which is called white coat hypertension[67]. Clearly, this explanation aims to free herself from whole responsibility for the uncontrolled high blood pressure. The doctor senses that the time of spotting her explanation may not be precisely right, and that their rapport may be at risk. So, instead of giving an authoritative response explicitly, the physician laughs to rectify this awkward situation in line 7. Afterward, their talk grounds to a halt, lasting for 4.0s. Here, a challenge for the doctor, accordingly, is to assure the patient receives timely and appropriate treatment within a harmonious rapport. After the awkward silence, the patient first mentions her plaster cast on the feet (line 9), answering the doctor’s previous question about foot pain (line 4). This sudden change in topics interrupts the physician’s thinking. Besides her words, the doctor turns to look her from feet to knees, and her crooked shape of knees catches the physician’s attention. The doctor takes this moment to point out the crooked knees, which is likely an underlying symptom of high blood pressure. Note, despite direct dissuasion, the doctor appeals to little authority, and this speech act actually prevents potentially negative consequences and is a set up for a harmonious rapport. It is supported by the patient’ s indirect response showing no resistance and only repeating her physical condition. So far in this sequence the doctor gains an accurate understanding of her “literally hard mouth”, and decides to use storytelling as the strategy. In order to make his emotive involvement interpretable to her, the doctor skillfully tells a fact-based story through inclusion of personal topic (line 14) about what happened to his mom. The story’s climax are not delivered in a neutral tone or manner. Rather, it is reinforced by the doctor’s sharing of his mother’s physical suffering (line 15) and its experience of powerlessness and helplessness although he is a physician (line 16). Practically, the story happened to doctor’ mother is the marked cue that is possibly more or less a continuum of the patient. This marked realization of the story is more noticeable in comparison to other persuasion. Besides, empathy is often created along with storytelling, serving as the engine of rapport management[68]. It is clear that from the patient’s voice that the doctor’s empathy is fairly consistent, as she signs with sadness in a tense, pressed voice. Later the doctor describes her knees’ crookedness (line 19) and recommends the magnetic resonance imaging (MRI) as a treatment in line 20. Storytelling proceeds to introduce cases of recovered patients and the doctor assures she can even recover sooner under treatments. In subsequent consultations about the high cost of magnetic resonance imaging, the doctor informs that MRI is already covered in the free public healthcare. When the patient answers “okay”, it is seen that her antipathy is relieved, avoiding stirring up any potential rapport-threatening consequences. Even so, the patient still does not agree with the doctor’s treatment in a direct way. In this case, shortly afterwards the doctor encourages the patient to weigh up different options between early intervention and more painful symptoms (line 25) in accordance with previous history takings. Concomitantly, the patient displays with astonishment and affiliative agreement of the painful experience in a high pitch register(see line 28 and excalmatory mark in line 29). The doctor thus receives the patient’s permission for further medical treatment. In Extract 2, the articulation of other patients’ stories, and the process of putting words to the experience by physicians allow patients to position themselves as insiders and even allies to these stories. It is not only the verbal storytelling that boosts the emotional involvement but also the skill that the doctor repeats the pain feeling even in more or less the same descriptions. In sharing stories, physicians open others’ lives to scrutiny and critique, and patients therefore understand own positions and have reflexivity throughout the treatment. Based on patient feedback, storytelling is effective for acquiring emotional information[69]and heightening emotive involvement when patient challenges the rapport. Through the interpretation of empathy and emotion involvement in the story, the rapport is established and built even it is challenged at the beginning of consultations. When the doctor provides advice not matching in the patient’s affectivity and thoughts, the storyteller therefore upgrades the displays and rendering of emotions, thus creating opportunities for the patient to play an active role in the rapport.
5.3 Participation domain
Compared with other domains, the participant domain receives limited attention regarding RMM. It deals with the procedural aspects of interchanges[46]that have unlimited contexts. A key aspect of the participation domain is the inclusion and exclusion of people present. The participation in medical consultations refers to the joint efforts from doctors and patients who exchange information, share medical expertise, build a enhanced rapport and ultimately make health-related decisions together. In fact, medical treatment satisfaction and control over patients' health are closely associated with doctors’ participation. As evidenced in the following data, doctors’ participation plays a significant role in rapport management and treatment acceptance, particularly when patients engage in rapport-challenging behaviors. For instance, in Extract 3, an elderly patient with high blood pressure visits a doctor for the first time in the department of cardiology.
|
1．
|
D:
|
如果不吃药啊,很危险.
No drugs will definitely put you into danger.
|
|
2．
|
P:
|
这这这十盒药都要三百啊
But..but..but a ten-box supply of medicines costs three hundred Yuan
|
|
3．
|
|
长期吃哪行啊
No, it is not allowed to eat it for a long time.
|
|
4．
|
D:
|
是是不过大姨咱们吃国产的一样啊
Yes, I know it is a burden. But domestic drugs have the same curative effect.
|
|
5．
|
|
只要能降压就行
As long as it can lower your blood pressure.
|
|
6．
|
|
吭,脑溢血就麻烦了.
This time, however, it could all go wrong with cerebral haemorrhage.
|
|
7．
|
P:
|
我还是挺正常的,就这两年
I am fine in recent two years.
|
|
8．
|
D:
|
吭大姨作为大夫来说,你整体很好.
Ahh. I could give you a a clean bill of health.
|
|
9．
|
|
咱现在条件好,咱不是说没钱啊,每个月拿着这么多退休金
We have a good living condition now. You also enjoy the sufficient pension.
|
|
10．
|
|
咱得好好活着啊.多看看小孙子小孙女啊
Live your life. Spend more time with your grandchildren.
|
|
11．
|
|
不能说我不把这个东西当回事儿,
You cannot disregard for life.
|
|
12．
|
|
大姨你说,我高的时候一百五,
As you say, its only one hundred high.
|
|
13．
|
|
我低的时候一百三十多,这个就不用管了.
It is only one hundred and thirteen low and therefore we can dispense with it.
|
|
14．
|
|
你就不用吃药了.
Then you don’t have to take medicine.
|
|
15．
|
|
但是你现在是什么问题啊,
But the point is that,
|
|
16．
|
|
高的时候一百六七了,这就不行了.
the blood pressure is as high as one hundred sixty or seventy. It’s risky.
|
|
17．
|
P:
|
也是啊,俺还要看小孙女嘞
Well, I'm blessed to watch my granddaughter grow up.
|
|
18．
|
|
身体不能不行.
Fitness is foremost.
|
In Extract 4, an senior patient with cerebrovascular diseases have a consultation with a physician after the thorough physical examination.
|
1．
|
D:
|
对对对,因为您这个年龄啊,咱一定要睡眠质量好
Oh, yeah, yeah. Must ensure you get enough good-quality sleep.
|
|
2．
|
|
不然的话,咱这个心脑血管儿这个疾病的风险=
Otherwise, the risk of cardiovascular and cerebrovascular diseases is=
|
|
3．
|
P:
|
=我去年吃安定了感觉没事了啊
=I ate some antipsychotic last year and that’s fine.
|
|
4．
|
D:
|
啊对对对,你吃安定这不是个长[法儿
Yes, yes. Antipsychotic is not a long-term solution.
|
|
5．
|
|
安定吃多了还会骨折啊
Antipsychotic could cause fractures.
|
|
6．
|
|
这个年纪可摔不起啊
You can not afford to fall down at this age.
|
|
7．
|
P:
|
也是啊一把年纪了
Well, I am getting on a bit now.
|
As shown above, both patients refuse to follow their physicians’ treatment advice at first, attempting to challenge their harmonious rapport (see line2 and line 7 in Extract 3, line 3 in Extract 4). Patients’ words imply their belief that they should not be unduly controlled or imposed upon treatment recommendations. This kind of behavioral expectations vary in some respects, including the compromise of patients’ thoughts in this setting. However, it is obviously not really ethical and this act goes against doctors’ duties and responsibilities. The direct medical advice is inherently face-threatening, and doctors should select appropriate rapport strategies to mitigate the face-threat and hence be polite. In Extract 3. the doctor first deals with issues of concern by prescribing alternative medicines in line 4 and mentions the same pharmaceutical effect even the patient uses the medicine with lower prices. Then, the doctor position the patient as the skipped-generation grandparents to demonstrate the significance of companionship with her grandchildren. For the majority of Chinese older people, they are much emotionally closer to their grandchildren than to their own children. Therefore, the doctor’s persuasion is sure to be emotionally touching because the patient will probably accept the advice in order to spent more time with children. In Extract 4, the doctor mentions the serious consequences of taking anti psychotic over long periods of time and highlights that the patient is of a certain age now. Considering his age, the patient finally accepts the doctor’s professional advice and moves on towards his later life. In both extracts, after the doctors’ participation, patients demonstrate more active attitudes as well as greater commitment to health care activities. The patients’ involvement in consultations, coupled with the physicians’ participation, draws a circle of rapport. It is evident that from the above conversation that doctors devote large efforts to rapport management due to patients’ rapport-challenging behaviors. The doctors’ participation, as a dynamic process, goes beyond giving professional medical advice, displaying empathy and strengthening the therapeutic alliance. Instead, it comprises a range of patient-centered rapport strategies, such as generating a variety of opportunities for mutual gain, offering a number of options and rendering emotions. In other words, however conscientious a physician might be, if he cannot associate himself with a patient and establish close rapport, his capability is going to be impractical. In general, a mutually trusting and respectful rapport is a hallmark of the joint participation, especially the doctors’ participation, in which patients accept timely medical treatments and doctors have higher job satisfaction as well as raised self-esteem. When patients disregard the presence of doctors’ treatment advice to shatter the rapport, it is the doctors’ participation that cures both diseases and their rapport.
5.4 Stylistic domain
Within the stylistic domain, three key components are typically discussed, including choice of tone, use of genre-appropriate lexis and syntax, use of genre-appropriate honorifics and titles. In spite of the fact that researchers generally agree on the importance of stylistic domain, it is still generally discussed from the patients’ perspective instead of the doctors’ perspective. Gradually, the role of genre-appropriate honorifics or titles in medical consultations comes to be known in pragmatics[70]. In this study, the major rapport-building strategy identified within this domain is the choice of appropriate titles, demonstrating esteem, courtesy or respect. During patient-centered consultations, doctors usually greet with patients at the openings, establishing the concordance as well as rapport connection. An appropriate titles in greeting makes a great first impression, and this simple act helps both participants find their niches and grow into their roles. The titles with a high frequency and/or wide range of occurrence across the data are the “laoshi”(老师in Chinese, laoshi in pinyin), “auntie” (大姨in Chinese, dayi in pinyin) and “uncle”(大叔in Chinese, daye in pinyin). The polite title “auntie” here, refers to the oldest maternal aunt or the sister-in-law. In Extract 6, the doctor starts a motivated sequence by calling an elderly female patient as auntie, as the confirmation of her status. In this way the doctor absorbs the patient into his own circles and asks her for the medical and surgical history smoothly. It then comes as a pleasant surprise that the patient in the follow-up shows continuous cooperation including compliance with prescribed regimens, which reflects the rapport function of polite titles. The line down to the right represents the hidden content which is not vital for the analysis here.
|
1．
|
D:
|
来,大姨坐到凳子上.
Come on, auntie, seat down please.
|
|
|
2．
|
P:
|
哦,好:::
Ah, fine:::
|
|
|
3．
|
|
(4.0)
|
|
|
4．
|
P:
|
谢谢啊,
Oh, thank you.
|
|
|
5．
|
D:
|
行,大姨.
Okay, auntie.
|
|
The title “uncle” performs the similar function but different meanings, referring to the father's elder brother or uncle. In Extract 7, the patient sometimes feels numbness, pain and tingling in legs, and therefore comes to this hospital for treatment recommendations. The doctor goes up to greet the patient calling him “uncle”, allowing the patient to perceive himself as a full participant with attachment and closeness at the beginning. “The first blow is half the battle.” Naturally, the general interrogation starts in an unruffled way and a accomplished rapport naturally with ease.
|
1．
|
D:
|
来,大叔坐到凳子上.
Come on, uncle, seat here please.
|
|
|
2．
|
|
(清嗓子)
(clear throat)
|
|
|
3．
|
|
(4.0)
|
|
|
4．
|
|
平时有手麻或者头晕吗?
Have you usually experienced hand numbness or dizzy?
|
|
|
5．
|
P:
|
没有.
Nope.
|
|
|
6．
|
P:
|
好好,谢谢.
Alright, thanks.
|
|
|
7．
|
D:
|
哎,没事儿.
That's no problem.
|
|
The doctor in Extract 7 lays low to call the male patient as “uncle” with an attitude of respect, which boosts the patient’s status and narrows the psychological distance. The middle section of this consultation consists of a thorough history and physical examination, which minimizes his risk of serious illness. The use of “uncle”, stretching through this consultation, is exhibited by the physician without thinking about it. As part of the final treatment, the patient shows less anxiety regarding his symptoms and acceptance of non-prescription drug at prescription strength. With these speech acts involving titles, this patient engages in the consultation with a positive mindset, establishing a good rapport and eliciting better treatment outcomes. In general, the extension of kinship, including the above titles, socializes the non-kin patients into a family relation. Use by the doctor of these titles introduces more politeness into the interpersonal dynamics and promote greater harmony in the rapport. The third title is the “laoshier” in Chinese pinyin. As a dialect, it serves as a title going beyond the meaning of “teacher” in English. It was once regarded as a title of respect for teachers, and gradually grows into a term referring to individuals who impart knowledge or have qualities others should learn from[71]. As a gender neutral title, it is commonly used to call individuals of any professions in central Shandong, especially when asking unfamiliar people to open the door for further conversation[72]. The use of “liaoshier” flows across the whole corpus. Take Extract 8 as an example.
|
6．
|
D:
|
对.然后老师您这个呢,先::不要乱做按摩.
That's right. Laoshi, you would better now::don't take a massage.
|
|
|
7．
|
|
吭钱也没少花.
It really, cost a bundle.
|
|
|
8．
|
D:
|
吭,咱不能说老师您这儿::整天这治那治,现在
Yet, we can not::try medication here and there, now
|
|
|
9．
|
|
目前来说,就是效果不好.
For now, treatment effect is not good.
|
|
|
10．
|
D:
|
行老师,建议做核磁,不着急.
Okay, laoshi. I suggest nuclear magnetic resonance, not in a rush.
|
|
|
11．
|
|
您这个回去看看.
Take a moment to think about it.
|
|
|
12．
|
|
咱说看清楚了,咱咱说怎么治.
Get familiar with your case, and then turn to the treatment plan.
|
|
|
13．
|
P:
|
嗯.
Hum.
|
|
|
14．
|
D:
|
对对对.
Yes.
|
|
In the Extract 8, the patient takes the initiative at first to mention inappropriate and erratic self-medication. This case does not allow the doctor to put forward his opinion. Therefore, he tries to call the patient as “liaoshier” to break the ice (line 6 and 8). Then the doctor sits in the driver's seat to initiate a new sequence. The preferred treatment in line 10 is also pointed by the doctor along with calling the patient as “liaoshier” again. Whenever the patient have a tough response, the doctor here always responds kindly with respectful title “liaoshier” to avoid the patient feel judged. So, the patient feel supported to express satisfaction with treatment recommendations. In the end of their consultation, the patient shows compliance with physician’s instructions and accepts the full treatment plan, indicating a harmonious rapport building. Starting conversations with titles, including “laoshi”, “auntie” and “uncle” is equivalent to the recognition of patients’ status and the presentation of doctors’ politeness and respect. The doctors treat patients like their own family members and insist on the actual delivery of medical advice with expressing politeness through consultations. To make appropriate use of titles, doctors have to master dimensions of use. It is also important to identify the pragmatic conditions of using titles on marking different degrees of politeness. For example, the specific use of titles differ and are based on the status, age, and sex of patients. Since patients seem quite aware of correlations of power or status in medical consultations, doctors should learn how they are expected to call male or female patients in consultations. To conclude, titles, especially with a sign of respect, are also noteworthy for a doctor-patient rapport medical contexts.