Four communication strategies are extracted from the corpus: BORS, PPS, NPS and ORS, and each of them have multiple categories. Table 2 presents categories of PPS and their frequencies.
Table 2
The categories and their frequencies of PPS
category definition | example | freq./% |
1:Repeating or partly repeating what a patient said in previous turns | P:… it is really caused by the inflammation. D: Sure, that’s it.(conv. 8) | 20/1.4 |
2:Using an in-group marker | D:… your baby (‘baobao’) had better take the following treatments…(conv. 1) | 24/1.7 |
3:Making a consolation, wish or encouragement, or being optimistic | 78/5.6 |
(1)Using a consolation routine | D:…In general there’s not problem.(conv. 8) | 44 |
(2)Making a wish or encouragement | D:You need to persevere to recover.(conv. 85) | 4 |
(3)Being optimistic | D:… it’s often curable.(conv. 29) | 30 |
4:Showing friendly expressions, esp. empathy, understanding | D: I’m also happy as long as I can provide you guidance.(conv. 125) | 4/0.3 |
5:Asking for a reason | D: Why not accept the surgery?…(conv. 110) | 1/0.1 |
Sum | 127/9.1 |
Note: The percentage after the slash “/” in the last column in Tables 2, 3 and 4 represents the frequency before “/” divided by the total frequency in the three tables (1395 in total), multiplied by 100.
The purpose of using the strategy in category one is to meet a patient’s desire for approval, thus building the common ground between them. In-group markers in category two include expressions like ‘let’s’ (‘zan’, ‘zanmen’), ‘baby’ (referring to a child in Mandarin Chinese, ‘baobao’ in pinyin), ‘dear’ (‘qin’), ‘grandma’ (‘nainai’) and so on. Consolation routines in the first subcategory of category three include expressions such as ‘Don’t worry’, ‘Don’t be (so) worried’, ‘It’s all right’, ‘Don’t be (too) sensitive (about it)’. The second subcategory involves wish expressions for a patient’s good recovery from a disease. The encouragement, referring to expressions that motivate a patient to accept a treatment, also falls under this sub-category. Being optimistic in the third subcategory means making a positive evaluation of a certain treatment and medicine, highlighting the good quality of a certain medical institution, or emphasizing the trustworthiness of a particular doctor or medical team. The friendly expressions in category four demonstrate understanding or willingness to provide further help if the patient needs it. Category five is associated with sentence patterns similar to those in English such as ‘Why not …?’, ‘Why don’t …?’.
The categories of NPS and their frequencies are displayed in Table 3.
Table 3
The categories and their frequencies of NPS
category definition | example | freq./% |
1:Apologizing and its reasons | D: Sorry to keep you waiting so long.(conv. 110) | 13/0.9 |
2:Using deference in an imposition or offence. | D:You (Nin) buy the medicine of ….(conv. 32) | 48/3.4 |
3:Stating a certain diagnosis as a general clinical practice | D:The accepted treatment (of the adenoid hypertrophy) in doctors is surgery.(conv. 27) | 13/0.9 |
4:Minimizing the imposition when asking a patient to accept a certain treatment | 235/16.8 |
(1)Offering one an option to make one’s own decision | D:It’s up to you for your consideration.(conv. 62) | 6 |
(2)Making a diagnosis by personal advice | D:I advise to continue the nebulized inhalation if the cough gets serious.(conv.18) | 129 |
(3)Using an imposition minimal expression | D:Take some probiotics like Mummy Love and … (conv. 5) | 47 |
(4)Using a mitigating expression | D:Have a try (shishi) of an oral pain killer.(conv. 64) | 53 |
5: Making a vague diagnosis | 317/22.7 |
(1)Using a hedge | D:Some colds can possibly lead to bronchitis.(conv. 12) | 116 |
(2)Using a guess or disjunctive expression | D:but it does not seems to be the case judged from the test.(conv. 32) | 38 |
(3)Using a conditional clause | D:Whether to use antibiotics should be based on a diagnosis if it’s convenient to make it.(conv. 12) | 163 |
6:Providing justifications or explanations for a diagnosis | D:Don’t take yogurt at the moment because he is having diarrhea.(conv. 5) | 584/41.9 |
7:Explaining reasons of not being able to make an accurate diagnosis | D:Please contact the Customer Service to transfer to another department.(conv. 53) | 31/2.2 |
Sum | 1241/89.0 |
The apologies in category one are made for not answering patients on time or not being able to make an accurate diagnosis. The expressions used include ‘I apologize’ (‘daoqian’ or ‘baoqian’), ‘I’m sorry’ (‘duibuqi’), ‘Excuse me’ (‘buhaoyisi’). However, not all instances of apologizing expressions in the corpus convey an actual apology. For example, in conversation 170, ‘Excuse me’ is used with a denial meaning, and in conversations 180 and 196, ‘I’m sorry’ is used to indicate refusal. Deference in category two refers to the use of the horific term ‘nin’. However, it is important to note that if ‘nin’ is used in a greeting or consolation routine, such as ‘Don’t worry’ (‘Nin fangxin’), it is not counted as a deference in this category. Category three includes the diagnosis of a certain examination, treatment and use of medicine. The first subcategory of category four involves sentence patterns such as ‘It’s up to you …’ (‘You nin/ni jueding’), ‘You can ask your family members to see whether …’ (‘He nin/ni jiaren shangliang kanan …’). A tag like ‘…, will you?’ (‘…, haoma?’/‘…, keyima?’) can also be used to give the patient the option. The second subcategory involves personal advice, which is attached to sentence patterns like ‘I (don’t) suggest/advise …’ (‘bu jianyi …’), ‘I think/Personally (speaking) …’ (‘Wo renwei/Laoshi shuo …’). The third subcategory includes minimal expressions such as indefinite description like ‘some/a few’ (‘yixie’), ‘a little’ (‘yidian’), as well as indefinite adverbial (sometimes replicated) like ‘yixia (xia)’, ‘yidian (dian)’, which means ‘a little bit’. For example, in the sentence ‘Qu kan yixia yisheng’ (‘Go to see a doctor’), ‘yixia’ conveys the meaning of ‘a little bit’. The mitigating expressions in the fourth subcategory include verb phrases like ‘try one’s best’ (‘jinliang’), ‘had better’ (‘zuihao’), and ‘ought to’ (‘keyi’), as well as reduplicated verbs like ‘kankan’ (‘see (a doctor)’), ‘shishi’ (‘try’). For example, in the sentences ‘Chi dian xiaoyanyao kankan’ (‘Take some antibiotics’) and ‘Da ge diandi shishi’ (‘You can try an intravenous injection’). Sentence-ending particles like ‘ba’, ‘o’, ‘ne’ also fall into this subcategory. For instance, in the sentence ‘Haizi fa gaoshao le doude dao yiyuan jiancha o’ (‘A child who has caught a high fever has to be taken to the doctor’), the particle ‘o’ is a mitigating expression. In category five, a hedge is an adaptor or rounder. Adaptors includes expressions like ‘generally’, ‘usually’, ‘possibly’, and ‘almost/nearly’, while rounders encompass expressions like ‘sometimes’, ‘most’, and ‘roughly’. The second subcategory of category five involves guesses, expressed through phrases or sentence patterns like ‘I guess/estimate …’, ‘it should be/is considered to be…’, and ‘I don’t rule out…’. Disjunctive expressions, referring to sentence patterns like ‘Either… or …’ (‘Yaome … yaome…’, ‘… huozhe…’), also fall under this subcategory. Conditional clauses in the third subcategory are the expressions like ‘If…’, ‘… on the condition that …’, ‘…in case that…’, with their Mandarin Chinese equivalents being ‘Ruguo…’, ‘Zhiyao…’ and ‘Yaoshi…’. Category six refers to the medical advice given for examinations, treatments and the use of medicine, as well as precautions. In category seven when a doctor tries to explain the difficulty of making a diagnosis they may use an imposition minimizing expression. This strategy is counted as category four.
BORS, ORS and their frequency are displayed in Table 4.
Table 4
The categories and their frequencies of BORS and ORS
category definition | example | freq./% |
BORS 1:Directly asking one to accept certain treatments | D: Have your intestines and stomach kept in order.(conv. 28) | 4/0.3 |
BORS 2:Directly asking one to take certain examinations | D:Have your eye pressure measured.(conv. 137) | 1/0.1 |
BORS3:Directly asking one to accept certain recovery proposals or take some precautions | D:Quit the habit of watching TV and … in the meal.(conv. 19) | 8/0.6 |
ORS1:Indirectly reminding sb of sth | —P:Can Macaroon Oral Liquid be used for expectorant? —D:Oulingma.(conv. 27) | 2/0.1 |
ORS2:Indirectly giving a positive answer | —P:Any treatment is available for the metastasized cancer cells? —D:Iodine-131. (conv. 184) | 3/0.2 |
ORS3:Indirectly refusing or denying | —P: Can he take a chicken egg? — D: It is hard to be digested.(conv. 13) | 9/0.6 |
sum | 27/1.9 |
BORS and ORS originate from B & L’s (1987) conception. BORS focuses on propositional content of the message, disregarding any mitigating redress, while ORS involves hiding a face threatening act (FTA) and requires co-textual information for the hearer to understand the force behind it. Consequently, the italicized utterances given as examples for the categories of ORS in Table 4 need to be preceded by the previous turn of discourse. The first category of BORS involves medication and/or surgery as part of the treatment. The examination in the second category includes equipment- or non-equipment-assistance examination. The third category of BORS refers to precautionary measures, such as dietary restrictions (e.g., a voiding greasy food), drinking habits (e.g., consuming more warm water), choice of footwear (e.g., avoiding high-heels), use of daily household items (e.g., brushing teeth with fluoride-free toothpaste), and certain lifestyle habits (e.g., not watching TV while eating and not staying up late). The first category of ORS involves indirectly reminding patients about medicine usage and related precautions. The second category involves indirectly providing positive answers for patients’ queries about the required examinations, medicine and treatment. The third category involves indirect refusals, where a doctor declines to make a diagnosis, and indirect denials, where a doctor disagrees with a patient’s prescribed medicine use or lifestyle habit.
The distribution of these strategy categories is presented in the last column of Tables 2,3 and 4. Overall, NPSs are the most frequently used strategy, accounting for 89% of the instances. PPSs have a significantly lower frequency, only accounting for 9.1%, while BORSs and ORSs are the least used, totaling 1.9% in frequency. Such distribution aligns with out intuition about diagnostic activities, as doctors impose certain treatments and medication on patients. Consequently, doctors often employ various redressive measures like apologies, hedges or deference to mitigate the potential FTAs. Within the NPS categories, class six (providing justifications or explanations for a diagnosis) is most frequently used, accounting for 42.1% of all strategies. This aligns with common sense, as physicians often support their diagnosis with justifications or explanations to enhance their authority. Class five (making a vague diagnosis) ranks second, with a percentage of 22.8%. This finding may be related to the limitations of teleconsultations, where doctors can not conduct face-to-face diagnoses and must resort to vague expressions like ‘possibly’, ‘roughly’, ‘Either… or…’, and ‘If…’. Class four (minimizing imposition when asking patients to accept certain treatments) accounts for 16.8%, indicating that some doctors employ various measures to minimize FTAs. These measures include providing patients with the option to make their own decision, giving personal advice during treatment, and using expressions with minimal imposition. However, categories one to three (making apologies, using deference and stating certain treatments as a general clinical practice) and category seven (explaining the difficulty of making an accurate diagnosis) each have significantly low frequencies, with categories one and three each accounting for less than 1%. This suggests that few doctors in Mainland Chinese setting are willing to apologize to patients, and almost all doctors are reluctant to prescribe specific treatments as general requirements within the clinical circle.
In PPS, category three (providing consolation, good wishes, and encouragement to patients and being optimistic when discussing aspects related to the disease and its treatment) accounts for 5.6%, more than half of the total frequency of PPS (9.1%). This indicates that a few doctors are attentive to a patient’s psychological state and are willing to take measures to provide comfort during the medical interview. The remaining categories of PPS are rarely used, each accounting for no more than 2%, particularly category five (inquiring about the reasons why a patient is willing or unwilling to accept a treatment), which has only one occurrence. The frequency of each category in both BORS and ORS is extremely low, all less than 1%, suggesting that doctors are not inclined to use directness strategies that could threaten a patient’s positive or negative face. Additionally, doctors rarely use highly implicit strategies because there is usually no need to hide their intentions when making a diagnosis.