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Article published In: Language and Dialogue
Vol. 6:3 (2016) ► pp.395–421

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Polyphony in a ward

Tracking professional theories in members’ dialogues

 | University of Bologna (Italy) / Niguarda Hospital in Milan (Italy)
Published online: 8 December 2016
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https://doi.org/10.1075/ld.6.3.03car
Contemporary research on the communicative constitution of organization conceives organization as made up of multiple voices embodied in and enacted by the different actors inhabiting this social world. This paper illustrates the inner polyphony at play in the complex and sensitive workplace of an Intensive Care Unit. The study focuses on the diagnostic talk concerning infectious disease and on the communicative resources deployed by physicians to pursue or resist their often conflicting diagnostic trajectories and professional stances toward the use of antibiotics. Adopting a conversation analytical approach to video-recorded morning briefings, we will illustrate how polyphony characterises the team members’ conduct during this communicative event and the consequences this polyphony has on the decision-making process. As we will illustrate, in this as in most cases, the members of the community appear to be active users of their professional culture, yet are also — and unavoidably — its carriers.
References (70)
American Thoracic Society and Infectious Disease Society of America. 2005. “Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia.” American Journal of Respiratory and Critical Care Medicine 171 (4): 388–416. Google Scholar logo with link to Google Scholar
Anspach, Renee R. 1993. Deciding Who Lives: Fateful Choices in the Intensive-care Nursery. Berkeley, CA: University of California Press.Google Scholar logo with link to Google Scholar
Ashcraft, Karen L., Timothy R. Kuhn, and François Cooren. 2009. “Constitutional Amendments: ‘Materializing’ Organizational Communication.” Academy of Management Annals 3 (1): 1–64. Google Scholar logo with link to Google Scholar
Atkinson, Paul. 1995. Medical Talk and Medical Work. The Liturgy of the Clinic. London: Sage.Google Scholar logo with link to Google Scholar
. 1999. “Medical Discourse, Evidentiality and the Construction of Professional Responsibility.” In Talk, Work and Institutional Order. Discourse in Medical, Mediation and Management settings, ed. by Srikant Sarangi, and Celia Roberts, 75–108. Berlin/New York: Mouton de Gruyter. Google Scholar logo with link to Google Scholar
Bakhtin, Michael M. 1981. The Dialogic Imagination: Four Essays by M.M. Bakhtin. Austin, TX: University of Texas Press.Google Scholar logo with link to Google Scholar
. 1984. Rabelais and his World. Bloomington, IN: Indiana University Press.Google Scholar logo with link to Google Scholar
Bazzanella, Carla. 1996. Repetition in Dialogue. Tubingen, DE: Niemeyer.Google Scholar logo with link to Google Scholar
Bencherki, Nicolas, and François Cooren. 2011. “Having to be: The possessive constitution of organization.” Human Relations, 641: 1579–1607. Google Scholar logo with link to Google Scholar
Bourdieu, Pierre. 1984. Distinction: A Social Critique of the Judgement of Taste. London: Routledge. Originally published in Pierre Bourdieu, La distinction. Critique sociale du jugement (Paris: Les Éditions de Minuit, 1979).Google Scholar logo with link to Google Scholar
. 1990. The Logic of Practice. Stanford, CA: Stanford University Press. Originally published in Pierre Bourdieu, Le sens pratique (Paris: Les Éditions de Minuit, 1980).Google Scholar logo with link to Google Scholar
Byrne, Patrick S., and Barrie E.L. Long. 1976. Doctors Talking to Patients: A Study of the Verbal Behaviours of Doctors in the Consultation. London, UK: HMSO.Google Scholar logo with link to Google Scholar
Caronia, Letizia. 2002. La socializzazione ai media. Contesti, interazioni e pratiche educative [Media Socialization. Contexts, Interactions and Educational Practices]. Milano, IT: Guerini.Google Scholar logo with link to Google Scholar
Caronia, Letizia, and Arturo Chieregato. 2015. “Assembling (Non)Treatable Cases: Physicians’ Epistemic and Interactive Resources to Pursue and Resist an “Off-label” Policy in an Intensive Care Unit.” Paper presented at the annual ICA International Conference, San Juan, Puerto Rico, May 21–25.
Caronia, Letizia, and François Cooren. 2014. “Decentering Our Analytical Position: The Dialogicity of Things.” Discourse & Communication 8 (1): 41–61. Google Scholar logo with link to Google Scholar
Caronia, Letizia, and Luigina Mortari. 2015. “The Agency of Things: How Spaces and Artefacts Organize the Moral Order of an Intensive Care Unit.” Social Semiotics 25 (4): 401–22. Google Scholar logo with link to Google Scholar
Choo, Chun Wei 2005. The Knowing Organization. How Organizations Use Information to Construct Meaning, Create Knowledge and Make Decision. Oxford, UK: Oxford University Press. Google Scholar logo with link to Google Scholar
Cicourel, Aaron V. 1986. “The Reproduction of Objective Knowledge: Commonsense Reasoning in Medical Decision Making.” In Contemporary Perceptions of Language: Interdisciplinary Dimensions, ed. by Heidi Byrnes, 48–78. Georgetown, DC: Georgetown University Press.Google Scholar logo with link to Google Scholar
. 1987. “Cognitive and Organizational Aspects of Medical Diagnostic Reasoning.” Discourse Processes 10 (4): 346–367. Google Scholar logo with link to Google Scholar
. 1992. “The Interpenetration of Communicative Contexts: Examples from Medical Encounters.” In Rethinking Contexts: Language as an interactive phenomenon, ed. by Alessandro Duranti, and Charles Goodwin, 291–310. Cambridge, MA: Cambridge University Press.Google Scholar logo with link to Google Scholar
. 1999. “The Interaction of Cognitive and Cultural Models in Health Care Delivery.” In Talk, Work and Institutional Order. Discourse in Medical, Mediation and Management settings, ed. by Srikant Sarangi, and Celia Roberts, 183–224. Berlin/New York: Mouton de Gruyter. Google Scholar logo with link to Google Scholar
Cooren, François. 2004. “Textual agency: How Texts Do Things in Organizational Settings.” Organization 11 (3): 373–393. Google Scholar logo with link to Google Scholar
. 2006. “The Organizational World as a Plenum of Agencies.” In Communication as Organizing: Practical Approaches to Research into the Dynamic of Text and Conversation, ed. by François Cooren, James R. Taylor, and Elizabeth J. Van Every, 81–100. Mahwah, NJ: Lawrence Erlbaum.Google Scholar logo with link to Google Scholar
. 2008. “The selection of agency as a rhetorical device: Opening up the scene of dialogue through ventriloquism.” In Dialogue and rhetoric, ed. by Edda Weigand, 23–37. Amsterdam, NE: Benjamins. Google Scholar logo with link to Google Scholar
. 2012. “Communication Theory at the Center: Ventriloquism and the Communicative Constitution of Reality.” Journal of Communication 62 (1): 1–20. Google Scholar logo with link to Google Scholar
Cooren, François, Gail T. Fairhurst, and Romain Huët. 2012. “Why Matter Always Matters in (Organizational) Communication.” In Materiality and Organizing: Social Interaction in a Technological World, ed. by Paul M. Leonardi, Bonnie A. Nardi, and Jannis Kallinikos, 296–314. Oxford, UK: Oxford University Press. Google Scholar logo with link to Google Scholar
Cooren, François, and Sergeiy Sandler. 2014. “Polyphony, Ventriloquism, and Constitution: In Dialogue with Bakhtin.” Communication Theory 24 (3): 225–244. Google Scholar logo with link to Google Scholar
Eggiman, Philippe, and Didier Pittet. 2001. “Infections Control in the ICU.” CHEST 120 (6): 2059–2093. Google Scholar logo with link to Google Scholar
Erikson, Frederick. 1999. “Local Identities and Presentation of Self as a Fellow Physician: Aspects of a Discourse of Apprenticeship in Medicine.” In Talk, Work and Institutional Order. Discourse in Medical, Mediation and Management settings, ed. by Srikant Sarangi, and Celia Roberts, 109–143. Berlin/New York: Mouton de Gruyter. Google Scholar logo with link to Google Scholar
Fairhurst, Gail T. 2004. “Textuality and Agency in Interaction Analysis.” Organization 11 (3): 335–353. Google Scholar logo with link to Google Scholar
Garfinkel, Harold. 2002. Ethnomethodology’s Program. Working out Durkheim’s Aphorism. Lanham, MD: Rowman & Littlefield.Google Scholar logo with link to Google Scholar
Goodwin, Charles. 1994. “Professional Vision.” American Anthropologist 96 (3): 606–633. Google Scholar logo with link to Google Scholar
Heath, Christian. 1992. “The Delivery and Reception of Diagnosis and Assessment in General Practice Consultation.” In Talk at Work: Interaction in Institutional Settings, ed. by Paul Drew, and John Heritage, 235–267. Cambridge, MA: Cambridge University Press.Google Scholar logo with link to Google Scholar
Heritage, John. 1984. Garfinkel and Ethnomethodology. Cambridge, MA: Cambridge University Press.Google Scholar logo with link to Google Scholar
. 1997. “Conversation Analysis and Institutional Talk: Analyzing Data.” In Qualitative Research: Theory, Method and Practice, ed. by David Silverman, 221–245. London, UK: Sage.Google Scholar logo with link to Google Scholar
. 2006. “Revisiting Authority in Physician-Patient Interaction.” In Diagnosis as Cultural Practice, ed. by Judith Felson Duchan, and Dana Kovarsky, 83–102. Berlin/New York: Mouton de Gruyter.Google Scholar logo with link to Google Scholar
. 2012. “Epistemics in Action: Action Formation and Territories of Knowledge.” Research on Language & Social Interaction 45 (1): 1–29. Google Scholar logo with link to Google Scholar
Heritage, John, and Douglas W. Maynard. 2006. Communication in Medical Care: Interaction between Primary Care Physicians and Patients. Cambridge, MA: Cambridge University Press. Google Scholar logo with link to Google Scholar
Heritage, John, and Geoffrey Raymond. 2005. “The terms of agreement: Indexing epistemic authority and subordination in talk-in- interaction.” Social Psychology Quarterly, 681: 15–38. Google Scholar logo with link to Google Scholar
Heritage, John, and Rod Watson. 1979. “Formulations as Conversational Objects.” In Everyday Language: Studies in Ethnometodology, ed. by George Psathas, 123–162. New York, NJ: Irvington Press.Google Scholar logo with link to Google Scholar
Husserl, Edmund G.A. 1954. The Crisis of European Sciences and Trascendental Philosophy. Evantson, IL: Northwestern University Press.Google Scholar logo with link to Google Scholar
Koschmann, Timothy, Curtis LeBaron, Charles Goodwin, and Paul Feltovich. 2011. “‘Can You See the Cystic Artery Yet?’ A Simple Matter of Trust.” Journal of Pragmatics 43 (2): 521–541. Google Scholar logo with link to Google Scholar
Maynard, Douglas W. 1992. “On Clinicians’ Co-Implicating Recipients’ Perspective in the Delivery of Diagnostic News.” In Talk at Work: Interaction in Institutional Settings, ed. by Paul Drew, and John Heritage, 331–358. Cambridge, MA: Cambridge University Press.Google Scholar logo with link to Google Scholar
. 2003. Bad News, Good News: Conversational Order in Everyday Talk and Clinical Settings. Chicago, IL: University of Chicago Press.Google Scholar logo with link to Google Scholar
Mishler, Elliot G. 1984. The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, NJ: Ablex.Google Scholar logo with link to Google Scholar
Moerman, Michael. 1988. Talking Culture: Ethnography and Conversation Analysis. Philadelphia, PA: University of Pennsylvania Press. Google Scholar logo with link to Google Scholar
Mondada, Lorenza. 2011. “The Organization of Concurrent Courses of Action in Surgical Demonstration.” In Embodied Interaction: Language and Body in the Material World, ed. by Jürgen Streeck, Charles Goodwin, and Curtis LeBaron, 207–226. Cambridge, MA: Cambridge University Press.Google Scholar logo with link to Google Scholar
Nicolini, Davide. 2009. “Zooming in and out: Studying Practices by Switching Theoretical Lenses and Trailing Connections.” Organization Studies 30 (12): 1391–1418. Google Scholar logo with link to Google Scholar
Niederman, Michael S. 2005. The clinical diagnosis of VAP. Respiratory Care 50 (6): 788–796.Google Scholar logo with link to Google Scholar
Orlikowski, Wanda J. 2007. “Socio-material Practices: Exploring Technology at Work.” Organization Studies 28 (9): 1435–1448. Google Scholar logo with link to Google Scholar
Sacks, Harvey, Emmanuel A. Schegloff, and Gail Jefferson. 1974. “A symplest systematics for the organization of turn-taking for conversation.” Language 50(4): 696–735. Google Scholar logo with link to Google Scholar
Sanchez Svenssson, Marcus, Paul Luff, and Christian Heath. 2010. “Embedded Instruction in Practice: Contingency and Collaboration during Surgical Training.” Communication in healthcare settings. Policy, Participation and New Technologies, ed. by Alison Pilnick, John Hindmarsh, and Virginia Teas Gill, 99–116. Oxford, UK: Wiley-Blackwell. Google Scholar logo with link to Google Scholar
Schegloff, Emmanuel. 1987. “Between Micro and Macro. Context and other connections”. In The micro-macro link, eds. by Jeffrey C. Alexander, Bernhard Giesen, Richard Munch, and Neil J. Smelser, 207–234. Berkeley, CA: University of California Press.Google Scholar logo with link to Google Scholar
. 1992. “On talk and its institutional occasions”. In Talk at Work. Interaction in institutional settings, eds. by Paul Drew, and John Heritage, 101–134. Cambridge, MA: Cambridge University Press.Google Scholar logo with link to Google Scholar
Schütz, Alfred. 1962. Collected Papers I: The Problem of Social Reality. Dordrecht, NL: Martinus Nijhoff Publishers.Google Scholar logo with link to Google Scholar
Schütz, Alfred, and Thomas Luckmann. 1973. The Structure of the Life-world. Vol.11. Evanston, IL: Northwestern University Press.Google Scholar logo with link to Google Scholar
Silverman, David. 2005. Doing Qualitative Research. A Practical Handbook. London, UK: Sage.Google Scholar logo with link to Google Scholar
Stivers, Tania. 2002. “Participating in Decisions about Treatment: Overt Parent Pressure for Antibiotic Medication in Pediatric Encounters.” Social Science & Medicine 54 (7): 1111–1130. Google Scholar logo with link to Google Scholar
. 2005. “Non-antibiotic Treatment Recommendations: Delivery Formats and Implications for Parents Resistance.” Social Science & Medicine 60 (5): 946–964. Google Scholar logo with link to Google Scholar
. 2006. “Treatment decisions: negotiations between doctors and patients in acute care encounters.” In Communication in Medical Care: Interaction between Primary Care Physicians and Patients, eds. by John Heritage, and Douglas Maynard, 279–312. Cambridge, MA: Cambridge University Press. Google Scholar logo with link to Google Scholar
. 2007. Prescribing Under Pressure. Parents-Physician Conversations and Antibiotics. Oxford, UK: Oxford University Press. Google Scholar logo with link to Google Scholar
. 2008. “Stance, Alignment, and Affiliation during Storytelling: When Nodding is a Token of Affiliation.” Research on Language & Social Interaction 41 (1): 31–57. Google Scholar logo with link to Google Scholar
Taylor, James R., and Elizabeth J. Van Every. 2011. The Situated Organization. London: Routledge.Google Scholar logo with link to Google Scholar
. 2014. When Organizations Fail: Why Authority Matters. London/New York: Routledge. Google Scholar logo with link to Google Scholar
Timmermans, Stefan, and Alison Angell. 2001. “Evidence-based Medicine, Clinical Uncertainty, and Learning to Doctor.” Journal for Health and Social Behaviour 42 (4): 342–359. Google Scholar logo with link to Google Scholar
Tracy, Sarah J. 2013. Qualitative Research Methods: Collecting Evidence, Crafting Analysis, Communicating Impact. Chichester/Oxford/Malden: Wiley-Blackwell.Google Scholar logo with link to Google Scholar
van Dijk, Teun A. 2006. “Discourse, Context and Cognition.” Discourse Studies 8 (1): 159–177. Google Scholar logo with link to Google Scholar
Weathersbee, Elizabeth T., and Douglas W. Maynard. 2010. “Dialling for Donations: Practices and Actions in the Telephone Solicitation of Human Tissues.” Sociology of Health & Illness 31 (6): 803–816. Google Scholar logo with link to Google Scholar
Weigand, Edda. 2010. Dialogue: The Mixed Game. Amsterdam, NE: John Benjamins. Google Scholar logo with link to Google Scholar
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