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In:A Pragmatic Agenda for Healthcare: Fostering inclusion and active participation through shared understanding
Edited by Sarah Bigi and Maria Grazia Rossi
[Pragmatics & Beyond New Series 338] 2023
► pp. 172–199

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Chapter 7
Negotiation and joint construction of meaning (or why health providers need philosophy of communication)

 | University of Cambridge
 | University of Oxford
Published online: 17 November 2023
DOI logo with link
https://doi.org/10.1075/pbns.338.07jas
Abstract
Meaning is often agreed on through negotiation, whose purpose can be clarification or joint construction of what starts as a ‘fuzzy thought’, or settling on a mutually acceptable way forward in communication and establishing common ground. The paper offers a critical introduction to main approaches to negotiating meaning, focusing on concepts that help explicate it, such as conventions, intentions, and meaning co-construction on one hand, and accountability, perception of authority, and normative expectations on the other. It then moves to the question of negotiating commitments, in particular as applied to Doctor-Patient Talk. It concludes with outlining the advantages of providing doctors with an understanding of dynamic pragmatics, highlighting that negotiating meaning does not inevitably lead to a loss of authority.
Article outline
  • 1.Emergent meanings: A preamble
  • 2.Problems with “static meaning”: From intentions and conventions to … the unknown
    • 2.1Intentions and inferences
    • 2.2Focus on convention
    • 2.3Speaker meaning or addressee meaning? (or asking a wrong question)
    • 2.4Interactively achieved functional proposition
  • 3.Interaction and meaning negotiation
    • 3.1Co-construction models
    • 3.2Negotiation and context parameters
    • 3.3Negotiation and defaults
  • 4.The question of accountability
    • 4.1Negotiating norms and interpersonal standards
    • 4.2Accountability, but for what exactly? Commitment, but to what exactly?
    • 4.3Negotiating commitments
  • 5.Doctor-Patient talk, dynamic meaning, and metadiscursive awareness
    • 5.1Negotiation and negotiation of meaning
    • 5.2Professional-to-lay and back
    • 5.3Parameters again
    • 5.4Negotiation, implicit meaning, and emotions
    • 5.5Looking forward
  • Acknowledgements
  • Notes
  • References
References (84)
References
Ainsworth-Vaughn, Nancy. 1998. Claiming Power in Doctor-Patient Talk. Oxford: Oxford University Press.Google Scholar logo with link to Google Scholar
Alexander, Larry and Michael Moore. 2020. “Deontological Ethics.” In Stanford Encyclopedia of Philosophy, edited by Edward Zalta (online) [URL] [accessed 5 August 2021].
Ariel, Mira. 2002. “Privileged Interactional Interpretations”. Journal of Pragmatics 34: 1003–1044. Google Scholar logo with link to Google Scholar
Arundale, Robert B. 1999. “An Alternative Model and Ideology of Communication for an Alternative to Politeness Theory”. Pragmatics 9: 119–153.Google Scholar logo with link to Google Scholar
2010. “Constituting Face in Conversation: Face, Facework, and Interactional Achievement”. Journal of Pragmatics 42: 2078–2105. Google Scholar logo with link to Google Scholar
Austin, John L. 1975. How To Do Things With Words. Oxford: Oxford University Press. Second edition. First published in 1962. Google Scholar logo with link to Google Scholar
Barton, Ellen. 2006. “Medical Specialty Encounters”. In Elsevier Encyclopedia of Language and Linguistics. Second edition, edited by Keith Brown, 732–742. Oxford: Elsevier. Google Scholar logo with link to Google Scholar
Borg, Emma. 2004. Minimal Semantics. Oxford: Clarendon Press. Google Scholar logo with link to Google Scholar
. 2012. Pursuing Meaning. Oxford: Oxford University Press. Google Scholar logo with link to Google Scholar
. 2019. “Explanatory Roles for Minimal Content”. Noûs 53: 513–539. Google Scholar logo with link to Google Scholar
Borg, Emma and Patrick J. Connolly. 2022. “Exploring Linguistic Liability”. In Oxford Studies in Philosophy of Language. Vol. 2, edited by Ernie Lepore and David Sosa, 1–26. Oxford: Oxford University Press. Google Scholar logo with link to Google Scholar
Brandom, Robert. 1994. Making It Explicit. Cambridge, MA: Harvard University Press.Google Scholar logo with link to Google Scholar
Brown, Penelope and Stephen C. Levinson. 1987. Politeness: Some Universals in Language Usage. Cambridge: Cambridge University Press. Google Scholar logo with link to Google Scholar
Carston, Robyn. 1988. “Implicature, Explicature, and Truth-Theoretic Semantics”. In Mental Representations: The Interface Between Language and Reality, edited by R. M. Kempson, 155–181. Cambridge: Cambridge University Press.Google Scholar logo with link to Google Scholar
. 2002. Thoughts and Utterances: The Pragmatics of Explicit Communication. Oxford: Blackwell. Google Scholar logo with link to Google Scholar
Castro, Cesar M. et al. 2007. “Babel Babble: Physicians’ Use of Unclarified Medical Jargon with Patients”. American Journal of Health Behaviour 31: S85–S95. Google Scholar logo with link to Google Scholar
Clark, Herbert H. 1996. Using Language. Cambridge: Cambridge University Press. Google Scholar logo with link to Google Scholar
DeRose, Keith. 1992. “Contextualism and Knowledge Attributions”. Philosophy and Phenomenological Research 52: 913–929. Google Scholar logo with link to Google Scholar
. 2009. The Case for Contextualism: Knowledge, Skepticism, and Context. Vol. 1. Oxford: Clarendon Press. Google Scholar logo with link to Google Scholar
Drew, Paul, and John Heritage. 1992. “Analyzing Talk at Work: An Introduction”. In Talk at Work, edited by Paul Drew and John Heritage, 3–65. Cambridge: Cambridge University Press.Google Scholar logo with link to Google Scholar
Elder, Chi-Hé. 2019. “Negotiating What Is Said in the Face of Miscommunication”. In Philosophical Insights into Pragmatics, edited by Piotr Stalmaszczyk, 107–126. Berlin: De Gruyter. Google Scholar logo with link to Google Scholar
. 2021. “Speaker Meaning, Commitment and Accountability”. In The Cambridge Handbook of Sociopragmatics, edited by Michael Haugh, Dániel Z. Kádár and Marina Terkourafi, 48–68. Cambridge: Cambridge University Press. Google Scholar logo with link to Google Scholar
Elder, Chi-Hé and Michael Haugh. 2018. “The Interactional Achievement of Speaker Meaning: Toward a Formal Account of Conversational Inference”. Intercultural Pragmatics 15: 593–625. Google Scholar logo with link to Google Scholar
Finlay, I. G. and Srikant Sarangi. 2006. “Medical Discourse: Communication Skills and Terminally Ill Patients”. In Elsevier Encyclopedia of Language and Linguistics. Second edition, edited by Keith Brown, 665–674. Oxford: Elsevier. Google Scholar logo with link to Google Scholar
von Fintel, Kai and Lisa Matthewson. 2008. “Universals in Semantics”. The Linguistic Review 25: 139–201. Google Scholar logo with link to Google Scholar
Fogal, Daniel, Daniel W. Harris, and Matt Moss (eds). 2018. New Work on Speech Acts. Oxford: Oxford University Press. Google Scholar logo with link to Google Scholar
Garfinkel, Harold. 1967. Studies in Ethnomethodology. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar logo with link to Google Scholar
Geurts, Bart. 2018. “Convention and Common Ground”. Mind and Language 33: 115–129. Google Scholar logo with link to Google Scholar
. 2019. “Communication as Commitment Sharing: Speech Acts, Implicatures, Common Ground”. Theoretical Linguistics 45: 1–30. Google Scholar logo with link to Google Scholar
Grice, Paul. 1989a. “Logic and Conversation”. In Studies in the Way of Words, edited by Paul Grice, 22–40. Cambridge, MA: Harvard University Press. First published in 1975 in Syntax and Semantics. Vol. 3, edited by Peter Cole and Jerry L. Morgan. New York: Academic Press.Google Scholar logo with link to Google Scholar
. 1989b. “Meaning”. In Studies in the Way of Words, edited by Paul Grice, 213–223. Cambridge, MA: Harvard University Press. First published in 1957 in Philosophical Review 66.Google Scholar logo with link to Google Scholar
Goldberg, Sanford. C. 2011. “Putting the Norm of Assertion to Work: The Case of Testimony”. In Assertion: New Philosophical Essays, edited by Jessica Brown and Herman Cappelen, 175–195. Oxford: Oxford University Press. Google Scholar logo with link to Google Scholar
Goldberg, Sanford C. 2015. Assertion: On the Philosophical Significance of Assertoric Speech. Oxford: Oxford University Press.Google Scholar logo with link to Google Scholar
2020. Conversational Pressure: Normativity in Speech Exchanges. Oxford: Oxford University Press. Google Scholar logo with link to Google Scholar
Gregoromichelaki, Eleni and Ruth Kempson. 2016. “Joint Utterances and the (Split-)Turn Taking Puzzle”. In Interdisciplinary Studies in Pragmatics, Culture and Society, edited by Alessandro Capone and Jacob L. Mey, 703–743. Cham: Springer. Google Scholar logo with link to Google Scholar
Hamblin, C. L. 1971. “Mathematical Models of Dialogue”. Theoria 37: 130–155. Google Scholar logo with link to Google Scholar
Haugh, Michael. 2007. “The Co-Constitution of Politeness Implicature in Conversation”. Journal of Pragmatics 39: 84–110. Google Scholar logo with link to Google Scholar
. 2008. “The Place of Intention in the Interactional Achievement of Implicature”. In Intention, Common Ground and the Egocentric Speaker-Hearer, edited by Istvan Kecskes and Jacob Mey, 45–85. Berlin: Mouton de Gruyter. Google Scholar logo with link to Google Scholar
. 2013. “Speaker Meaning and Accountability in Interaction”. Journal of Pragmatics 48: 41–56. Google Scholar logo with link to Google Scholar
Heritage, John. 1984. Garfinkel and Ethnomethodology. Cambridge: Polity Press.Google Scholar logo with link to Google Scholar
Horn, Laurence R. 1984. “Toward a New Taxonomy for Pragmatic Inference: Q-based and R-based Implicature”. In Georgetown University Round Table on Languages and Linguistics 1984, edited by Deborah Schiffrin, 11–42. Washington, D.C.: Georgetown University Press.Google Scholar logo with link to Google Scholar
2004. “Implicature”. In The Handbook of Pragmatics, edited by Laurence R. Horn and Gregory Ward, 3–28. Oxford: Blackwell.Google Scholar logo with link to Google Scholar
Howard, Tera, Kara L. Jacobson, and Sunil Kripalani. 2013. “Doctor Talk: Physicians’ Use of Clear Verbal Communication”. Journal of Health Communication 18: 991–1001. Google Scholar logo with link to Google Scholar
Hydén, Lars-Christer and Pia H. Bülow. 2006. “Medical Discourse, Illness Narratives”. In Elsevier Encyclopedia of Language and Linguistics. Second edition, edited by Keith Brown, 697–703. Oxford: Elsevier. Google Scholar logo with link to Google Scholar
Jaszczolt, Kasia M. 2005. Default Semantics: Foundations of a Compositional Theory of Acts of Communication. Oxford: Oxford University Press. Google Scholar logo with link to Google Scholar
2010. “Default Semantics”. In The Oxford Handbook of Linguistic Analysis, edited by Bernd Heine and Heiko Narrog, 193–221. Oxford: Oxford University Press.Google Scholar logo with link to Google Scholar
2016. Meaning in Linguistic Interaction: Semantics, Metasemantics, Philosophy of Language. Oxford: Oxford University Press. Google Scholar logo with link to Google Scholar
2019. “Semantics/Pragmatics Boundary Disputes”. In Semantics Interfaces, edited by Claudia Maienborn, Klaus von Heusinger, and Paul Portner, 368–402. Berlin: De Gruyter Mouton. First published in 2012 in Semantics: An International Handbook of Natural Language Meaning. Vol. 3, edited by Claudia Maienborn, Klaus von Heusinger, and Peter Portner. Berlin: De Gruyter Mouton. Google Scholar logo with link to Google Scholar
2021. “Functional Proposition: A New Concept for Representing Discourse Meaning?”. Journal of Pragmatics 171: 200–214. Google Scholar logo with link to Google Scholar
2022. “Defaults in Semantics and Pragmatics.” Third edition. In Stanford Encyclopedia of Philosophy (online), edited by Edward Zalta. First published in 2006.Google Scholar logo with link to Google Scholar
2023. “Post-Gricean Pragmatics for Intercultural Communication”. In The Cambridge Handbook of Intercultural Pragmatics, edited by Istvan Kecskes, 11–39. Cambridge: Cambridge University Press.Google Scholar logo with link to Google Scholar
Linell, Per. 2009. Rethinking Language, Mind, and World Dialogically: Interactional and Contextual Theories of Human Sense-Making. Charlotte, NC: Information Age Publishing.Google Scholar logo with link to Google Scholar
Levinson, Stephen C. 1987. “Minimization and Conversational Inference.” In The Pragmatic Perspective: Selected Papers From the 1985 International Pragmatics Conference, edited by Jef Verschueren and Marcella Bertuccelli-Papi, 61–129. Amsterdam: John Benjamins.
2000. Presumptive Meanings: The Theory of Generalized Conversational Implicature. Cambridge, MA: MIT Press. Google Scholar logo with link to Google Scholar
Lewis, David. 1991. “Scorekeeping in a Language Game”. In Pragmatics: A Reader, edited by Steven Davis, 416–427. Oxford: Oxford University Press. First published in 1979 in Journal of Philosophical Logic 8.Google Scholar logo with link to Google Scholar
Macdonald, Elisabeth. 2004. Difficult Conversations in Medicine. Oxford: Oxford University Press.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, edited by Paul Drew and John Heritage, 331–358. Cambridge: Cambridge University Press.Google Scholar logo with link to Google Scholar
McFarlane, John. 2011. “Relativism and Knowledge Attributions”. In Routledge Companion to Epistemology, edited by Sven Bernecker and Duncan Pritchard, 536–544. London: Routledge. Google Scholar logo with link to Google Scholar
Moran, Richard. 2018. The Exchange of Words: Speech, Testimony, and Intersubjectivity. Oxford: Oxford University Press. Google Scholar logo with link to Google Scholar
Morse, Diane, Elizabeth Edwardsen, and Howard Gordon. 2008. “Missed Opportunities for Interval Empathy in Lung Cancer Communication”. Archives of Internal Medicine 168: 1853–1858. Google Scholar logo with link to Google Scholar
Neighbour, Roger. 2016. “You’ve Been ICE’d”. BMJ Talk Medicine; BMJ Podcasts. [URL] [Accessed 27 April 2022]
Parikh, Prashant. 2010. Language and Equilibrium. Cambridge MA: MIT Press. Google Scholar logo with link to Google Scholar
Pendleton, David, Theo Schofield, and Peter Tate. 1984. The Consultation: An Approach to Learning and Teaching. Oxford: Oxford University Press.Google Scholar logo with link to Google Scholar
Perükylü, Anssi. 1997. “Conversation Analysis: A New Model of Research in Doctor-Patient Communication”. Journal of the Royal Society of Medicine 90: 205–208. Google Scholar logo with link to Google Scholar
Plum, Alan. 1981. “Communication as Skill: A Critique and Alternative Proposal”. Journal of Humanistic Philosophy 21: 3–19. Google Scholar logo with link to Google Scholar
Recanati, François. 1989. “The Pragmatics of What Is Said”. Mind and Language 4. Reprinted in 1991 in Pragmatics: A Reader, edited by Steven Davis, 97–120. Oxford: Oxford University Press.Google Scholar logo with link to Google Scholar
. 2010. Truth-Conditional Pragmatics. Oxford: Clarendon Press. Google Scholar logo with link to Google Scholar
Rossi, Maria Grazia and Srikant Sarangi. 2021. “Communication Skills, Expertise and Ethics in Healthcare Education and Practice”. Rivista Italiana di Filosofia del Linguaggio 15: 106–122.Google Scholar logo with link to Google Scholar
Rossi, Maria Grazia, Fabrizio Macagno, and Sarah Bigi. 2022. “Dialogical Functions of Metaphors in Medical Interactions”. Text & Talk 42: 77–103. Google Scholar logo with link to Google Scholar
Sacks, Harvey, Emmanuel A. Schegloff, and Gail Jefferson. 1974. “A Simplest Systematics for the Organization of Turn-Taking for Conversation”. Language 50: 696–735. Google Scholar logo with link to Google Scholar
Saul, Jennifer. 2002. “What Is Said and Psychological Reality; Grice’s Project and Relevance Theorists’ Criticisms”. Linguistics and Philosophy 25: 347–372. Google Scholar logo with link to Google Scholar
Sayre-McCord, Geoff. 2012. “Metaethics.” In Stanford Encyclopedia of Philosophy (online), edited by Edward Zalta. [URL] [accessed 5 August 2021].
Sbisà, Marina. 2020. “Assertion among the Speech Acts”. In The Oxford Handbook of Assertion (online), edited by Sanford Goldberg. Oxford: Oxford University Press. Google Scholar logo with link to Google Scholar
Searle, John. R. 1969. Speech Acts: An Essay in the Philosophy of Language. Cambridge: Cambridge University Press. Google Scholar logo with link to Google Scholar
1990. “Collective Intentions and Actions”. In Intentions in Communication, edited by Philip R. Cohen, Jerry Morgan, and Martha E. Pollack, 401–415. Cambridge, MA: MIT Press.Google Scholar logo with link to Google Scholar
Silverman, Jonathan, Suzanne Kurtz, and Juliet Draper. 2013. Skills for Communicating with Patients. London: Ratcliffe Publishing. Third edition. First published in 1998.Google Scholar logo with link to Google Scholar
Snow, Rosamund. 2016. “I Never Asked to Be ICE’d.” The British Medical Journal 354: i3729.Google Scholar logo with link to Google Scholar
Sperber, Dan and Deirdre Wilson. 1995. Relevance: Communication and Cognition. Oxford: Blackwell. Second edition. First edition published in 1986.Google Scholar logo with link to Google Scholar
. 2012. “Pragmatics, Modularity and Mindreading”. In Meaning and Relevance, edited by Deirdre Wilson and Dan Sperber, 261–278. Cambridge: Cambridge University Press. First published in 2002 in Mind and Language 17. Google Scholar logo with link to Google Scholar
Stainton, Robert J. 2006. Words and Thoughts: Subsentences, Ellipsis, and the Philosophy of Language. Oxford: Clarendon. Google Scholar logo with link to Google Scholar
Strawson, Peter F. 1964. “Intention and Convention in Speech Acts”. Philosophical Review 73: 439–460. Google Scholar logo with link to Google Scholar
Todd, Alexandra. 1983. “A Diagnosis of Doctor – Patient Discourse in the Prescription of Contraception”. In The Social Organization of Doctor-Patient Communication, edited by Sue Fisher and Alexandra Todd, 159–188. Washington, D.C.: Center for Applied Linguistics.Google Scholar logo with link to Google Scholar
Zethsen, Karen Korning and Inger Askehave. 2005. “Medical Communication: Professional – Lay”. In Encyclopaedia of Language & Linguistics. Second edition, edited by Keith Brown, 644–649. Amsterdam: Elsevier.Google Scholar logo with link to Google Scholar
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