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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. 200–226

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Chapter 8
Metapragmatics and reflections in support of knowledge transfer and common ground in doctor-patient interaction

 | Eötvös Loránd University
 | Hungarian Research Centre for Linguistics
Published online: 17 November 2023
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https://doi.org/10.1075/pbns.338.08kun
Abstract
In doctor-patient interactions, successful knowledge transfer and mutual understanding play a key role. To achieve them, participants need to construct common ground and collaborate jointly on meanings, while also overcoming difficulties arising from asymmetry of knowledge. These processes are often supported by a meta-management of discourse, mainly by the use of metapragmatic reflections. This paper investigates the metapragmatic expressions and meta-comments in 24 doctor-patient interactions, including 4 G.P. consultations, 12 dental appointments and 8 educational videos. The analysis demonstrates that metapragmatic reflections and comments may serve as an important means for the dynamic management of knowledge transfer and common ground in the domains of information, interaction and feelings, and help to adjust attention, negotiate interpretations, and resolve misunderstandings in the consultations.
Article outline
  • 1.Introduction
  • 2.Metapragmatic reflections and common ground in doctor-patien-interactions
    • 2.1Metapragmatic reflections and the management of discourse
    • 2.2The role of common ground and mutual understanding in succesful communication
    • 2.3Metapramatic reflection, knowledge sharing and common ground in doctor-patient interactions
  • 3.Research material, methods and questions
    • 3.1Data
    • 3.2Defining metapragmatic reflections for annotation
  • 4.Results
    • 4.1Content (propositional) information and knowledge
    • 4.2The process and activities of interaction
      • 4.2.1Reflection on actions as interaction management
      • 4.2.2Reflecting on the doctor’s actions
      • 4.2.3Therapy meta-discourse
      • 4.2.4Discourse marker concerning actions (understanding and acceptance)
    • 4.3Emotions and feelings (inner states)
  • 5.Summary
  • Notes
  • References
  • Appendix
References (50)
References
Bálint, Katalin, Tamás Nagy, and Márta Csabai. 2014. “The Effect of Patient-centeredness and Gender of Professional Role Models on Trainees’ Mentalization Responses. Implication for film-aided education.” Patient Education and Counseling 97: 52–58. Google Scholar logo with link to Google Scholar
Bigi, Sarah. 2016. Communicating (with) Care. A Linguistic Approach to the Study of Doctor-Patient Interactions. Amsterdam/Berlin/Washington: IOS.Google Scholar logo with link to Google Scholar
Bublitz, Wolfram and Axel Hübler (eds). 2007. Metapragmatics in Use. Amsterdam/Philadelphia: John Benjamins. Google Scholar logo with link to Google Scholar
Caffi, Claudia. 1994. “Metapragmatics.” In Encyclopedia of Language and Linguistics, edited by Ron E. Asher, 2461–2466. Oxford: Pergamon.Google Scholar logo with link to Google Scholar
. 2006. “Metapragmatics.” In Encyclopedia of Language and Linguistics, 2nd edited, edited by Keith Brown, 82–88. Amsterdam: Elsevier. Google Scholar logo with link to Google Scholar
. 2016. “Revisiting Metapragmatics: What Are We Talking About?” In Pragmemes and Theories of Language Use, edited by Keith Allan, Alessandro Capone, and Istvan Kecskes, 799–821. Cham, Heidelberg, New York, Dordrecht and London: Springer. Google Scholar logo with link to Google Scholar
Ciliberti, Anna, and Laurie Anderson. 2007. “Metapragmatic Comments in Institutional Talk: A Comparative Analysis across Settings.” In Metapragmatics in Use, edited by Wolfram Bublitz, and Alex Hübler, 143–166. Amsterdam/Philadelphia: John Benjamins. Google Scholar logo with link to Google Scholar
Clark, Herbert. 1996. Using Languages. Cambridge: Cambridge University Press. Google Scholar logo with link to Google Scholar
Cohen-Cole, Steven A. (ed). 1991. The Medical Interview: The Three Functional Approach. St. Louis: Mosby Year Book.Google Scholar logo with link to Google Scholar
Csabai, Márta, Ilona Csörsz, and Katalin Szili 2009. A gyógyító kapcsolat élménye. Kézikönyv és oktatólemez a kapcsolati készségek fejlesztéséhez [The experience of a healing relationship. Handbook and educational CD-ROM for the development of relationship-oriented skills]. Budapest: Oriold és Társai Kiadó.Google Scholar logo with link to Google Scholar
Dingwall, Robert, and Alison Pilnick. 2020. “Shared Decision Making: Doctors Have Expertise that Patients Want or Need.” British Medical Journal 2020, 368:m128. Google Scholar logo with link to Google Scholar
Flavell, John H. 1979. “Metacognition and Cognitive Monitoring: A New Area of Cognitive – Developmental Inquiry.” American Psychologist 34 (10): 906–911. Google Scholar logo with link to Google Scholar
Fong Ha, Jennifer, Dip Surg Anat, and Nancy Longnecker. 2010. “Doctor-Patient Communication: A Review.” The Ochsner Journal 10 (1): 38–43.Google Scholar logo with link to Google Scholar
Frankel, Richard M. 1984. “From Sentence to Sequence: Understanding the Medical Encounter through Microinteractional Analysis.” Discourse Process 7: 135–70. Google Scholar logo with link to Google Scholar
Hadley, Gregory. 2017. Grounded Theory in Applied Linguistics Research. A Practical Guide. London/New York: Routledge. Google Scholar logo with link to Google Scholar
Hámori, Agnes. 2019. “A metanyelvi és metapragmatikai tudatosság jelzései óvodáskorban: 6 éves gyermekek társalgásainak metapragmatikai elemzése [Signals of metalinguistic and metapragmatic awareness in preschool age: metapragmatic analysis of conversations between 6-years-old children].” In Az anyanyelv fejlődése 3 éves kor után [First language development after age 3], edited by Judit Bóna, and Viktória Horváth, 17–38. Budapest: Eötvös Kiadó.Google Scholar logo with link to Google Scholar
Heritage, John, and Douglas W. Maynard (eds). 2006. Communication in Medical Care. Interaction between Primary Care Physicians and Patients. Cambridge: Cambridge University Press. Google Scholar logo with link to Google Scholar
Heritage, John, and Tanya Stivers. 1999. “Online Commentary in Acute Medical Visits: A Method of Shaping Patient Expectations.” Social Science and Medicine 49 (11): 1501–1517. Google Scholar logo with link to Google Scholar
Horton, William S. 2012. “Shared Knowledge, Mutual Understanding, and Meaning Negotiation.” In Cognitive Pragmatics, edited by Hans-Jörg Schmid, 375–404. Berlin / New York: Mouton de Gruyter. Google Scholar logo with link to Google Scholar
Hübler, Axel, and Wolfram Bublitz. 2007. “Introducing Metapragmatics in Use.” In Metapragmatics in Use, edited by Wolfram Bublitz, and Axel Hübler, 1–26. Amsterdam/Philadelphia: John Benjamins. Google Scholar logo with link to Google Scholar
Kádár, Dániel Z., and Michael Haugh. 2013. Understanding Politeness. Cambridge: Cambridge University Press. Google Scholar logo with link to Google Scholar
Kecskes, Istvan. 2008. “Dueling Contexts: A Dynamic Model of Meaning”. Journal of Pragmatics. 40: 385–406. Google Scholar logo with link to Google Scholar
. 2014. Intercultural Pragmatics. Oxford: Oxford University Press.Google Scholar logo with link to Google Scholar
Kecskes, Istvan, and Fenghui Zhang. 2009. “Activating, Seeking, and Creating Common Ground: A Socio-cognitive Approach.” Pragmatics & Cognition 17 (2): 331–355. Google Scholar logo with link to Google Scholar
Kuckartz, Udo, and Stefan Rüdiker. 2019. Analyzing Qualitative Data with MAXQDA. Text, Audio, and Video. Cham: Springer. Google Scholar logo with link to Google Scholar
Kuna, Ágnes. (2024, forthc.). Az orvos-beteg kommunikáció nyelvészeti elemzése. Elmélet, gyakorlat, módszer [Linguistic analysis of healthcare communication. Theory, method and praxis]. Budapest: Eötvös Könyvkiadó.Google Scholar logo with link to Google Scholar
Kuna, Ágnes, and Ágnes Hámori. 2019. “Hallgatom, mi a panasz? A metapragmatikai reflexiók szerepei és mintázatai az orvos-beteg interakciókban [I’m listening, what is the problem? On the role and patterns of metapragmatic reflections in doctor-patient interactions].” In Kontextualizáció és metapragmatikai tudatosság [Contextualization and metapragmatic awareness], edited by Krisztina Laczkó, and Szilárd Tátrai, 260–283. Budapest: Eötvös Collegium.Google Scholar logo with link to Google Scholar
Liu, Ping, and Huiying Liu. 2017. “Creating Common Ground: The Role of Metapragmatic Expressions in BELF Meeting Interactions.” Journal of Pragmatics 107: 1–15. Google Scholar logo with link to Google Scholar
Liu, Ping, and Yongping Ran. 2016. “Creating Meso-contexts: The Functions of Metapragmatic Expressions in Argumentative TV Talk Shows.” Intercultural Pragmatics 13 (2): 283–307. Google Scholar logo with link to Google Scholar
Liu, Ping, and Xiaoye You 2019. “Metapragmatic Comments in Web-based Intercultural Peer Evaluation.” Intercultural Pragmatics 16 (1): 57–83. Google Scholar logo with link to Google Scholar
Lucy, John A. 1993. “General Introduction.” In Reflexive Language: Reported Speech and Metapragmatics, edited by John A. Lucy, 1–4. Cambridge: Cambridge University Press. Google Scholar logo with link to Google Scholar
Maynard, Douglas W. 1991. “Interaction and Asymmetry in Clinical Discourse.” American Journal of Sociology 97 (2): 448–495. Google Scholar logo with link to Google Scholar
Muntigl, Peter. 2007. “A Metapragmatic Examination of Therapist Reformulations.” In Metapragmatics in use, edited by Wolfram Bublitz, and Alex Hübler, 235–262. Amsterdam/Philadelphia: John Benjamins. Google Scholar logo with link to Google Scholar
Muntigl, Peter, and Dam Horvath. 2005. “Language, Psychotherapy and Client Change. An Interdisciplinary Perspective.” In A New Agenda in (Critical) Discourse Analysis. Theory, Methodology and Interdisciplinarity. (Discourse approaches to politics, society and culture 13), edited by Ruth Wodak, and Paul Chilton, 213–239. Amsterdam/Philadelphia: John Benjamins. Google Scholar logo with link to Google Scholar
Nowak, Peter. 2009. Eine Systematik sprachlichen Handelns von Ärzt/inn/en. Metastudie über Diskursforschungen zu deutschsprachigen Arzt-Patinet-Interaktionen. Frankfurt am Main: Peter Lang.Google Scholar logo with link to Google Scholar
Penz, Hermine. 2007. “Building Common Ground through Metapragmatic Comments in International Project Work.” In Metapragmatics in Use, edited by Wolfram Bublitz, and Axel Hübler, 263–292. Amsterdam/Philadelphia: John Benjamins. Google Scholar logo with link to Google Scholar
Pilnick, Alison, and Robert Dingwall. 2011. “On the Remarkable Persistence of Asymmetry in Doctor/Patient Interaction: A Critical Review.” Social Science & Medicine 72 (8): 1374–1382. Google Scholar logo with link to Google Scholar
Rossi, Maria Grazia, and Fabrizio Macagno. 2019. “Coding Problematic Understanding in Patient – Provider Interactions.” Health Communication 35 (12): 1487–1496. Google Scholar logo with link to Google Scholar
Selting, Margret, Peter Auer, Dagmar Barth-Weingarten, Jörg Bergmann, Pia Bergmann, Karin Birkner, Elizabeth Couper-Kuhlen, Arnulf Deppermann, Peter Gilles, Susanne Günthner, Martin Hartung, Friederike Kern, Christine Mertzlufft, Christian Meyer, Miriam Morek, Frank Oberzaucher, Jörg Peters, Uta Quasthoff, Wilfried Schütte, and Susanne Uhmann. 2011. “A System for Transcribing Talk-in-Interaction: GAT 2” Translated and Adapted for English by Elizabeth Couper-Kuhlen and Dagmar Barth-Weingarten. Gesprüchsforschung 12: 1–51.Google Scholar logo with link to Google Scholar
Semino, Elena, Zsófia Demjén, and Jane Demmen. 2018. “An Integrated Approach to Metaphor and Framing in Cognition, Discourse, and Practice, with an Application to Metaphors for Cancer.” Applied Linguistics 39 (5): 625–645. Google Scholar logo with link to Google Scholar
Skordai, Anna. 2019. Ön-és tudásreprezentáció a fogorvosi kommunikációban [Knowledge- and self-representation in dental appointments]. Budapest: KRE. MA-thesis.Google Scholar logo with link to Google Scholar
Smith, Sara W., and Liang Xiaoping. 2007. “Metapragmatic Expressions in Physics Lectures.” In Metapragmatics in Use, edited by Wolfram Bublitz, and Axel Hübler, 167–197. Amsterdam/Philadelphia: John Benjamins. Google Scholar logo with link to Google Scholar
Sterponi, Laura, Christina Zucchermaglio, Marilena Fatigante, and Francesca Alby. 2019. Structuring Times and Activities in the Oncology Visit. Social Science & Medicine 228:211–222. Google Scholar logo with link to Google Scholar
Tátrai, Szilárd. 2011. Bevezetés a pragmatikába. Funkcionális kognitív megközelítés [Introduction to pragmatics. A functional cognitive approach]. Budapest: Tinta Könyvkiadó.Google Scholar logo with link to Google Scholar
Tomasello, Michael. 1999. The Cultural Origins of Human Cognition. Cambridge, MA: Harvard University Press.Google Scholar logo with link to Google Scholar
Verschueren, Jef. 1999. Understanding Pragmatics. London: Arnold.Google Scholar logo with link to Google Scholar
. 2000. “Notes on the Role of Metapragmatic Awareness in Language Use.” Pragmatics 10 (4): 439–456.Google Scholar logo with link to Google Scholar
Wasserman, Richard C., and Thomas S. Inui. 1983. “Systematic Analysis of Clinician-Patient Interactions: A Critique of Recent Approaches with Suggestions for Future Research.” Medical Care 21 (3): 279–293. Google Scholar logo with link to Google Scholar
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