Communication and Medicine最新文献

This article presents a study on team talk in psychosocial rehabilitation with reference to collective decision making. It focuses on problem formulation processes that occur during weekly team meetings in a Swiss organization providing psychosocial rehabilitation to chronic mental health patients. The corpus of team meetings (34 hours of recorded talk) was analyzed along three narrative dimensions: participation framework, timeline organization and forms of evaluation. The analysis was supported by ethnographic information (field notes collected during participant observation over ten months), in order to access the local conception and organization of rehabilitation work, which is repeatedly referred to and reshaped through discourse. The discursive practices identified show that team members learn to formulate problems in a way that allows them to identify and plan interventions in line with their rehabilitation model and the actual opportunities they have. Further, the role-related forms of participation highlight how different professionals contribute to the problem formulation in specific ways. In sum, the interaction turns out to be strongly centralized around the role of a meeting coordinator, who is able to enhance the participation of the other team members and to build institutional narratives on the basis of individual contributions, carrying out discursive work that can be metaphorically described as the weaving and knotting threads that make up a tapestry.

Sickness does not involve just the human body but also has a psychological dimension, and a number of studies have identified the positive psychological potential of self-help books in relation to illness. This paper examines metaphorical mappings employed in describing cancer patients in self-help books, undertaking a comparison of an American and a Nigerian work and identifying new categorisations and highlighting their therapeutic potential. It seeks to answer the following questions: what new metaphorical categories can be identified in Nigerian and American self-help books?; what therapeutic potential do they have?; and what similarities/differences can be identified in these self-help books? The sample size is 102 self-help stories, of which 24 instances were considered relevant for close analysis. This study adopts the Conceptual Metaphor Theory (CMT) approach and employs the Metaphor Identification Procedure (MIP) and methodologies concerned with the comparison and categorisation of metaphoric membership. The findings focus on four metaphorical categories: military, journey, personification and sports. The difference between the Nigerian and American self-help books lies in the contextualised manner of metaphorical presentation. In particular, the findings highlight sports metaphors in the American books as possessing more therapeutic tendencies due to the presence of humour, trivialisation, self-deprecation and satire. This category reflects that humour can ease stress and anxiety/panic and aid relaxation.

In Nigeria, diagnoses of schizophrenia and descriptions of its symptoms and experiences are shaped by numerous biomedical and sociocultural perspectives. However, although many studies have focused on the social realities and public attitudes towards the disorder, the interactional means of how its diagnoses and experiences are constituted in psychiatric interviews have not hitherto received close attention from linguists in Nigeria. This paper thus examines a corpus of 56 audio recorded interviews in mental health clinics in southwestern Nigeria, using insights from Arundale's concept of communicating and relating and Stalnaker's notion of common ground. It observes that diagnoses of the disorder do not subscribe to any rigid diagnostic pathways, but evolve from the relational, provisional and operative interpretation of the design of its experiences and other shared contextual situations that collectively instantiate the knowledge of mental illness in Nigeria.

Medical humour within the medical community is a diverse and contextualised phenomenon that includes 'difficult' material that is cognitively challenging to non-insiders. This paper addresses the under-researched topic of medical students' humour and its link to medical identity formation, by exploring how the humour preferences of medical students from different cohorts regarding medical memes reflects changes in their medical identity at different stages of their studies. A total of 216 medical students rated 50 medically related memes of different difficulty levels targeting doctors, patients, students and other medical issues. The results reveal that when comparing cohorts earlier in their studies vs. later on, doctor- and student-targeted memes become less and less popular while the popularity of memes about patients and other medical issues remain stable. Overall, students find memes about doctors the least funny. Simple memes also were funnier for students early in their studies compared with those approaching graduation. Our findings indicate that students most strongly identify with student and doctor memes, as these concern their current and future selves most strongly. The fact that medical identity plays a significant role in medical humour preferences may indicate that students find insider humour emotionally bonding. Our study also shows the emotional influence of humour processing (represented by targets) can have a greater impact on students' humour preferences than the cognitive aspect (represented by difficulty levels).

This article looks at team talk in a validation committee meeting assessment of a guidance document text item. The item assessment was not evidence-based in terms of Evidence Based Medicine (EBM) criteria; instead, the item was assessed via the committee members present drawing on their clinical practitioner members' knowledge and professional experience. Analysis of the meeting reveals such apparently 'mere opinion' to be a systematic evaluation of professional knowledge and personal experiences, in ways 'compatible' with thought experiments. Thought experiments are argued to be a members' resource as well as an analyst's one, although their detailed occasionedness is not reducible to a constructivist formalisation. The article's approach is informed by ethnomethodology and conversation analysis, and while the use of thought experiments as a heuristic device in the analysis is controversial, a warrant for this is attempted. The research was undertaken to locate ways of understanding and supporting team members' work of robust and useful guidance content production. 'Validating' guidance is shown in-and-as the emergent collaborative work of the committee members themselves.

Giving patients a voice in medical consultations and encouraging patient-centered communication are essential to improving the effectiveness and appropriateness of medical treatments. However, this is often difficult to achieve when patients are children, as paediatricians prefer to interact with parents and need parental consent. Drawing on a corpus of 12 authentic interactions recorded in an Italian diabetes outpatient clinic, this paper investigates the ways in which migrant children exercise agency and how this can be supported by paediatric diabetologists and sometimes by their parents. Adopting a discourse analysis approach, the paper identifies two ways in which children assert their agency by displaying epistemic authority, namely (1) by taking initiatives to trigger talk, and (2) by accepting the floor from other participants. Children's initiatives are produced that provide information, ask questions and sometimes contradict adults' utterances. Paediatricians usually support children's exercise of agency in such cases. Children's agency can also be promoted when children do not take the floor spontaneously but are encouraged to speak by pediatricians, who invite them to elaborate on their answers by using minimal positive feedback, by asking questions and by formulating and encouraging children's answers. The findings also show how parents' competition to take or hold the floor can hamper children's agency.

Team meetings are central to social workers' decision-making practices. These meetings often function as a forum for collegial consultations, when applications are processed and recommendations on decisions are discussed. In this paper, we present findings from a case study on team talk and decision-making practices in gerontological social work. The data come from a body of material gathered within the framework of a larger project covering the process of assessing elder care for older persons in three Swedish municipalities. The case concerns an application, due to homelessness, from a couple for an apartment in special housing. The team meeting was analysed using a data-driven perspective within a micro-analytical approach to talk, focusing in detail on how conflicting perspectives in the assessment of the couple's needs are dealt with, and how tensions between divergent views and opinions are handled in relation to institutional and professional conversational frames. The findings show how the care managers (in Sweden the professional title for social workers working in elder care) negotiated the boundaries of responsibility and power within both the institutional and professional frames, revealing that the institutional frame dominated when it came to making decisions. The findings have implications for practice, as they give insight into the interactional dynamics involved in social workers' assessments when navigating different conversational frames within their decision-making practices.