How do Doctors Use Language to Shape, Challenge and Form Relationships?

This month we published Reflective Writing in Medical Practice by Miriam A. Locher. In this post the author explains the focus of the book and how it came about.

This book is about the linguistic analysis of written reflective writing texts that were produced in the context of medical education and medical practice. The texts were collected from medical students from the University of Basel and the University of Nottingham (in connection with courses on communication skills in doctor-patient interaction), and are supplemented by a corpus of texts written by doctors for columns published in medical journals.

The genre of reflective writing has several purposes: it invites the writer to learn from a past experience and to reflect on potential future behaviour. In its focus on a past experience it involves narrative elements and in its trajectory on learning it involves reflection and projection. As a practice, the value of reflective writing has long been established within the medical humanities and medical professionals are encouraged to make reflective writing a life-long habit.

My own expertise in online health communication and (im)politeness studies led me to ask how medical students and doctors use language to shape, challenge and form relationships (a process for which I use the term ‘relational work’), and thus to study the texts in the reflective writing corpus from an interpersonal pragmatics perspective. In addition, the texts are explored with respect to topic, composition, and genre. In the book, we explore:

  • what topics and communication skills the authors write about
  • how the narratives develop
  • how these texts are shaped
  • what genres influence their composition
  • how relational work surfaces in them
  • how the writers linguistically create their identities as experts or novices

The medical humanities have long played an important role in medical training at the University of Basel. When I joined the staff of the English department in 2008, two important scholars on the medical humanities committee, Prof. Alexander Kiss (psychosomatics) and Prof. Franziska Gygax (English literary and cultural studies) approached me and we developed a joint interdisciplinary project entitled ‘Life (Beyond) Writing’: Illness Narratives, (funded by the Swiss National Science Foundation). This project joins the study of life writing, reflective writing and medical education. During the years that the project was funded, we have learnt from each others’ different ways of developing questions and approaching data. We also organized an interdisciplinary conference, which resulted in an edited collection (Narrative Matters across Disciplines in Medical Practice, Benjamins, 2015).

The current book is the result of the linguistic branch of the project, which deals with the reflective writing corpus as outlined above. Our collaborator Victoria Tischler (Nottingham) and the linguistics project member Regula Koenig were important team members throughout the genesis of the book. While bringing the ideas together as a whole and writing it up was a single-author experience, I feel indebted to both and therefore use the authorial “we” when writing. Without their help in obtaining data, coding and feedback, the completion of this project would not have been possible.

More information on the author can be found on her website.

More information on the interdisciplinary project can be found on the project website.

For more information about this book, please see our website. If you found this interesting, you might also like Medical Discourse in Professional, Academic and Popular Settings edited by Pilar Ordóñez-López and Nuria Edo-Marzá and English in Medical Education by Peih-ying Lu and John Corbett.


War – The Mother of all Metaphors in Cancer Discourse

This month we are publishing Medical Discourse in Professional, Academic and Popular Settings edited by Pilar Ordóñez-López and Nuria Edo-Marzá. This post debates whether some of the metaphors used to discuss cancer are more appropriate than others.

Medical Discourse in Professional, Academic and Popular SettingsCancer metaphors are not new. However, they still spur interest among researchers, patients, families and doctors. Are some metaphors more appropriate than others? Their use helps to create our mental image of the immensely diverse group of diseases we understand as cancer. In the same way, nonetheless, they can provide an excessively simplified or negative image of treatments.

While some studies have been critical of war metaphors for decades, others prefer to consider the validity of metaphors regarding their usefulness for the experience of each patient. While some patients can be encouraged to deal with the disease in terms of battling, others can suffer if they see themselves as the losers in a fight after doing their best. Therefore, some patients or professionals prefer to refer to cancer with other metaphors such “the disease as a journey”.

Two chapters in this new book, Medical Discourse in Professional, Academic and Popular Settings, address cancer metaphors from different perspectives. The first reviews metaphors used in a particular cancer type, lymphoma caused by human immunodeficiency virus (HIV), through the analysis of texts of different genres: research papers, science news and press articles. The most formal genre, the research article, reduces metaphor usage while press authors exploit metaphors more deliberately for discursive and argumentative purposes.

The next chapter focuses on analysing the case of the two FC Barcelona figures who were diagnosed with cancer, the player Eric Abidal and the manager Tito Vilanova. It concludes that the journalistic discourse on the disease, even in a sport context, is still dominated by the war metaphor. Although the two figures often used sport metaphors publicly (“I know I’m not playing this match alone”), as did the media (“Tito faces his most difficult match”, “Vilanova plays the hardest competition, cancer, against the worst rival, death”) war metaphors were predominant.

There are similarities between war and sport metaphors (two opposing teams, the battle/match, the winners/champions), but there are also differences. The losers in war are captured, humiliated, even killed. The loser in a football match may have the feeling of having played better than the opponent or think that they were just unlucky. The media collect different metaphors and sanction them through use. As we can see, although new metaphors are introduced and enjoy general acceptance in certain contexts, as happens with the sport metaphor, military alternatives are still the mother of metaphors when discussing cancer.

This interesting debate shows how to face the challenge of defining such a complex disease, one that scares us, a disease described by Dr. Siddhartha Mujkerhee – using a new metaphor – as “the emperor of all maladies”.

 English in Medical EducationFor further information about this book, please see our website. You might also be interested in English in Medical Education edited by Peih-ying Lu and John Corbett.

English in Medical Education, ESP and ELF

We published English in Medical Education by Peih-ying Lu and John Corbett last week.  Here, John answers our questions on, among other topics, the inspiration for the book and its unusual cover.

By Peih-ying Lu and John CorbettWhat inspired you to research English in medical education for this book?

Peih-ying (‘Peggy’) teaches English to pre-clinical students at Kaohsiung Medical University (KMU). She and I are both interested in intercultural language education. Peggy organised a conference at KMU in late 2008 on teaching cross-cultural competences in medical education, a conference that involved a number of experts in medical education from the USA and the UK as well as Taiwan. John attended this conference and chaired one of the sessions, and he and Peggy were both struck by the parallel concerns of medical education and intercultural language education. Both disciplines address the daunting challenge of going beyond the development of subject knowledge and skills to the nurturing of insight and appropriate attitudes to communication and human relationships. And both were experimenting with similar solutions – experiential learning based on problems or tasks, and cultural exploration through disciplines like ethnography and the arts. We became very excited by the possibility of bringing these two fields together – a few educators have already done some brilliant cross-disciplinary work in this area, but there seems room for much more.

How is your book different from others on English for Specific Purposes?

ESP is founded on two pillars: first, identifying students’ needs, and secondly, describing and teaching the language that will meet those needs. It sounds simple and logical, but obviously the definition of human ‘needs’ and the prescription of the language that meets  those needs – and then the teaching of it – is all very complicated. An intercultural approach to medical ESP allows us to step back from a narrow definition of needs and genres, to address broader issues of professionalism, or ‘social needs’, if you like. What kind of doctors and nurses does society want to have? What is ‘a good listener’? How might patients from different backgrounds ‘perform’ their illnesses? How do specialists and non-specialists talk about illness? How does the rise of internet-based health advice change the way doctors negotiate treatments with patients? What does the internet do to a doctor’s authority? How do patients characterise their problems on online medical chat-rooms? The intercultural ESP classroom becomes not just a place to learn the genres associated with the specialist discourse community, it becomes an arena where identities, attitudes and professional beliefs can be explored.

Who in particular do you hope will find your book useful?

This is a book for teachers of English to medical students, and for medical educators with an interest in communication and the arts.  One thing we realised when writing this book is that few universities with medical faculties remain untouched by the issues we raise in the book: universities in Anglophone countries have a substantial proportion of students from non-Anglophone countries, and many universities in non-Anglophone countries, like KMU, are delivering medical curricula – or part of their curriculum – in English. Medical education is increasingly under pressure to address issues of identity and professionalism – we are arguing that the English classroom is a legitimate place to address these issues. In the book we give our reasons why, and suggest how. More broadly, we think the book might interest ESP teachers and curriculum designers who want to look beyond narrower definitions of needs and genre analyses. These aspects of ESP courses are obviously important, but intercultural approaches to ESP can usefully address broader professional concerns. I have recently been doing work with students and teachers of tourism in Kaohsiung, and was interested to see that some of the recent literature on tourism and hospitality is drawing on the debates around codes of professionalism in medicine. We can see these debates impacting on other areas like banking, where professional conduct has come under scrutiny in the aftermath of the global financial crisis.

English is now a lingua franca for people of all nationalities and is one of the widest spoken in the world but do you ever think this will change?

Well, ‘lingua franca’ is a Latin expression, and look what happened to that language, over the centuries! Neither of us has a crystal ball, but it is difficult to see English being knocked off its pedestal as the default lingua franca any time soon – there is too much investment in English education globally, and global media – films, internet, games – reinforce its status. In a world of mass migration, too, healthcare workers are very likely to use English in their daily lives – an Italian doctor or a Filippino nurse might communicate with a Turkish patient, or the patient’s translator, through English. One of the general precepts of communication in English as a lingua franca, widely discussed in the literature, is the ‘let it pass’ principle, that is, if you don’t understand what someone is saying, you should simply let it pass and hope to get the gist of the meaning from the rest of conversation. This principle is of course problematical in medical contexts – healthcare providers can’t afford to let important details pass; they do have to work to understand their patients and to ensure that their own meanings are explicit and clear.

What is next for you in terms of research projects?

Peggy is heading for the USA in January 2013, and will be spending time at Harvard and Georgetown Universities on a Fulbright scholarship. She plans to make further observations of ways in which the medical humanities – particularly art and literature –are used in medical education programs there.  She is also working on ways of evaluating the interface between task-based language learning and By John Corbettproblem-based learning in medicine – how do the skills taught in the language classroom transfer to the medical classroom? In 2013, I am heading to Brazil for a spell, to Sao Paulo, and there I plan to begin working on a second edition of my 2003 book An Intercultural Approach to English Language Teaching. A lot has happened in the last decade, and I am looking forward to updating the volume.

Finally can you explain the relevance of the picture ‘A Loving Skin-graft’ which appears on the front cover?

That’s a great story, and we tell it in some detail in the book. Briefly, the painting portrays one of the first skin-graft operations to be conducted in Taiwan, in 1928. It was performed by a Scottish medical missionary, David Landsborough. A Chinese boy had presented at his hospital with a badly infected leg, apparently made worse by the application of Chinese folk remedies, and Landsborough decided to try the then-innovative procedure to save the leg. Landsborough’s wife, Marjorie, agreed to be the donor – she is faintly visible in the background of the painting. The first operation failed, but the boy recovered, and later, under Mrs Landsborough’s guidance, he became a Presbyterian minister. The story of the skin-graft operation later inspired Dr. Tsung-ming Tsu, the founder of the medical institution that eventually became KMU, to commission an artist, Shi Qiao Li, to commemorate the incident. For both of us, the painting is perfect for use in intercultural education: an Asian artist has adopted an impressionistic European style to portray an incident that has a strong didactic element. The painting embodies an ideological conflict between western science and Chinese folk medicine, and the missionary’s wife’s sacrifice has an allegorical religious significance. It was also commissioned specifically to inspire particular values in the students who viewed it. Today, we do try to deconstruct these elements in a more critical fashion when we use this painting in class. We treat it as a painting that is designed to disseminate values that can be contested. But, on a personal level, the painting also represents an intercultural encounter between Scotland and Taiwan, and, for obvious reasons, that resonates with us too!

English in Medical Education and An Intercultural Approach to English Language Teaching are both part of our Languages for Intercultural Communication and Education series.  Information on all of the titles can be found on our website here.