Communication in the hospital setting: A survey of medical and everyday language use amongst patients, nurses and doctors

doi:10.1016/0277-9536(89)90035-X

Social Science & Medicine

Volume 28, Issue 4, 1989, Pages 339-346

https://doi.org/10.1016/0277-9536(89)90035-X Get rights and content

Abstract

Forty physicians, 40 student nurses, and 40 hospital patiemts were surveyed regarding their usage and evaluations of medical and everyday language use in the hospital setting. Medical language (ML) and everyday language (EL) were operationalized as distinct speech registers that doctors, nurses and patients can use in their encounters with each other. A complex interaction of speaker characteristics (bilingualism in ML and EL) motivational factors (accommodation theory), situational language norms in favor of communicative effectiveness, as well as status and power differentials that exist between health setting. While doctors reported using mostly ML with health professionals, they did report converging to the EL of their patients. However, patients and student nurses did not perceive doctors converging to the EL of their patient. Student nurses reported using an equal mixture of ML/EL with each other, while converging to the ML of the doctor and converging to the EL of their patients. The ‘communication broker’ role of the nurse was corroborated by perceptions of nurses' language use from all groups. Patients reported using mostly EL with each other while attempting to converge to the ML of the health professional. Nurses perceived these attempts to converge by the patients, but doctors did not report a change in the patients' register as a function of conversants. Regarding the evaluation of language use strategies, all groups felt that it was more appropriate for health professionals to converge to the EL of patients than to maintain ML. In conversations with health professionals, patient use of EL was seen as more appropriate than ML. Use of ML by health professionals was felt to be a source of problems for patients, while EL was seen to promote better understanding for patients. The results are discussed with regard to the interplay of factors influencing language choice strategies in complex organizational structures such as hospitals.

References (28)

P. Swenson
Communicating with surgeons is possible when you learn the language
AORN J.
(1984)
C.M. Eastwood
Nurse-patient communication skills in Northern Ireland
Int. J. Nurs. Stud.
(1985)
D. Pendleton
Doctor-patient communication: a review
J. Richards et al.
Doctor-patient communication in surgery
J. R. Soc. Med.
(1985)
J. Jaspars et al.
The consultation: a social psychological analysis
N. Scott et al.
“Patientspeak”: an exercise in communication
J. med. Educ.
(1984)
J. Samora et al.
Medical vocabulary knowledge among hospital patients
J. Hlth Human Behav.
(1961)
Handbook of Patients' Rights
(1984)
R.A. Hudson
Sociolinguistics
(1980)
H. Giles et al.
Speech and Social Evaluation
(1975)

R.Y. Bourhis

Language in ethnic interaction: a social psychological approach

H. Giles et al.

Towards a theory of language in ethnic group relations

H. Giles et al.

Speech accommodation theory: the first decade and beyond

C.R. Berger et al.

Some explorations in initial interactions and beyond: toward a developmental theory of interpersonal communication

Hum. Commun. Res.

(1975)

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^☆: An abridged version of this paper was presented at the Third International Conference on Social Psychology and Language, July 1987, University of Bristol, England. This paper was also presented at the Chedoke-McMaster Hospital Education Round, April 1987, Hamilton, Ontario, Canada.

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Communication in the hospital setting: A survey of medical and everyday language use amongst patients, nurses and doctors☆

Abstract

AORN J.

Int. J. Nurs. Stud.

Doctor-patient communication: a review

Doctor-patient communication in surgery

J. R. Soc. Med.

The consultation: a social psychological analysis

“Patientspeak”: an exercise in communication

J. med. Educ.

Medical vocabulary knowledge among hospital patients

J. Hlth Human Behav.

Handbook of Patients' Rights

Sociolinguistics

Speech and Social Evaluation

Language in ethnic interaction: a social psychological approach

Towards a theory of language in ethnic group relations

Speech accommodation theory: the first decade and beyond

Some explorations in initial interactions and beyond: toward a developmental theory of interpersonal communication

Hum. Commun. Res.