Discursive Repetitions and Voices in Nigerain Clinical Meetings
Keywords:Nigerian consultative meetings; Discursive repetitions; Polyphony; Negotiation of clinical outcomes
This paper argues that discursive repetitions sometimes work to demonstrate multiple voices on diagnoses and health state assessments in Nigerian hospital meetings, and that they consequently exert an influence on the negotiation of clinical outcomes. Previous studies on discursive repetitions have acknowledged other-repetitions/reformulations in consultative meetings, but have neither focused on the occurrences of a combination of self and other repetitions nor connected them to the polyphonic dimensions of the interactions. For this paper, findings from 100 repetitions in 30 doctor-patient interactions in Out-Patient Department clinics are analysed with theoretical insights from the concept of tracking and the theory of polyphony. The analysis demonstrates how doctors, in producing diagnostic and post-diagnostic utterances, repeat non-contiguous constituents of their turns in a way that superposes the conjectural voice of the doctor, the medical institutional voice, the voice of medical science and the voice of culture . In some instances, the conjectural voice self-terminates; in others, it interlaces with institutional and medical voices and develops into diagnoses and post-diagnoses that are co-constituted and co-constructed by doctors and patients in a medley of repetitive and non-repetitive turns and that are predicated as attributes of patients. Doctors equally sometimes use contiguous repetitions to provide medical assessments of patients’ conditions. In these repetitions, the voices of medical science, medical institution and culture are echoed jointly or individually. These evaluations are singly constituted basically by the doctor, but are co-constructed in repetitive turns with patients as warnings and assurance. In both the diagnostic and the evaluative scenario, repetitive turns are negotiated with the parties’ common ground to produce three clinical outcomes: joint verdicts on patients’ health state, admittance of non-compliance with regimens and commitment to adherence.
Adegbite, Adewale and Akin Odebunmi. 2006. “Discourse Tact in Doctor-Patient Interactions in English: An Analysis of Diagnosis in Medical Communication in Nigeria.” Nordic Journal of African Studies 15(4): 499–519.
Amfo, Nana, Ekua Houphounet, Eugene Dordoye and Rachel Thompson. 2018. “The Expression of Mental Health Challenges in Akan.” International Journal of Language and Culture 5(1): 1–28.
Bakhtin, Mikhail. 1981. “Discourse in the Novel.” In The dialogic imagination: Four Essays, edited by M. Mikhail, 273-335. Texas: University of Texas Press.
Bendix, Torben. 1980. Din nervösa patient : Det terapeutiska samtalet: Introduktion till en undersökningsteknik du aldrig fick undervisning i. Lund: Studentlitteratur.
Bolden, Galina. 2000. “Toward Understanding Practices of Medical Interpreting: Interpreters’ Involvement in History Taking.” Discourse Studies 2(4): 387-419.
Boluwaduro, Eniola (2018): (Non) Adherence in Doctor/Patient Interactions in Nigerian HIV Clinics. PhD Thesis. University of Bayreuth. epub.uni-bayreuth.de/3828/ [01.02.2020].
Caffi, Claudia. 2002. Seilezioni di pragmaticalinguistica. Genova: Name.
Caffi, Claudia. 2007. Mitigation. Oxford: Elsevier.
Capone, Alesandro. 2005. “Pragmemes: A study with Reference to English and Italian”. Journal of Pragmatics 37: 1355-1371.
Ducrot, Oswald. 1972. Dire et ne pas dire. Hermann.
Fox, Barbara, Sandra Thompson, Cecilia Ford and Elizabeth Couper-Kuhlen. 2013. “Conversation Analysis and Linguistics”. In The Handbook of Conversation Analysis edited by Jack Sidnell and Tanya Stivers, 726-740. Chichester, UK:Wiley-Blackwell.
Kecskes, Istvan. 2014. Intercultural Pragmatics. Oxford: Oxford University Press.
Lindstrom, Nataliya. 2011. “Use of Other-repetitions/reformulations as Feedback by Foreign and Swedish Physicians in Medical Consultations.” In Proceedings of the 3rd Nordic Symposium on Multimodal Communication Vol 15 edited by Patrizia Paggio, Elisabeth Ahlsen, Jens Allwood, Kristiina Jokinen, CostanzaNavarretta, 10-17. Helsinki: Northern European Association for Language Technology.
Maynard, Douglas W. 1991. “The Perspective-Display Series and the Delivery and
Receipt of Diagnostic News”. In Talk and Social Structure. Studies in Ethnomethodology and Conversational Analysis edited by Deirdre Boden and Don H. Zimmerman, 164-192. Cambridge: Cambridge University Press.
Maynard, Douglas W. 2003. “Bad News Good News: Conversational Order in Everyday Talk and Clinical Settings”. Chicago: University of Chicago Press.
Maynard, Douglas W. 2004. “On Predicating a Diagnosis as an Attribute of a Person.” Discourse Studies 6(1): 53–76.
Mey, Jacob. 2001. Pragmatics. An Introduction. Malden: Blackwell.
Mey, Jacob. 2021. “In Tempore Opportuno: Of Certainty and Uncertainty in (Non) Time.” In Pragmatics, Discourse and Society: A Festschrift for Akin Odebunmi, edited by Niyi Osunbade, Foluke Unuabonah, Ayo Osisanwo, Funke Oni and Akin Adetunji, 1-25. Cambridge: Cambridge Scholars Publishing.
Mikesell, Lisa. 2009. “Conversational Practices of a Frontotemporal Dementia Patient and His Interlocutors.” Research on Language and Social Interaction, 42(2): 135–162.
Odebunmi, Akin. 2008. “Pragmatic Strategies of Diagnostic News Delivery in Nigerian Hospitals.” Linguistic Online 36(4): 21-37.
Odebunmi, Akin. 2016. “‘You didn't give me to go and buy’: Negotiating Accountability for Poor Health in Post-recommendation Medical Consultations.” Journal of Pragmatics 93: 1-15.
Odebunmi, Akin. 2018. “Current Approaches to Analysis in Pragmatics Research.” A presentation at the First Pragmatics Research Workshop of the Nigerian Pragmatics Association, Lagos State University, Nigeria, 18 July 2018.
Odebunmi, Akin. 2020. “Negotiating Patients’ Therapy Proposals in Paternalistic and Humanistic Clinics.” Pragmatics 31(1): 430-454.
Odebunmi, Akin and Oluwaseun Amusa. 2016. “Discursive Practices in STI/HIV Diagnostic Encounters in Ondo State, Nigeria.” In Grammar, Applied Linguistics and Society edited by Akin Odebunmi, Ayo Osisanwo, Helen Bodunde and Stella Ekpe, 502-545. Ile-Ife: Obafemi Awolowo University Press.
Roulet, Eddy. 2011. “Polyphony”. In Discursive Pragmatics edited by Jan Zienkowski, Jan Ola Ostman and Jef Verschueren, 208-222. Amsterdam: John Benjamins.
Salami, Foluke. 2007. A Speech Act Analysis of Doctor-patient Conversational Interactions in Selected Hospitals in Ibadan. Unpublished MA thesis, University of Ibadan.
Sigurd, D’hondt and Akin Odebunmi. 2019. “Identity and Consultative Differentiality in Nigerian Clinical Encounters.” Paper presented at the 16th International Pragmatics Conference held at the Hong Kong Polytechnic University, 9-14 June 2019.
Wei, Li and Mayouf Ali Mayouf. 2009. “The Effects of the Social Status of the Elderly in Libya on the Way they Institutionally Interact and Communicate with Younger Physicians.” Journal of Pragmatics 41(1): 136-146.
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