Discursive Repetitions and Voices in Nigerain Clinical Meetings

Abstract

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.