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Article published In:
Towards Culture(s) of Dialogue: Communicating Unity and Diversity through Language and Discourse
Edited by Urszula Okulska, Grzegorz Kowalski and Urszula Topczewska
[Language and Dialogue 12:2] 2022
► pp. 284–305

Shifting addressivity

In/Exclusionary practices in triadic medical interaction with unaccompanied foreign minors

| University of Bologna
| University of Bologna
| University of Bologna

In dealing with recent migration-related phenomena, inclusion has become an increasingly common normative ethical imperative in socio-political discourse. Considering inclusion as a situated interactive accomplishment, this article reports findings from a study on medical visits, each one involving a physician, an unaccompanied foreign minor (UFM) and a professional educator. Adopting a Conversation Analysis-informed approach to a corpus of video-recorded visits, we analyze (a) the physician’s shifts in addressivity, which either foster or hinder UFM’s inclusion during the history-taking phase, and b) when and how these shifts occur. We contend that, by shifting addressivity, the physician navigates the locally incompatible goals of gaining reliable information on UFM patients and fostering their active participation. We contend that the micro-practice of shifting addressivity is consistent with the management of cultural-linguistic diversity proposed by the intercultural dialogue perspective.

Keywords: triadic medical interaction, interactive inclusion, unaccompanied foreign minors, addressivity, intercultural dialogue
Article outline
  • 1.Introduction
  • 2.Unaccompanied Foreign Minors in an inclusion-oriented society
  • 3.Epistemic asymmetries and agency distribution in medical encounters
    • 3.1Triadic medical visits with UFMs: The multiple asymmetries at stake
    • 3.2The history-taking phase in triadic medical visits with UFMs
  • 4.Data and analytical procedures
  • 5.Addressing the patient vs the professional educator: The physician’s in/exclusionary practices
    • 5.1Inclusionary shift: From the professional educator to the patient
    • 5.2Exclusionary shift: From the patient to the professional educator
    • 5.3Ex/Inclusionary shifts: From the patient to the professional educator and back
  • 6.Discussion
  • 7.Concluding remarks: Finding a balance between inclusion and (unavoidable) exclusion
  • Notes
  • References
Published online: 8 August 2022
DOI logo
https://doi.org/10.1075/ld.00126.car
References (65)
Athreya, Balu H. and Benjamin K. Silverman
1985 Paediatric Physical Diagnosis. Upper Saddle River, NJ: Appleton and Lange.Google Scholar
Auer, Peter
2017 “Gaze, Addressee Selection and Turn-Taking in Three-Party Interaction.” InLiSt – Interaction and Linguistic Structures 601: 2–32.Google Scholar
Baraldi, Claudio and Laura Gavioli
2014 “Are Close Renditions the Golden Standard? Some Thoughts on Translating Accurately in Healthcare Interpreter-Mediated Interaction.” The Interpreter and Translator Trainer 8 (3): 336–353. DOI logoGoogle Scholar
Bazzanella, Carla, Cristina Bosco, Alessandro Garcea, Barbara G. Fivela, Johanna Miecznikowski, and Francesca T. Brunozzi
2007 “Italian allora, French alors: Functions, Convergences and Divergences.” Catalan Journal of Linguistics 61: 9–30. DOI logoGoogle Scholar
Berg, Marc
1996 “Practices of Reading and Writing: the Constitutive Role of the Patient Record in Medical Work.” Sociology of Health & Illness 18 (4): 499–524. DOI logoGoogle Scholar
Bolden, Galina B.
2000 “Toward Understanding Practices of Medical Interpreting: Interpreters’ Involvement in History Taking.” Discourse Studies 2 (4): 387–419. DOI logoGoogle Scholar
Boyd, Elizabeth and John Heritage
2006 “Taking the History: Questioning During Comprehensive History Taking.” In Communication in Medical Care: Interaction Between Primary Care Physicians and Patients, ed. by John Heritage and Douglas W. Maynard, 151–184. Cambridge, UK: Cambridge University Press. DOI logoGoogle Scholar
Byrne, Patrick S. and Barrie E. Long
1976 Doctors Talking to Patients. London: DHSS.Google Scholar
Caronia, Letizia and Franca Orletti
2019 “The Agency of Language in Institutional Talk: An Introduction.” Language and Dialogue 91: 1–27. DOI logoGoogle Scholar
Caronia, Letizia, Vittoria Colla, and Federica Ranzani
2020 “The Agency in Language and the Professionals’ Intercultural Competences: A Case Study on the Educators’ “Pivot Move” in Medical Visits of Unaccompanied Minors.” Civitas Educationis. Education, Politics, and Culture 9 (1): 1–24.Google Scholar
Caronia, Letizia, Federica Ranzani, and Vittoria Colla
2020 “ ‘I See You Have an Injury There’: Physician’s Communicative Practices Fostering Unaccompanied Minors’ Interactional Agency in the History-Taking Phase of the Medical Visit.” Journal of Health Care Education in Practice 2 (1): 45–55.Google Scholar
Castro, Eva., Tine Van Regenmortel, Kris Vanhaecht, Walter Sermeus, and Ann Van Hecke
2016 “Patient Empowerment, Patient Participation and Patient-Centeredness in Hospital Care: a Concept Analysis Based on a Literature Review.” Patient education and counseling 99 (12): 1923–1939. DOI logoGoogle Scholar
Colla, Vittoria, Federica Ranzani, and Letizia Caronia
2020 “Distributing Next Speakership. A Case Study on Doctor’s ‘Oscillating Addressivity’ in Triadic Medical Visits with Unaccompanied Minors.” Paper presented at ECCA2020, European Conference on Conversation Analysis, Radboud University in Nijmegen , NL , June 29–30, 2020.
Crowley, Caitlin
2009 “The Mental Health Needs of Refugee Children: a Review of Literature and Implications for Nurse Practitioners.” Journal of the American Academy of Nurse Practitioners 21 (6): 322–331. DOI logoGoogle Scholar
Deppermann, Arnulf
2013 “Turn-Design at Turn-Beginnings: Multimodal Resources to Deal with Tasks of Turn-Construction in German.” Journal of Pragmatics 461: 91–121. DOI logoGoogle Scholar
Derluyn, Ilse and Eric Broekaert
2008 “Different Perspectives on Emotional and Behavioural Problems in Unaccompanied Refugee Children and Adolescents.” Ethnicity and Health 12 (2): 141–162. DOI logoGoogle Scholar
Drew, Paul
2013 “Turn Design.” In The Handbook of Conversation Analysis, edited by Tania Stivers and Jack Sidnell, 131–149. Hoboken, NJ: Wiley-Blackwell.Google Scholar
Finlay, William M. L., Charles Antaki, Chris Walton, and Penny Stribling
2008 “The Dilemma for Staff in ‘Playing a Game’ with a Person with Profound Intellectual Disabilities: Empowerment, Inclusion and Competence in Interactional Practice.” Sociology of Health & Illness 30 (4): 531–549. DOI logoGoogle Scholar
Galatolo, Renata and Letizia Cirillo
2017 “Collective Evaluation in Specialized Medical Consultations: The Co-Construction of the Diagnostic Object.” Journal of Applied Linguistics and Professional Practice 10 (3): 337–361. DOI logoGoogle Scholar
Ganesh, Shiv and Prue Holmes
2011 “Positioning Intercultural Dialogue – Theories, Pragmatics, and an Agenda.” Journal of International and Intercultural Communication 4 (2): 81–86. DOI logoGoogle Scholar
Garcia, Angela C.
2012 “Medical Problems Where Talk Is the Problem: Current Trends in Conversation Analytic Research on Aphasia, Autism Spectrum Disorder, Intellectual Disability, and Alzheimer’s.” Sociology Compass 6 (4): 351–364. DOI logoGoogle Scholar
Garfinkel, Harold and Lawrence Wieder
1992 “Two Incommensurable, Asymmetrically Alternate Technologies of Social Analysis.” In Text in Context: Contributions to Ethnomethodology, ed. by Graham Watson and Robert M. Seiler, 175–206. Newbury Park: Sage Publications.Google Scholar
Goodwin, Charles
2000 “Action and Embodiment within Situated Human Interaction.” Journal of Pragmatics 321: 1489–1522. DOI logoGoogle Scholar
Have ten, Paul
1989 “The Consultation as a Genre.” In Text and Talk as Social Practice, ed. by Brian Torode, 115–135. Dordrecht/Providence, R.I.: Foris Publications. DOI logoGoogle Scholar
1991 “Talk and Institution: A Reconsideration of the “Asymmetry” of Doctor-Patient Interaction.” In Talk and Social Structure: Studies in Ethnomethodology and Conversation Analysis, ed. by Deirdre Boden, and Don H. Zimmerman, 138–163. Los Angeles: University of California Press.Google Scholar
Hayashi, Makoto
2013 “Turn Allocation and Turn Sharing.” In The Handbook of Conversation Analysis, ed. by Jack Sidnell, and Tania Stivers, 167–190. Chichester, England: Wiley Blackwell.Google Scholar
Heath, Christian
1992 “Diagnosis and Assessment in the Medical Consultation.” In Talk at work: Interaction in Institutional Settings, ed. by Paul Drew, and John Heritage, 235–267. Cambridge: Cambridge University Press.Google Scholar
Heritage, John
2010 “Questioning in Medicine”. In “Why do you ask?”: The Function of Questions in Institutional Discourse, ed. by Alice Freed, and Susan Ehrlich, 42–68. New York: Oxford University Press.Google Scholar
2012 “Epistemics in Action: Action Formation and Territories of Knowledge.” Research on Language and Social Interaction 45 (1): 1–29. DOI logoGoogle Scholar
2018 “The Expression of Authority in US Primary Care: Offering Diagnoses and Recommending Treatment.” Georgetown University Round Table, Approaches to Discourse.Google Scholar
Heritage, John and Douglas W. Maynard
(eds.) 2006a Communication in Medical Care: Interactions Between Primary Care Physicians and Patients. Cambridge: Cambridge University Press. DOI logoGoogle Scholar
2006b “Problems and Prospects in the Study of Physician-Patient Interaction: 30 Years of Research.” Annual Review of Sociology 321: 351–374. DOI logoGoogle Scholar
Heritage, John and Jeffrey D. Robinson
2006 “The Structure of Patients’ Presenting Concerns: Physicians’ Opening Questions.” Health Communication 19 (2): 89–102. DOI logoGoogle Scholar
Jefferson, Gail
2004 “Glossary of Transcript Symbols with an Introduction”. In Conversation Analysis: Studies from the First Generation, ed. by Gene H. Lerner, 13–31. Amsterdam: John Benjamins. DOI logoGoogle Scholar
Lerner, Gene H.
2003 “Selecting Next Speaker: The Context-Sensitive Operation of a Context-Free Organization.” Language in Society 321: 177–201. DOI logoGoogle Scholar
Linell, Per, Lennart Gustavsson, and Paivi Juvonen
1988 “Interactional Dominance in Dyadic Communication: A Presentation of Initiative-Response Analysis.” Linguistics 26 (3): 415–442. DOI logoGoogle Scholar
Lynch, Margaret A.
2001 “Providing Health Care for Refugee Children and Unaccompanied Minors.” Medicine, Conflict and Survival 17 (2): 125–130. DOI logoGoogle Scholar
Maynard, Douglas W.
2006 “Ethnography and Conversation Analysis. What is the context of an utterance?” In Emergent Methods in Social Research, ed. by Sharlene Hesse-Biber, and Patricia Leavy, 55–94. Thousand Oaks, CA: Sage Publications. DOI logoGoogle Scholar
Mead, Nicola, and Peter Bower
2000 “Patient-Centredness: a Conceptual Framework and Review of the Empirical Literature.” Social Science & Medicine 51 (7): 1087–1110. DOI logoGoogle Scholar
Mishler, Elliot G.
1984 The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, NJ: Ablex.Google Scholar
Moerman, Michael
[1988] 2010 Talking Culture: Ethnography and Conversation Analysis. Philadelphia, PA: University of Pennsylvania Press. DOI logoGoogle Scholar
Mondada, Lorenza
2007 “Multimodal Resources for Turn-Taking: Pointing and the Emergence of Possible Next Speakers.” Discourse studies 9 (2): 194–225. DOI logoGoogle Scholar
2016 “Multimodal Resources and the Organization of Social Interaction.” In Verbal Communication, ed. by Andrea Rocci, and Louis de Saussure, 329–350. Berlin: De Gruyter. DOI logoGoogle Scholar
Muntigl, Peter, Stephanie Hödl, and Gerhard Ransmayr
2014 “Epistemics and Frontotemporal Dementia.” Ricerche Di Pedagogia E Didattica. Journal of Theories and Research in Education 9 (1): 69–95.Google Scholar
Ochs, Elinor, Tamar Kremer-Sadlik, Olga Solomon, and Karen G. Sirota
2001 “Inclusion as Social Practice: Views of Children with Autism.” Social Development 10 (3): 399–419. DOI logoGoogle Scholar
Orletti, Franca
2000 La conversazione diseguale. Potere e interazione. Roma: Carocci.Google Scholar
Peräkylä, Anssi
1998 “Authority and Accountability: The Delivery of Diagnosis in Primary Health Care.” Social Psychology Quarterly 61 (4): 301–320. DOI logoGoogle Scholar
2002 “Agency and Authority: Extended Responses to Diagnostic Statements in Primary Care Encounters.” Research on Language and Social Interaction 35 (2): 219–247. DOI logoGoogle Scholar
Pino, Marco
2013 “Gli educatori sono consapevoli del peso delle parole? Educatori e utenti nell’incontro faccia a faccia” [Are social workers aware of the strength of words? Social workers and clients in face-to-face encounter]. Animazione Sociale, agosto/settembre: 42–53.Google Scholar
Robinson, Jeffrey D.
1998 “Getting Down to Business: Talk, Gaze, and Body Orientation During Openings of Doctor-Patient Consultations.” Human Communication Research 251: 98–124. DOI logoGoogle Scholar
2001 “Asymmetry in Action: Sequential Resources in the Negotiation of a Prescription Request.” Text & Talk 21 (1–2): 19–54. DOI logoGoogle Scholar
2003 “An Interactional Structure of Medical Activities During Acute Visits and Its Implications for Patients’ Participation.” Health Communication 15(1): 27–59. DOI logoGoogle Scholar
Rossano, Federico and Tania Stivers
2010 “Mobilizing Response.” Research on Language and Social Interaction 431: 3–31. DOI logoGoogle Scholar
Sacks, Harvey, Emmanuel A. Schegloff, and Gail Jefferson
1974 “A Simplest Systematics for the Organization of Turn-Taking for Conversation.” Language 501: 696–735. DOI logoGoogle Scholar
Sterponi, Laula, Cristina Zucchermaglio, Francesca Alby, and Marilena Fatigante
2017 “Endangered Literacies? Affordances of Paper-Based Literacy in Medical Practice and Its Persistence in the Transition to Digital Technology.” Written Communication 34 (4): 359–386. DOI logoGoogle Scholar
Stivers, Tania
2002a “Presenting the Problem in Pediatric Encounters: ‘Symptoms Only’ versus ‘Candidate Diagnosis’ Presentations.” Health Communication 14 (3): 299–338. DOI logoGoogle Scholar
2002b “Participating in Decisions about Treatment: Overt Parent Pressure for Antibiotic Medication in Pediatric Encounters.” Social science & medicine 54 (7): 1111–1130. DOI logoGoogle Scholar
2005 “Parent Resistance to Physicians’ Treatment Recommendations: One Resource for Initiating a Negotiation of the Treatment Decision.” Health communication 18 (1): 41–74. DOI logoGoogle Scholar
2007 Prescribing Under Pressure. Parents-Physician Conversations and Antibiotics. Oxford: Oxford University Press. DOI logoGoogle Scholar
Stivers, Tania, John Heritage, Rebecca K. Barnes, Rose McCabe, Laura Thompson, and Merran Toerien
2018 “Treatment Recommendations as Actions.” Health Communication 331: 1335–1344. DOI logoGoogle Scholar
Tates, Kiek and Ludwien Meeuwesen
2001 “Doctor–Parent–Child Communication. A (Re)View of the Literature.” Social Science & Medicine 52 (6): 839–851. DOI logoGoogle Scholar
Taurino, Alessandro, Leonarda V. Vergatti, M. Teresa Colavitto, Paola Bastianoni, Silvia Godelli, and Emanuele Del Castello
2012 “The Unaccompanied Foreign Minors between Trauma and Repair Interventions. A Study on Post-Traumatic Stress Disorder, Anxiety, Depression and Dissociative Tendencies in Young Migrants Living in Community Health Centers.” Infanzia e adolescenza 11 (1): 47–64.Google Scholar
Weiste, Elina, Melisa Stevanovic, and Camilla Lindholm
2020 “Introduction: Social Inclusion as an Interactional Phenomenon.” In Joint Decision Making in Mental Health. The Language of Mental Health, ed. by Camilla Lindholm, Melisa Stevanovic, and Elina Weiste, 1–41. Cham: Palgrave Macmillan. DOI logoGoogle Scholar
Zucchermaglio, Cristina, Francesca Alby, and Marilena Fatigante
2016 “What Counts as Illness? Anamnesis as a Collaborative Activity.” Testing, Psychometrics, Methodology in Applied Psychology 23 (4): 471–487.Google Scholar
Cited by (2)

Cited by 2 other publications

Caronia, Letizia, Federica Ranzani & Vittoria Colla
2023. Chapter 6. Pursuing understanding or engaging the patient?. In A Pragmatic Agenda for Healthcare [Pragmatics & Beyond New Series, 338], ► pp. 144 ff. DOI logo
Caronia, Letizia, Vittoria Colla & Federica Ranzani
2022. Practices of Inclusion in Primary Care Visits of Unaccompanied Foreign Minors: Allocating Agency as an Interprofessionally Distributed Intercultural Competence. In Interculturality in Institutions [Culture in Policy Making: The Symbolic Universes of Social Action, ], ► pp. 209 ff. DOI logo

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