Cover not available
Article published In:
Language and Dialogue
Vol. 6:3 (2016) ► pp.395–421

Polyphony in a ward

Tracking professional theories in members’ dialogues

 | University of Bologna (Italy) / Niguarda Hospital in Milan (Italy)
Contemporary research on the communicative constitution of organization conceives organization as made up of multiple voices embodied in and enacted by the different actors inhabiting this social world. This paper illustrates the inner polyphony at play in the complex and sensitive workplace of an Intensive Care Unit. The study focuses on the diagnostic talk concerning infectious disease and on the communicative resources deployed by physicians to pursue or resist their often conflicting diagnostic trajectories and professional stances toward the use of antibiotics. Adopting a conversation analytical approach to video-recorded morning briefings, we will illustrate how polyphony characterises the team members’ conduct during this communicative event and the consequences this polyphony has on the decision-making process. As we will illustrate, in this as in most cases, the members of the community appear to be active users of their professional culture, yet are also — and unavoidably — its carriers.
Keywords: medical decision-making, Intensive Care Unit, poliphony, communicative constitution of organization (CCO), doctor-doctor interaction, diagnosis
Published online: 8 December 2016
DOI logo
https://doi.org/10.1075/ld.6.3.03car
References (70)
American Thoracic Society and Infectious Disease Society of America. 2005. “Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia.” American Journal of Respiratory and Critical Care Medicine 171 (4): 388–416. DOI logoGoogle Scholar
Anspach, Renee R. 1993. Deciding Who Lives: Fateful Choices in the Intensive-care Nursery. Berkeley, CA: University of California Press.Google Scholar
Ashcraft, Karen L., Timothy R. Kuhn, and François Cooren. 2009. “Constitutional Amendments: ‘Materializing’ Organizational Communication.” Academy of Management Annals 3 (1): 1–64. DOI logoGoogle Scholar
Atkinson, Paul. 1995. Medical Talk and Medical Work. The Liturgy of the Clinic. London: Sage.Google Scholar
. 1999. “Medical Discourse, Evidentiality and the Construction of Professional Responsibility.” In Talk, Work and Institutional Order. Discourse in Medical, Mediation and Management settings, ed. by Srikant Sarangi, and Celia Roberts, 75–108. Berlin/New York: Mouton de Gruyter. DOI logoGoogle Scholar
Bakhtin, Michael M. 1981. The Dialogic Imagination: Four Essays by M.M. Bakhtin. Austin, TX: University of Texas Press.Google Scholar
. 1984. Rabelais and his World. Bloomington, IN: Indiana University Press.Google Scholar
Bazzanella, Carla. 1996. Repetition in Dialogue. Tubingen, DE: Niemeyer.Google Scholar
Bencherki, Nicolas, and François Cooren. 2011. “Having to be: The possessive constitution of organization.” Human Relations, 641: 1579–1607. DOI logoGoogle Scholar
Bourdieu, Pierre. 1984. Distinction: A Social Critique of the Judgement of Taste. London: Routledge. Originally published in Pierre Bourdieu, La distinction. Critique sociale du jugement (Paris: Les Éditions de Minuit, 1979).Google Scholar
. 1990. The Logic of Practice. Stanford, CA: Stanford University Press. Originally published in Pierre Bourdieu, Le sens pratique (Paris: Les Éditions de Minuit, 1980).Google Scholar
Byrne, Patrick S., and Barrie E.L. Long. 1976. Doctors Talking to Patients: A Study of the Verbal Behaviours of Doctors in the Consultation. London, UK: HMSO.Google Scholar
Caronia, Letizia. 2002. La socializzazione ai media. Contesti, interazioni e pratiche educative [Media Socialization. Contexts, Interactions and Educational Practices]. Milano, IT: Guerini.Google Scholar
Caronia, Letizia, and Arturo Chieregato. 2015. “Assembling (Non)Treatable Cases: Physicians’ Epistemic and Interactive Resources to Pursue and Resist an “Off-label” Policy in an Intensive Care Unit.” Paper presented at the annual ICA International Conference, San Juan, Puerto Rico, May 21–25.
Caronia, Letizia, and François Cooren. 2014. “Decentering Our Analytical Position: The Dialogicity of Things.” Discourse & Communication 8 (1): 41–61. DOI logoGoogle Scholar
Caronia, Letizia, and Luigina Mortari. 2015. “The Agency of Things: How Spaces and Artefacts Organize the Moral Order of an Intensive Care Unit.” Social Semiotics 25 (4): 401–22. DOI logoGoogle Scholar
Choo, Chun Wei 2005. The Knowing Organization. How Organizations Use Information to Construct Meaning, Create Knowledge and Make Decision. Oxford, UK: Oxford University Press. DOI logoGoogle Scholar
Cicourel, Aaron V. 1986. “The Reproduction of Objective Knowledge: Commonsense Reasoning in Medical Decision Making.” In Contemporary Perceptions of Language: Interdisciplinary Dimensions, ed. by Heidi Byrnes, 48–78. Georgetown, DC: Georgetown University Press.Google Scholar
. 1987. “Cognitive and Organizational Aspects of Medical Diagnostic Reasoning.” Discourse Processes 10 (4): 346–367. DOI logoGoogle Scholar
. 1992. “The Interpenetration of Communicative Contexts: Examples from Medical Encounters.” In Rethinking Contexts: Language as an interactive phenomenon, ed. by Alessandro Duranti, and Charles Goodwin, 291–310. Cambridge, MA: Cambridge University Press.Google Scholar
. 1999. “The Interaction of Cognitive and Cultural Models in Health Care Delivery.” In Talk, Work and Institutional Order. Discourse in Medical, Mediation and Management settings, ed. by Srikant Sarangi, and Celia Roberts, 183–224. Berlin/New York: Mouton de Gruyter. DOI logoGoogle Scholar
Cooren, François. 2004. “Textual agency: How Texts Do Things in Organizational Settings.” Organization 11 (3): 373–393. DOI logoGoogle Scholar
. 2006. “The Organizational World as a Plenum of Agencies.” In Communication as Organizing: Practical Approaches to Research into the Dynamic of Text and Conversation, ed. by François Cooren, James R. Taylor, and Elizabeth J. Van Every, 81–100. Mahwah, NJ: Lawrence Erlbaum.Google Scholar
. 2008. “The selection of agency as a rhetorical device: Opening up the scene of dialogue through ventriloquism.” In Dialogue and rhetoric, ed. by Edda Weigand, 23–37. Amsterdam, NE: Benjamins. DOI logoGoogle Scholar
. 2010. Action and Agency in Dialogue: Passion, Incarnation, and Ventriloquism. Amsterdam, NE: John Benjamins. DOI logoGoogle Scholar
. 2012. “Communication Theory at the Center: Ventriloquism and the Communicative Constitution of Reality.” Journal of Communication 62 (1): 1–20. DOI logoGoogle Scholar
Cooren, François, Gail T. Fairhurst, and Romain Huët. 2012. “Why Matter Always Matters in (Organizational) Communication.” In Materiality and Organizing: Social Interaction in a Technological World, ed. by Paul M. Leonardi, Bonnie A. Nardi, and Jannis Kallinikos, 296–314. Oxford, UK: Oxford University Press. DOI logoGoogle Scholar
Cooren, François, and Sergeiy Sandler. 2014. “Polyphony, Ventriloquism, and Constitution: In Dialogue with Bakhtin.” Communication Theory 24 (3): 225–244. DOI logoGoogle Scholar
Eggiman, Philippe, and Didier Pittet. 2001. “Infections Control in the ICU.” CHEST 120 (6): 2059–2093. DOI logoGoogle Scholar
Erikson, Frederick. 1999. “Local Identities and Presentation of Self as a Fellow Physician: Aspects of a Discourse of Apprenticeship in Medicine.” In Talk, Work and Institutional Order. Discourse in Medical, Mediation and Management settings, ed. by Srikant Sarangi, and Celia Roberts, 109–143. Berlin/New York: Mouton de Gruyter. DOI logoGoogle Scholar
Fairhurst, Gail T. 2004. “Textuality and Agency in Interaction Analysis.” Organization 11 (3): 335–353. DOI logoGoogle Scholar
Garfinkel, Harold. 2002. Ethnomethodology’s Program. Working out Durkheim’s Aphorism. Lanham, MD: Rowman & Littlefield.Google Scholar
Goodwin, Charles. 1994. “Professional Vision.” American Anthropologist 96 (3): 606–633. DOI logoGoogle Scholar
Heath, Christian. 1992. “The Delivery and Reception of Diagnosis and Assessment in General Practice Consultation.” In Talk at Work: Interaction in Institutional Settings, ed. by Paul Drew, and John Heritage, 235–267. Cambridge, MA: Cambridge University Press.Google Scholar
Heritage, John. 1984. Garfinkel and Ethnomethodology. Cambridge, MA: Cambridge University Press.Google Scholar
. 1997. “Conversation Analysis and Institutional Talk: Analyzing Data.” In Qualitative Research: Theory, Method and Practice, ed. by David Silverman, 221–245. London, UK: Sage.Google Scholar
. 2006. “Revisiting Authority in Physician-Patient Interaction.” In Diagnosis as Cultural Practice, ed. by Judith Felson Duchan, and Dana Kovarsky, 83–102. Berlin/New York: Mouton de Gruyter.Google Scholar
. 2012. “Epistemics in Action: Action Formation and Territories of Knowledge.” Research on Language & Social Interaction 45 (1): 1–29. DOI logoGoogle Scholar
Heritage, John, and Douglas W. Maynard. 2006. Communication in Medical Care: Interaction between Primary Care Physicians and Patients. Cambridge, MA: Cambridge University Press. DOI logoGoogle Scholar
Heritage, John, and Geoffrey Raymond. 2005. “The terms of agreement: Indexing epistemic authority and subordination in talk-in- interaction.” Social Psychology Quarterly, 681: 15–38. DOI logoGoogle Scholar
Heritage, John, and Rod Watson. 1979. “Formulations as Conversational Objects.” In Everyday Language: Studies in Ethnometodology, ed. by George Psathas, 123–162. New York, NJ: Irvington Press.Google Scholar
Husserl, Edmund G.A. 1954. The Crisis of European Sciences and Trascendental Philosophy. Evantson, IL: Northwestern University Press.Google Scholar
Koschmann, Timothy, Curtis LeBaron, Charles Goodwin, and Paul Feltovich. 2011. “‘Can You See the Cystic Artery Yet?’ A Simple Matter of Trust.” Journal of Pragmatics 43 (2): 521–541. DOI logoGoogle Scholar
Maynard, Douglas W. 1992. “On Clinicians’ Co-Implicating Recipients’ Perspective in the Delivery of Diagnostic News.” In Talk at Work: Interaction in Institutional Settings, ed. by Paul Drew, and John Heritage, 331–358. Cambridge, MA: Cambridge University Press.Google Scholar
. 2003. Bad News, Good News: Conversational Order in Everyday Talk and Clinical Settings. Chicago, IL: University of Chicago Press.Google Scholar
Mishler, Elliot G. 1984. The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, NJ: Ablex.Google Scholar
Moerman, Michael. 1988. Talking Culture: Ethnography and Conversation Analysis. Philadelphia, PA: University of Pennsylvania Press. DOI logoGoogle Scholar
Mondada, Lorenza. 2011. “The Organization of Concurrent Courses of Action in Surgical Demonstration.” In Embodied Interaction: Language and Body in the Material World, ed. by Jürgen Streeck, Charles Goodwin, and Curtis LeBaron, 207–226. Cambridge, MA: Cambridge University Press.Google Scholar
Nicolini, Davide. 2009. “Zooming in and out: Studying Practices by Switching Theoretical Lenses and Trailing Connections.” Organization Studies 30 (12): 1391–1418. DOI logoGoogle Scholar
Niederman, Michael S. 2005. The clinical diagnosis of VAP. Respiratory Care 50 (6): 788–796.Google Scholar
Orlikowski, Wanda J. 2007. “Socio-material Practices: Exploring Technology at Work.” Organization Studies 28 (9): 1435–1448. DOI logoGoogle Scholar
Sacks, Harvey, Emmanuel A. Schegloff, and Gail Jefferson. 1974. “A symplest systematics for the organization of turn-taking for conversation.” Language 50(4): 696–735. DOI logoGoogle Scholar
Sanchez Svenssson, Marcus, Paul Luff, and Christian Heath. 2010. “Embedded Instruction in Practice: Contingency and Collaboration during Surgical Training.” Communication in healthcare settings. Policy, Participation and New Technologies, ed. by Alison Pilnick, John Hindmarsh, and Virginia Teas Gill, 99–116. Oxford, UK: Wiley-Blackwell. DOI logoGoogle Scholar
Schegloff, Emmanuel. 1987. “Between Micro and Macro. Context and other connections”. In The micro-macro link, eds. by Jeffrey C. Alexander, Bernhard Giesen, Richard Munch, and Neil J. Smelser, 207–234. Berkeley, CA: University of California Press.Google Scholar
. 1992. “On talk and its institutional occasions”. In Talk at Work. Interaction in institutional settings, eds. by Paul Drew, and John Heritage, 101–134. Cambridge, MA: Cambridge University Press.Google Scholar
Schütz, Alfred. 1962. Collected Papers I: The Problem of Social Reality. Dordrecht, NL: Martinus Nijhoff Publishers.Google Scholar
Schütz, Alfred, and Thomas Luckmann. 1973. The Structure of the Life-world. Vol.11. Evanston, IL: Northwestern University Press.Google Scholar
Silverman, David. 2005. Doing Qualitative Research. A Practical Handbook. London, UK: Sage.Google Scholar
Stivers, Tania. 2002. “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. “Non-antibiotic Treatment Recommendations: Delivery Formats and Implications for Parents Resistance.” Social Science & Medicine 60 (5): 946–964. DOI logoGoogle Scholar
. 2006. “Treatment decisions: negotiations between doctors and patients in acute care encounters.” In Communication in Medical Care: Interaction between Primary Care Physicians and Patients, eds. by John Heritage, and Douglas Maynard, 279–312. Cambridge, MA: Cambridge University Press. DOI logoGoogle Scholar
. 2007. Prescribing Under Pressure. Parents-Physician Conversations and Antibiotics. Oxford, UK: Oxford University Press. DOI logoGoogle Scholar
. 2008. “Stance, Alignment, and Affiliation during Storytelling: When Nodding is a Token of Affiliation.” Research on Language & Social Interaction 41 (1): 31–57. DOI logoGoogle Scholar
Taylor, James R., and Elizabeth J. Van Every. 2011. The Situated Organization. London: Routledge.Google Scholar
. 2014. When Organizations Fail: Why Authority Matters. London/New York: Routledge. DOI logoGoogle Scholar
Timmermans, Stefan, and Alison Angell. 2001. “Evidence-based Medicine, Clinical Uncertainty, and Learning to Doctor.” Journal for Health and Social Behaviour 42 (4): 342–359. DOI logoGoogle Scholar
Tracy, Sarah J. 2013. Qualitative Research Methods: Collecting Evidence, Crafting Analysis, Communicating Impact. Chichester/Oxford/Malden: Wiley-Blackwell.Google Scholar
van Dijk, Teun A. 2006. “Discourse, Context and Cognition.” Discourse Studies 8 (1): 159–177. DOI logoGoogle Scholar
Weathersbee, Elizabeth T., and Douglas W. Maynard. 2010. “Dialling for Donations: Practices and Actions in the Telephone Solicitation of Human Tissues.” Sociology of Health & Illness 31 (6): 803–816. DOI logoGoogle Scholar
Weigand, Edda. 2010. Dialogue: The Mixed Game. Amsterdam, NE: John Benjamins. DOI logoGoogle Scholar
Cited by (4)

Cited by four other publications

Castor, Theresa R.
2021. Dialogic matters. Language and Dialogue 11:1 ► pp. 1 ff. DOI logo
Caronia, Letizia, Marzia Saglietti & Arturo Chieregato
2020. Challenging the interprofessional epistemic boundaries: The practices of informing in nurse-physician interaction. Social Science & Medicine 246 ► pp. 112732 ff. DOI logo
Caronia, Letizia
2018. How “at home” is an ethnographer at home? Territories of knowledge and the making of ethnographic understanding. Journal of Organizational Ethnography 7:2 ► pp. 114 ff. DOI logo
Caronia, Letizia, Arturo Chieregato & Marzia Saglietti
2017. Assembling (non) treatable cases: The communicative constitution of medical object in doctor–doctor interaction. Discourse Studies 19:1 ► pp. 30 ff. DOI logo

This list is based on CrossRef data as of 16 september 2024. Please note that it may not be complete. Sources presented here have been supplied by the respective publishers. Any errors therein should be reported to them.