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Article published In:
Pragmatics and Society
Vol. 15:6 (2024) ► pp.839–857

Discursive positioning of doctors and e‑patients in online medical consultations in China

An orientation toward affective affiliation

ORCID logo | Beijing Information Science and Technology University
This study investigates the identity positioning of doctors and e‑patients in online medical consultations (OMCs) in China from the perspective of poststructuralist discourse analysis. Adopting positioning theory as the analytical framework, the study examines 100 asynchronous text-based OMCs with the purpose of identifying the positions of the OMC participants and the pragmatic function of these positions. The study found that the identity of e‑patients and doctors reflects multiple positions that are constructed and negotiated in the OMC discourse, including the emotional support seeker/giver position, the online buyer/seller position, the peer position, and the ‘family member’ position. Taken together, these positions can help establish an affective relationality between doctors and e‑patients, which contributes to a positive image of the participants and to the empowerment of e‑patients in particular.
Keywords: online medical consultation, identity positioning, pragmatic function, poststructuralist discourse analysis, positioning theory, China, doctors and e‑patients, affective affiliation
Article outline
  • 1.Introduction
  • 2.Literature review
  • 3.Data and analytical approach
  • 4.The multiple positions of doctors and e‑patients in OMCs
    • 4.1Emotional support seeker (ESS)/giver (ESG)
    • 4.2Online seller/buyer
    • 4.3Interpersonal proximity positioning
      • 4.3.1Egalitarian or horizontal affiliative positioning
      • 4.3.2Hierarchical or vertical affiliative positioning
  • 5.Discussion and conclusion
  • Acknowledgements
  • Notes
  • References
Published online: 30 October 2023
DOI logo
https://doi.org/10.1075/ps.19025.zha
References (40)
References
Al-Mahdi, Ibrahim, Kathleen Gray, and Reeva Lederman. 2015. “Online Medical Consultation: A Review of Literature and Practice.” In Proceedings of the 8th Australasian Workshop on Health Informatics and Knowledge Management, 2015 1, 27–30. Sydney: Australian Computer Society.Google Scholar
Anderson, James G., Michelle R. Rainey, and Gunther Eysenbach. 2003. “The Impact of CyberHealthcare on the Physician-Patient Relationship.” Journal of Medical Systems 27 (1): 67–84. DOI logoGoogle Scholar
Andersen, Niels Åkerstrøm. 2003. Discursive Analytical Strategies: Understanding Foucault, Koselleck, Laclau, Luhmann. Bristol: The Policy Press. DOI logoGoogle Scholar
Anesa, Patrizia, and Antoinette Fage-Butler. 2015. “Popularizing Biomedical Information on an Online Health Forum.” Ibérica, Revista de la Asociación Europea de Lenguas para Fines Específicos 291: 105–128.Google Scholar
Angermuller, Johannes. 2014. Poststructuralist Discourse Analysis: Subjectivity in Enunciative Pragmatics. New York: Springer. DOI logoGoogle Scholar
Barbalet, Jack. “Tripartite Guanxi: Resolving Kin and Non-kin Discontinuities in Chinese Connections”. Presentation at Hong Kong Baptist University, Hong Kong, May 28, 2019.
Briggs, Charles L. 2005. “Communicability, Racial Discourse, and Disease.” Annual Review of Anthropology 341: 269–291. DOI logoGoogle Scholar
Brown, Penelope, and Stephen C. Levinson. 1987. Politeness: Some Universals in Language Usage. Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Bucholtz, Mary, and Kira Hall. 2005. “Identity and Interaction: A Sociocultural Linguistic Approach.” Discourse Studies 7 (4–5): 585–614. DOI logoGoogle Scholar
Davies, Bronwyn, and Rom Harré. 1990. “Positioning: The Discursive Production of Selves.” Journal for the Theory of Social Behaviour 20 (1): 43–63. DOI logoGoogle Scholar
Fage-Butler, Antoinette, and Patrizia Anesa. 2016. “Discursive Construction and Negotiation of Laity on an Online Health Forum.” Pragmatics and Society 7 (2): 196–216. DOI logoGoogle Scholar
Fahy, Eamonn, Rohan Hardikar, Adrian Fox, and Sean Mackay. 2014. “Quality of Patient Health Information on the Internet: Reviewing a Complex and Evolving Landscape.” The Australasian Medical Journal 7 (1): 24–28. DOI logoGoogle Scholar
Feng, Hairong. 2011. “Politeness (Keqi): The Fragrance of Chinese Communication.” China Media Research 7 (4): 53–60.Google Scholar
Foucault, Michel. 1980. Power/Knowledge: Selected Interviews and Other Writings, 1972–1977. New York: Pantheon.Google Scholar
. 1985. The Use of Pleasure: The History of Sexuality. New York: Vintage.Google Scholar
. 1972. The Archaeology of Knowledge. New York: Pantheon.Google Scholar
Grimsbø, Gro Hjelmeland, Cornelia M. Ruland, and Arnstein Finset. 2012. “Cancer Patients’ Expressions of Emotional Cues and Concerns and Oncology Nurses’ Responses, in an Online Patient-Nurse Communication Service.” Patient Education and Counseling 88 (1): 36–43. DOI logoGoogle Scholar
Gottlieb, Benjamin H. 1978. “The development and Application of a Classification Scheme of Informal Helping Behaviours.” Canadian Journal of Behavioural Science/Revue Canadienne des Sciences du Comportement 10 (2): 105–115. DOI logoGoogle Scholar
Harré, Rom, and Luk Van Langenhove (eds). 1998. Positioning Theory: Moral Contexts of International Action. Hoboken, NJ: Wiley-Blackwell.Google Scholar
He, Ziran. 1991. “言语交际中的语用移情 [The Pragmatic Empathy in Verbal Communication].” Foreign Language Teaching and Research 88 (4): 11–15.Google Scholar
Hu, Peng, Fang Cheng, and Jiadong Gu. 2014. “上海市某区近五年医患纠纷情况分析与对策研究 [Analysis of Situation and Strategy of Medical Disputes in One District of Shanghai in Recent Five Years].” Clinical Misdiagnosis and Mistherapy 27(4), 87–91.Google Scholar
Locher, Miriam A. 2010. “Health Internet Sites: A Linguistic Perspective on Health Advice Columns.” Social Semiotics 20 (1): 43–59. DOI logoGoogle Scholar
Lu, Xinyi, and Runtong Zhang. 2019. “Impact of Physician-Patient Communication in Online Health Communities on Patient Compliance: Cross-Sectional Questionnaire Study.” Journal of Medical Internet Research 21 (5): e12891. DOI logoGoogle Scholar
Mao, Yansheng, and Xin Zhao. 2019. “By the Mitigation One Knows the Doctor: Mitigation Strategies by Chinese Doctors in Online Medical Consultation.” Health Communication: 1–8.Google Scholar
Markham, Annette, and Elizabeth Buchanan. 2012. “Ethical Decision-Making and Internet Research: Version 2.0. Recommendations from the AoIR Ethics Working Committee.” Available online: aoir. org/reports/ethics2. pdf.Google Scholar
Masters, Ken, Dick Ng’ambi, and Gail Todd. 2010. “‘I Found it on the Internet’: Preparing for the e-patient in Oman.” Sultan Qaboos University Medical Journal 10 (2): 169–179.Google Scholar
Ning, Dehuang, and Shanshan Wei. 2015. “近10 年来国内医患沟通研究综述 [A Review on the Domestic Researches of Doctor-Patient Communication in China in Recent 10 Years].” Journal of Kunming University of Science and Technology 15 (6): 6–11.Google Scholar
Pounds, Gabrina. 2018. “Patient-Centred Communication in Ask-the-Expert Healthcare Websites.” Applied Linguistics 39 (2): 117–134.Google Scholar
. 2010. “Empathy as ‘Appraisal’: A New Language-Based Approach to the Exploration of Clinical Empathy.” Journal of Applied Linguistics and Professional Practice 7 (2): 139–162.Google Scholar
Pounds, Gabrina, and De Pablos-Ortega. 2015. “Patient-centred Communication in British, Italian and Spanish Ask-the-Expert Healthcare Websites.” Communication and Medicine 12 (2–3): 225–241.Google Scholar
Prestin, Abby, and Wen-ying Sylvia Chou. 2014. “Web 2.0 and the chaning health communication environment.” In The Routledge Handbook of Language and Health Communication, ed. by Hamilton, Heidi, and Wen-ying Sylvia Chou, 184–197. Abingdon: Routledge.Google Scholar
Ran, Yongping. 2007. “指示语选择的语用视点、语用移情与离情 [The Pragmatic Stance, Empathic and De-Empathic Function of Chinese Person Deixis].” Foreign Language Teaching and Research, 39(5), 331–337.Google Scholar
Roter, Debra L., Susan Larson, Daniel Z. Sands, Daniel E. Ford, and Thomas Houston. 2008. “Can E-Mail Messages between Patients and Physicians be Patient-Centered?.” Health Communication 23 (1): 80–86. DOI logoGoogle Scholar
Suler, John. 2004. “The Online Disinhibition Effect.” Cyberpsychology and Behavior 7 (3): 321–326. DOI logoGoogle Scholar
Wang, Xi, Zhiya Zuo, and Kang Zhao. 2015. “The Evolution of User Roles in Online Health Communities – A Social Support Perspective.” In The Proceedings of Pacific Asia Conference on Information Systems, Paper 121. [URL]. DOI logo
Wetherell, Margaret. 1998. “Positioning and Interpretative Repertoires: Conversation Analysis and Post-Structuralism in Dialogue.” Discourse and Society 9 (3): 387–412. DOI logoGoogle Scholar
Wilce, James M. 2009. Language and Emotion. Cambridge: Cambridge University Press.Google Scholar
Williams, Glyn. 1999. French Discourse Analysis: The Method of Post-Structuralism. Abingdon: Routledge.Google Scholar
Winker, Margaret A., Annette Flanagin, Bonnie Chi-Lum, John White, Karen Andrews, Robert L. Kennett, Catherine D. DeAngelis, and Robert A. Musacchio. 2000. “Guidelines for Medical and Health Information Sites on the Internet: Principles Governing AMA Web Sites.” Journal of the American Medical Association 283 (12): 1600–1606. DOI logoGoogle Scholar
Ye, Qingyue, and Jiangang Wang. 2015. “武汉市某医院门诊投诉原因分析 [Analysis on Cause of Out-Patient’s Complaints in a Hospital, Wuhan].” Medicine and Society 28 (2): 55–57.Google Scholar
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