Concealment in consultative encounters in Nigerian hospitals

Akin Odebunmi

Abstract

Although communication in medical practice is reputed for exactitude and objectivity, many doctors in several countries make equivocal, concealing utterances in certain situations when relating with clients. This phenomenon, despite its importance in doctor-client interaction, has received little attention from language scholars who have discussed concealment mainly as a strategy in news delivery. The present study examines concealment items in the interaction between doctors and clients in South-western Nigerian hospitals and their pragmatic implications for medical communication in Nigeria. Fifty (50) conversations between doctors and clients on several ailments were tape-recorded in the six states of South-western Nigeria. Structured and unstructured interviews were conducted with selected doctors and clients. The corpus was examined for the linguistic and pragmatic resources deployed by doctors in concealing information, and was analysed using Jacob Mey’s theory of pragmeme and insights from the literature on news delivery strategies. Concealment was found to take place between doctors and clients in a two-phase mode: Referential and pragmatic. Utterances which have descriptive forms at the referential level assume subjective and divergent shades in the context of concealment at the pragmatic level. Nine concealment strategies (jargonisation, veiling, forecasting, mitigation, stalling, normalisation, dysphemisation, euphemisation and doublespeak) were found to be employed to achieve four broad goals: Preventive, palliative, culture-compliant and confidential with respect to 25 diseases /medical procedures. Concealment in consultative encounters takes into account the socio-psychological security needs of clients and attends positively to clients’ cultural expectations.

Keywords:
Quick links
A browser-friendly version of this article is not yet available. View PDF
Buckman, Robert
(2001) Communication skills in palliative care: A practical guide. Neurologic Clinics. 19 (4). http://​www​.ncbi​.nlm​.nih​.gov​/pubmed11854110. Accessed May 20, 2010. DOI logoGoogle Scholar
Capone, Alesandro
(2005) Pragmemes: A study with reference to English and Italian. Journal of Pragmatics. 37: 1355-1371. DOI logoGoogle Scholar
Chimombo, M., and R. Roseberry
(1998) The Power of Discourse: An Introduction to Discourse Analy- sis. New Jersey: Lawrence Erlbaum Associates, Inc.  BoPGoogle Scholar
Fairclough, Norman
(1989) Language and Power. London: Longman.  BoPGoogle Scholar
Frankel, R.M
(2001) Clinical care and conversational contingencies: The role of patients’ self-diagnosis in medical encounters. Text 21: 83-111.
Glasser, Barney, and Anselm L. Strauss
(1965) Awareness of Dying. Chicago, IL: Aldine.Google Scholar
Good, Mary-Jo, Byron Good, Cynthia Schaffer, and Stuart Lind
(1990) American oncology and the discourse on hope. Culture, Medicine and Psychiatry 14: 59-79. DOI logoGoogle Scholar
Heath, Collins
(1992) Diagnosis and assessment in the medical consultation. In P. Drew and J. Heritage (eds.), Talk at Work: Interaction in Institutional Settings. Cambridge: Cambridge University Press, pp. 235-267.Google Scholar
Heritage, John, and T. Stivers
(1999) Online commentary in acute medical visits: A method of shaping patient expectations. Social Science and Medicine 49: 1501-1517. DOI logoGoogle Scholar
Heritage, John, and Douglas Maynard
(2006) (eds) Communication in Medical Care: Interaction Between Primary Care Physicians and Patients. Cambridge: Cambridge University Press. DOI logo  BoPGoogle Scholar
Keskes, Istvan
(2010) Situation-bound utterances as pragmatic acts. Journal of Pragmatics. 42.1: 2889-2897. DOI logoGoogle Scholar
Leppanen, V
(1998) Structures of District Nurse-Patient Interaction. Lund, Sweden: Department of Sociology, Lund University.Google Scholar
Levinson, Stephen
(1979) Activity types and language. Linguistics 17: 365-399. DOI logo  BoPGoogle Scholar
Maynard, Douglas
(1989) Notes on the delivery and reception of diagnostic news regarding mental disabilities. In D.T. Helm, W.T. Anderson, A.J. Meehan and A.W. Rawls (eds.), The Interactional Order: New Directions in the Study of Social Order. New York: Irvington, pp. 54-67.Google Scholar
(1991) Interaction and asymmetry in clinical discourse. American Journal of Sociology 97: 448-495. DOI logoGoogle Scholar
(1996) On ‘realisation’ in everyday life: The forecasting of bad news as a social relation. American Sociological Review 16.1: 109-131. DOI logoGoogle Scholar
(2003) Bad News, Good News: Conversational Order in Everyday Talk and Clinical Settings. Chicago: University of Chicago Press.Google Scholar
(2005) ‘Does it mean I’m gonna die?’: On meaning assessment in the delivery of diagnostic news. Social Science and Medicine.Google Scholar
Mey, Jacob
(2001) Pragmatics: An Introduction. Oxford: Blackwell Publishers.Google Scholar
Odebunmi, Akin
(2003) Pragmatic features of English usage in hospital interactions amongst medical practitioners and patients in South-western Nigeria. Unpublished Ph.D. thesis. Obafemi Awolowo University, Ile-Ife.
(2005) Politeness and face management in hospital conversational interactions in South- Western Nigeria. Ibadan: Journal of English Studies 2: 1-22.Google Scholar
(2006a) Meaning in English: An introduction. Ogbomoso: Critical Sphere.Google Scholar
(2006b) Locutions in medical discourse in South-Western Nigeria. Pragmatics 16.1: 25-41.  BoP DOI logoGoogle Scholar
(2007) Acts doctors and patients perform in medical encounters in Nigeria. In Moji Olateju, Rotimi Taiwo and Adeleke Fakoya (eds.), Towards Understanding Discourse Strategies. Ago- Iwoye: Olabisi Onabanjo University Press, pp.1-17.Google Scholar
(2008) Pragmatic strategies of diagnostic news delivery in Nigerian hospitals. Linguistik Online 36.4: 21-37.Google Scholar
(2010a) Tracking ideology in political news. California Linguistic Notes XXXV (2).Google Scholar
(2010b) Ideology and body part metaphor in Nigerian English. Review of Cognitive Linguistics 8.2: 272-299. DOI logo  BoPGoogle Scholar
(2010c) Code selection at first meetings: A pragmatic analysis of doctor- client conversations in Nigeria. Unpublished manuscript.
Odebunmi, Akin, and M.A. Alo
(2010) Beliefs in GSM text-messaging among academics in two Nigerian universities. In Rotimi Taiwo (ed.), Handbook of Research on Discourse Behaviour and Digital Communication: Language Structures and So-cial Interaction. New York: IGI Global, pp. 468-478. DOI logoGoogle Scholar
Odebunmi, Akin, and Peter Auer
(2011) Face, politeness and culture in doctor-client encounters in Nigeria. Unpublished manuscript.
Ong, LM, J.C. de Haes, A.M. Hoos, and F.B. Lammes
(1995) Doctor-patient communication: A review of the literature. Public Medicine 40: 903-918.Google Scholar
Perakyla, Anssi
(1998) Authority and accountability: The delivery of diagnosis in primary health care. Social Psychology Quarterly 61.4: 301-320. DOI logoGoogle Scholar
Stivers, Tanya
(1998) Prediagnostic commentary in veteranarian-client interaction. Research on Language and Social Interaction 31.2: 241-277. DOI logo  BoPGoogle Scholar
The, Anne-Mei, Tony Hak, Gerard Koeter, and Gerrit van de Wal
(2000) Collusion in doctor-patient communication about imminent death: An ethnographic study. Pubmed Journal. http://​www​.ncbi​.nlm​.nih​.gov​/pmc​/articles​/PMC. Accessed May 20, 2010.Google Scholar
Tseng, Ming-Yu
(2010) The pragmatic act of fishing for personal details: From choice to performance. Journal of Pragmatics 42: 1982-1996. DOI logo  BoPGoogle Scholar
Williams, John
(2009) Medical Ethics Manual. France: World Medical Association.Google Scholar