A Dynamic Study Of Doctor-Patient Communication Discourse

Doctor-Patient (D-P for short) communication, as one of top public concerns in modern society, has aroused interests of many linguists and becomes an important topic in the linguistic society. The research of D-P communication cannot only deepen the understanding of its essentials, but also provide methodological enlightenments for the research model of institutional discourse. In addition, some instructional advices can be obtained concerning the practices of D-P communication, establishment of related communicative competence and management of D-P relationship, through the study of such subject.This paper aims at answering three fundamental questions:What is D-P communication, its essentials? How is D-P communication conducted, its mechanism or model? What can participants do in D-P communication, their dynamic roles? According to our investigation, we have found that:D-P communication is essentially a dynamic system consisting of three changing and connected factors, namely:context, purpose and conversation. Thus, the study of D-P communication shall be conducted in comprehensive consideration of the three factors as well as their changes. Guided by the concept of dynamic context, with application of Conversation Analysis (CA for short) methodology, this thesis conveys a dynamic and systematic study of D-P communication discourse, which contains the general analysis of D-P communication, institution-oriented analysis of conversation models in consideration of institutional context and purposes, and longitudinal analysis of concrete D-P interaction as well as participants'dynamic roles within the framework of the conversation model of certain institution. Besides the generality analysis, we also conduct a specialty analysis for concrete department-oriented variations of D-P discourses within the range of certain institution, concerning departmental context and specific purposes.This research is fundamentally empirical, which is based upon spot investigation and audio-recording in Handan Central Hospital covering institutions including clinic, ward and Operations (OPS for short)/Anaesthesia, etc. The findings of the study contain:Generally, there exists power asymmetry in D-P communication. However, the degree of such asymmetry changes with alternations of institutional context and purposes. In the macroscopic perspective, with the alternation of institution and related institutional purpose, the conversation model shifts. D-P communication is achieved through three models, namely: Structural Model, Communicative Model and Guiding Model, among which there exists the power asymmetry at various degrees. In the microscopic perspective:during the concrete process of D-P interaction, the participants'turns are influenced by the immediate context and purposes; meanwhile, the participants can also adjust their turns, sequences and non-verbal factors to alternate the immediate context towards expectation at the guide of immediate purpose, namely the dynamic roles of participants. Concrete process of D-P interaction varies as conversation model shifts, as a result of which participants'dynamic roles also alternate. Thus, the three conversation models are achieved through participants'different dynamic roles. In addition, within the range of certain institution, different departments feature distinguishing contextual factors and purposes, as a result of which detailed conversation characteristic may vary at certain degree.Finally, the major findings are concluded and integrated into a unified framework based upon the research model of this thesis. In addition, we point out the innovations, limitations and future explorations of this research, as well as certain practical suggestions for D-P communicative competence.