Argumentation in doctor-patient consultations in EkeGusii: A pragma-dialectical approach

[摘要] ENGLISH ABSTRACT: This dissertation investigates the argumentative discourse of (Eke)Gusii doctor-patientconsultations in Kenya using the framework of the extended pragma-dialectical theory ofargumentation. The study particularly investigates how Gusii doctors and Gusii patientsstrategically manoeuvre in resolving differences of opinion through the analysis of simulatedmedical consultations in (Eke)Gusii. The data for the research constituted transcripts of audiorecordings of twelve consultation simulations conducted in (Eke)Gusii involving Gusii doctorsand Gusii simulated patients with already diagnosed cases of HIV and AIDS, diabetes or cancer atThe Kisii Teaching and Referral Hospital, a public hospital in Kenya. The analysis conductedemployed the pragma-dialectical method which entailed the interpretation, reconstruction andevaluation of the dialogues. Utilising the model of critical discussion, the study also assessed thedisplay of communication accommodation and attitudinal aspects of evaluative language use instrategic manoeuvring in doctor-patient consultations. This multiperspective study establishes thatthe interplay of the macro contextual exigencies of contemporary western medicine and the traditional Gusii sociocultural belief system concerning illness, which determine the nature andproperties of strategic manoeuvring in the (Eke)Gusii doctor-patient consultation give rise to ahybrid of genres of consultation and persuasion. Displaying explicit and invoked evaluativelanguage, the Gusii doctors and Gusii patients continually exploit linguistic and psychologicalconvergence or divergence in their choice of presentational devices to accommodate theinstitutional constraints of the two institutions and realising the composite institutional point. Thestudy identifies and characterises the prototypical pattern of argumentation in the Gusii medicalconsultation, as one in which Gusii doctors and Gusii patients employ pragmatic argumentation asthe main argumentation to defend a desirable effect of a prescriptive standpoint. The findings ofthe study indicate that symptomatic argumentation or other pragmatic arguments entail the supportargumentation pattern for both parties but with diverse sources of authority. The sociocultural,macro and discursive contextual circumstances of the Gusii medical consultation determine the supporting argumentation and responses to the critical questions of pragmatic arguments. Thestudy concludes that argumentation in the (Eke)Gusii medical consultation presents empiricalevidence for the enhancement of the strategic manoeuvre design of the extended pragmadialecticaltheory with elements of evaluative language use and communication accommodation.

[发布机构] Stellenbosch University