A PRAGMATIC EXPLORATION OF DISCOURSE DEVICES IN DOCTORPATIENT CONSULTATIONS IN SELECTED TEACHING AND GENERAL HOSPITALS IN NIGERIA

Abstract

Doctor-patient consultation is a communicative situation which enables doctors to understand patients’ health challenges in order to prescribe appropriate treatments. Earlier works on doctor-patient interactions, particularly from linguistic and pragmatic perspectives, have largely examined speech acts, conversational maxims and (im)politeness, with little attention paid to the specific discourse devices and their pragmatic functions. Therefore, this study was designed to examine doctor-patient verbal interactions in selected teaching and general hospitals in Nigeria, with a view to determining the discourse devices deployed in the interactions and their pragmatic functions. Dan Sperber and Deidre Wilson’s Relevance Theory, complemented by M.A.K. Halliday’s Systemic Functional Grammar, was used as the framework, while the descriptive design was adopted. Data were sourced from 200 audio tape recordings and transcriptions of doctorpatient verbal interactions in two teaching hospitals (University College Hospital Ibadan (UCH) (50), and University of Ilorin Teaching Hospital (UITH) (50)) and two general hospitals (General Hospital Abeokuta (GHA) (50), and General Hospital Kabba (GHK) (50)). The selected hospitals were chosen because they were well-patronised and were easily accessible for data collection. Data were subjected to pragmatic analysis. Thirteen discourse devices were dominant in the interactions: circumlocution, repetition, counselling, modality, closing, direct question, indirect question, answering, phatic communion, rapport expressions, language switch, Face Threatening Act (FTA) with redress and FTA without redress. All of them were shared by the doctors and the patients across the hospitals, with the exception of FTA with redress, FTA without redress and counseling, which were doctor-specific. They performed the following pragmatic functions: phatic communion, for opening consultations; direct and indirect questions, for seeking information for diagnoses; code alternation, for explicitness, informativity and mutuality; repetition, for confirmation, emphasis and clarification; rapport expressions, for cordiality and solidarity; modality, for asymmetry of knowledge and power; counselling, for advising the patients on their health; answer, to respond to questions; closing, for ending consultations and circumlocution, for providing clues to diagnosis. Interrogatives were employed for; eliciting information. Modality was deployed for expressing views and expectations; FTA with and without redress, for correcting patients’ unwholesome health practices and obtaining information for diagnosis tactfully; tact maxim, for expressing compassion and granting permission; generosity maxim, for counselling and expressing compassion; and sympathy maxim, for counselling and expressing empathy. Declaratives were employed for providing information; imperatives, for giving directives; and collocation, for connecting texts. The contributions reflected adjacency pairs in different forms, showing cooperation amongst the interactants. There were variations in the deployment of the discourse devices. The UCH and UITH doctors employed questions more than those of GHA and GHK. The discourse devices addressed specific communication and health challenges through their pragmatic functions, thus underscoring the centrality of their knowledge to a better comprehension of diagnostic discourse in doctor-patient consultations in the Nigerian context.