At the start of studies on health communication, scholars were primarily concerned with showing the ethical implications of a new approach to care and with collecting evidence to demonstrate its greater effectiveness as opposed to the paternalistic and mechanistic paradigms.
Well into the second decade of the 21st century, different issues need to be addressed. Aging populations and the spread of chronic diseases are challenging the sustainability of health care systems worldwide; increased awareness of health issues among the population and greater citizen participation seem to threaten clinicians’ authority. In this new scenario, it is acknowledged that the quality of verbal communication plays a crucial role, but it is still not clear how it impacts on the outcomes of care, which are its constitutive components and how it interacts with the institutional, cultural and social context of interactions.
This book suggests that the time is ripe for a fresh start in health communication studies. As Debra Roter points out in her foreword, this proposal “is ambitious in attempting to integrate perspectives derived from pragmatics and argumentation theory with those derived from quantitative methods of medical interaction analysis and its prediction of outcomes”. On the other hand, as Giovanni Gobber explains in his foreword, “health communication can profit from an application of a performance-oriented linguistic analysis that pays attention to the role of the various relevant context factors in speech events related to specific activity types”. In this way, the open questions regarding communication in medical encounters are considered under a new light. The answers provided open up novel lines of research and provide an original perspective to face the new challenges in medical care.
After the pragmatic turn in the late seventies, an increasing interest in the analysis of speech events has produced a large amount of research in applied linguistics. Discourse studies and the analysis of conversation have offered more and more precise criteria for describing communication practices, focusing on the interplay between utterances and the relevant non-linguistic factors in speech events. Thanks to the contributions of descriptive and normative approaches to communicative actions, a new paradigm has emerged in the last decades, which takes into account different activity and dialogue types and makes it possible to elaborate more accurate description of communicative events in specific contexts.
Health communication can profit from an application of a performance-oriented linguistic analysis that pays attention to the role of the various relevant context factors in speech events related to specific activity types. Such an empirical utterance-oriented approach focuses on how semiotic (i.e. not only linguistic) items and processes are used by the interlocutors in the dynamic development of communication practices.
Sarah Bigi proposes a new perspective on communicative interactions between physicians and their patients, in which the interlocutors' experiences and expectations are reconstructed and their decisive role is considered for the development of a new model of decision making. The decision is progressively developed in a co-operative dialogue, in which the reasons for the decision are found in the patient's world of knowledge, values and beliefs. The patient is involved in the decision making and this can help her/him adhere to the commitment that follows from the deliberation.
This investigation helps understand the social relevance of linguistic research and encourages the analyst who cares for people and struggles for a better world.
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