Item Details

‘If it didn't work the first time, we can try it again’: Conditionals as a grounding device in a genre of illness discourse

Issue: Vol 11 No. 1 (2014)

Journal: Communication & Medicine

Subject Areas: Healthcare Communication Linguistics

DOI: 10.1558/cam.v11i1.25810


This article explores the occurrence and some special patterns of conditional usage in medical discourse produced by doctors and patients. Findings are based on the Journal of the American Medical Association with its section Clinical Crossroads, which was founded to further the cooperation of patients with medical professionals. The analysis centers upon the concept of prediction, which is considered both a semantic concept governing verb patterns as well as a communicative act prominent in medical encounters. It is found that, in the discourse context investigated here, patients are more concerned with prediction than doctors, but that they also produce at times unusual patterns in which they mirror their doctors’ voices. The mapping of mental spaces, inherent in the conditional construction, then takes the form of a mapping of voices as institutionalized by the genre. Such uses of conditionals suggest that a classification based on content, or ‘logic’, from which only pragmatic types of conditionals depart, turns out to be inadequate, since the construction operates on two simultaneous levels; these are grounded in the discourse situation provided by the genre. For medical communication, this illustrates that patients engage in their own predictions but also strive for an alignment with their doctors.

Author: Heidrun Dorgeloh

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References :

Ainsworth-Vaughn, N. (2001) The discourse of medical encounters. In D. Schiffrin, D. Tannen and H. E. Hamilton (eds) The Handbook of Discourse Analysis, 453−469. Malden, MA: Blackwell.

Athanasiadou, A. and Dirven, R. (1997) Conditionality, hypotheticality, counterfactuality. In A. Athanasiadou and R. Dirven (eds) On Conditionals Again, 61−96. Amsterdam: Benjamins.

Biber, D. and Conrad, S. (2009) Register, Genre, and Style. Cambridge: Cambridge University Press.

Bülow-Moller, A. M. (2004) Conditionals: Your space or mine? In T. Virtanen (ed.) Approaches to Cognition through Text and Discourse, 149−176. Berlin: Mouton de Gruyter.

Carter-Thomas, S. and Rowley-Jolivet, E. (2008) If-conditionals in medical discourse: From theory to disciplinary practice. Journal of English for Academic Purposes 7: 191−205.

Charon, R. (2006) Narrative Medicine: Honoring the Stories of Illness. Oxford: Oxford University Press.

Charon, R. and DasGupta, S. (2011) Editors’ preface: Narrative medicine, or a sense of a story. Literature and Medicine 29 (2): vii−xiii.

Clark, H. H. (1996) Using Language. Cambridge: Cambridge University Press.

Cordella, M. (2004) The Dynamic Consultation: A Discourse Analytical Study of Doctor–Patient Communication. Amsterdam: John Benjamins.

Dancygier, B. (1998) Conditionals and Prediction: Time, Knowledge, and Causation in Conditional Constructions. Cambridge: Cambridge University Press.

Dancygier, B. and Sweetser, E. (2005) Mental Spaces in Grammar: Conditional Constructions. Cambridge: Cambridge University Press.

Declerck, R. and Reed, S. (2001) Conditionals: A Comprehensive Empirical Analysis. Berlin: Mouton de Gruyter.

Declerck, R. and Reed, S. (2006) Tense and time in counterfactual conditionals. Belgian Journal of Linguistics 20 (1): 169−192.

Dorgeloh, H. and Wanner, A. (eds) (2010) Syntactic Variation and Genre. Berlin: Mouton de Gruyter.

Ferguson, C. A., Snitzer Reilly, J., ter Meulen, A. and Traugott, E. C. (1986) Overview. In E.C. Traugott, A. ter Meulen, J. Snitzer Reilly, and C.A. Ferguson (eds) On Conditionals, 3−20. Cambridge: Cambridge University Press.

Ferguson, G. (2001) If you pop over there: A corpus-based study of conditionals in medical discourse. English for Specific Purposes 20: 61−82.

Fillmore, C. J. (1990) Epistemic stance and grammatical form in English conditional sentences. In M. Ziolkowski, M. Noske and K. Deaton (eds) Papers from the 26th Regional Meeting of the Chicago Linguistic Society, 137−162. Chicago: Chicago Linguistic Society.

Fleischman, S. (2001) Language and medicine. In D. Schiffrin, D. Tannen and H. E. Hamilton (eds) The Handbook of Discourse Analysis, 470−502. Malden, MA: Blackwell.

Ford, C. (1997) Speaking conditionally: Some contexts for conditionals in conversation. In A. Athanasiadou and R. Dirven (eds) On Conditionals Again, 61−96. Amsterdam: Benjamins.

Ford, C. E. and Thompson, S. A. (1986) Conditionals in discourse: A text-based study from English. In E. C. Traugott, A. ter Meulen, J. Snitzer Reilly and C. Ferguson (eds) On Conditionals, 353−372. Cambridge: Cambridge University Press.

Frankel, R. M. (2000) The (socio)linguistic turn in physician–patient communication research. In J. E. Alatis, H. E. Hamilton and A. Tan (eds) Linguistics, Language, and the Professions, 81−103. Washington, DC: Georgetown University Press.

Georgakopoulou, A. and Goutsos, D. (2000) Mapping the world of discourse: The narrative vs. non-narrative distinction. Semiotica 131 (1–2): 112–141.

Gerteis, M., Edgman-Levitan, S., Daley, J. and Delbanco, T. L. (eds) (1993) Through the Patient’s Eyes: Understanding and Promoting Patient-centered Care. San Francisco, CA: Jossey-Bass.

Giltrow, J. (2010) Genre as difference: The sociality of linguistic variation. In H. Dorgeloh and A. Wanner (eds) Syntactic Variation and Genre, 29−52. Berlin: Mouton de Gruyter.

Goffman, E. (1974) Frame Analysis: An Essay on the Organization of Experience. New York: Harper & Row.

Goffman, E. (1981) Forms of Talk. Philadelphia, PA: University of Pennsylvania Press.

Gotti, M. and Salager-Meyer, F. (2006) Introduction. In M. Gotti and F. Salager-Meyer (eds) Advances in Medical Discourse Analysis: Oral and Written Contexts, 9−15. Bern: Peter Lang.

Haegeman, L. (1984) Pragmatic conditionals in English. Folia Linguistica 18: 485−502.

Haiman, J. and Kuteva, T. (2002) The symmetry of counterfactuals. In J. L. Bybee and M. Noonan (eds) Complex Sentences in Grammar and Discourse: Essays in Honor of Sandra A. Thompson, 101–124. Amsterdam: John Benjamins.

Heritage, J. and Maynard, D. W. (eds) (2006) Communication in Medical Care: Interaction Between Primary Care Physicians and Patients. Cambridge: Cambridge University Press.

Hunter, K. M. (1991) Doctors’ Stories: The Narrative Structure of Medical Knowledge. Princeton, NJ: Princeton University Press.

Hurwitz, B. (2006) Form and representation in clinical case reports. Literature and Medicine 25 (2): 216−240.

Hydén, L. and Bülow, P. (2006) Medical discourse, illness narratives. In K. Brown (ed.) Encyclopedia of Language and Linguistics. Second edition, 697−
703. Oxford: Elsevier.

Maseide, P. (2003) Medical talk and moral order: Social interaction and collaborative clinical work. Text 23 (3): 369−403.

McCullough, L. B. (1989) The abstract character and transforming power of medical language. Soundings 72 (1): 111−125.

Miller, C. R. (1984) Genre as social action. Quarterly Journal of Speech 70: 151−167.

Mishler, E. G. (1984) The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, NJ: Ablex.

Murawska, M. (2012) The many narrative faces of medical case reports. Poznan Studies in Contemporary Linguistics 48 (1): 55−75.

Page, R. (2012) Stories and Social Media: Identities and Interaction. New York: Routledge.

Paltridge, B. (2006) Discourse Analysis. London & New York: Continuum.

Pennebaker, J. W. (1990) Opening Up: The Healing Powers of Confiding in Others. New York: William Morrow.

Pennebaker, J. W. and Seagal, J. D. (1999) Forming a story: The health benefits of narrative. Journal of Clinical Psychology 55: 1243−1254.<1243::AID-JCLP6>3.0.CO;2-N

Quirk, R., Greenbaum, S., Leech, G. and Svartvik, J. (1985) A Comprehensive Grammar of the English Language. London: Longman.

Ribeiro, B. T. (1996) Conflict talk in a psychiatric discharge interview: Struggling between personal and official footings. In C. R. Caldas-Coulthard and M. Coulthard (eds) Texts and Practices: Readings in Critical Discourse Analysis, 179–193. London: Routledge.

Ribeiro, B. T. and Hoyle. S. M. (2009) Frame analysis. In F. Brisard, J. Östman and J. Verschueren (eds) Grammar, Meaning and Pragmatics, 74–90. Amsterdam: John Benjamins.

Sarangi, S. (2000) Activity types, discourse types and interactional hybridity: The case of genetic counselling. In S. Sarangi and M. Coulthard (eds) Discourse and Social Life, 1–27. Harlow: Longman.

Sarangi, S. (2004) Towards a communicative mentality in medical and healthcare practice. Communication & Medicine 1 (1): 1–11.

Sarangi, S. and Roberts, C. (1999) Introduction: Discourse hybridity in medical work. In S. Sarangi and C. Roberts (eds) Talk, work, and Institutional Order: Discourse in Medical, Mediation, and Management Settings, 61–74. Berlin: Mouton de Gruyter.

Schryer, C. F., Lingard, L., Spafford, M. and Garwood, K. (2003) Structure and agency in medical case presentations. In C. Bazerman and D. R. Russell (eds) Writing Selves/ Writing Societies: Research from Activity Perspectives, 62−96. Fort Collins, CO: The WAC Clearinghouse and Mind, Culture, and Activity.

Scontras, G. and Gibson, E. (2011) A quantitative investigation of the imperative-and-declarative construction in English. Language 87 (4): 817−829.

Swales, J. M. (2004) Research Genres: Explorations and Applications. Cambridge: Cambridge University Press.

Sweetser. E. (1990) From Etymology to Pragmatics. Cambridge: Cambridge University Press.

Ten Have, P. (1989) The consultation as genre. In B. Torode (ed.) Text and Talk as Social Practice, 115−135. Dordrecht: Foris.

Wiltshire, J. (1998) The patient writes back: Bioethics and the illness narrative. In J. Adamson, R. Freadman and D. Parker (eds) Renegotiating Ethics in Literature, Philosophy, and Theory, 181−198. Cambridge: Cambridge University Press.

Winker, M. A. (2006) Clinical crossroads: Expanding the horizons. Journal of the American Medical Association 295 (24): 2888−2889.