REVIEWS ARTICLE LANGUAGE AND MEDICINE

1 .Doctor–Patient Communication

By far the lion’s share of literature on language and medicine is about doctor–patient communication. As this is the topic of a separate chapter (Ainsworth-Vaughn, this volume), I limit my remarks here to noting interesting differences between the ap- proaches and methodologies of researchers from biomedicine and those of discourse analysts, coming mainly from linguistics, English for science and technology (EST), and social science fields. Discourse analysts (DA) tend to look at lexicogrammatical features (lexical choices, tense–mood variables, hedging devices, pronouns and passive voice, transitivity rela- tionships), discourse structures and organization (“moves,” schemas and frames, them- atic progression, topic–focus relations, foregrounding and backgrounding), features of conversation analysis (turn-taking, structures of adjacency), and particularly at the functions these phenomena fulfill in the discourse forms in question. By contrast, the interactional analysis systems (ISAs) developed within medicine – “observational instruments” (the term itself is revealing) designed to analyze the medical encounter – typically involve the methodic identification, categorization, and notably quantifica- tion of salient features of doctor–patient communication.

2 .Medical Language and Discourse Genres

French writer Julien Green once observed that while thought flies, words walk. Jammal (1988) comments similarly that science flies and its terminology walks – typically at a pace that lags far behind scientific advances. There is less literature than one might expect on medical language, the occupa- tional register of a tribe of white-coated speakers that gets passed from one genera- tion of physicians to the next through the highly ritualized institutions of medical education. It is widely recognized as what sociolinguistics would call an “in-group dialect,” i.e. largely opaque outside the medical “confraternity.”

2.1 Spoken and written genres

The literature on medical language tends to concentrate in two areas: doctor–patient communication (section 1 above and Ainsworth-Vaughn, this volume), where the focus is on spoken discourse, and the language of particular genres of medical dis- course. The latter are primarily written humanitarian values or a service orientation.

2.2 The lexicon and semantics of medicine

From a statistical study of 100,000 words from medical English texts, Salager (1983) distills “the core lexis of medicine” across specialties, while Jammal (1988) looks at how and why (mainly how) the technical vocabularies of medical specialties come to be constituted. Based on his experience compiling a dictionary of epidemiology, he offers a practical guide to the creation of terminology for fields of specialization. Since the dictionary he worked on was bilingual (French–English), he pays particular attention to problems of translation from English, the international language of medi- cine (see Maher 1986).

      Depersonalization, i.e. the separation of biological processes from the individual.

 See the opening sentence of the excerpt above; throughout this excerpt the woman is referred to as “the patient” or “she,” no name, and ellipted altogether from statements of the physician’s observations (“positive for. . . ,” “remarkable (only) for . . .”). 2 Omission of agents, e.g. through existential “there was. . .” constructions and agentless passives. These have the effect of emphasizing what was done rather than who did it let alone why a decision was made to engage in a given course of action.18 3 Treating medical technology as the agent (“The CT scan revealed . . . ,” “Angiography showed . . .”). These formulations carry the process of objectification a step further than the passive voice: not only do the writers fail to mention the person(s) who performed the diagnostic procedures, but they also omit mention of the often complex processes by which angiograms and CT scans are interpreted. In treating medical technology as if it were the agent, such formulations support a view of knowledge in which instruments rather than people create the “data.” 4 The use of non-factive predicators such as “states,” “reports,” and “denies” (Anspach calls these “account markers”), which emphasize the subjectivity of the patient’s accounts.

3.1 Narrative in medicine

Narratologists who have studied (nonfictional) narrative are keenly aware that what storytellers provide is not a verbal icon of a pre-existing structure of real-world experience. Rather, they cull from, and configure, the experiential database from which the story is constructed, notably in ways that support “the point” they wish to make in telling the story (see, e.g. Labov 1972; Fleischman 1990: section 4.1). This commonplace of narratology comes as “news” to at least some researchers who have undertaken to analyze medical case histories from a narrative point of view.

3.2 Narrative “voice” and point of view

Literary narratology insists on a distinction between “narrative voice” (who is speak- ing?) and “point of view” (whose perception orients the report of information?).23 Since narrators commonly undertake to tell what other individuals have seen or experienced (this is standard in the medical chart or case history, where the patient’s words and experiences are entered into the record using the physician’s language), it is necessary to keep these two notions distinct at the theoretical level. In theliterature on medical discourse the two notions are often conflated and the terms used inter- changeably. Poirier et al.’s discussion of “the absent voice of the patient” (1992: 7–9) is really about the absence from the chart of the patient’s point of view (they mention

3.3 Pathography

Narratives about an experience of illness have proliferated in America over the past several decades, notably in the form of biographies and autobiographies oftenreferred

  The nominalization of disease

Warner’s most interesting remarks concern lexical categorization and grammar. The use of nouns instead of verbs to express the idea of illness (he has cancer/hypertension 

vs., e.g. *he is cancering/hypertenses) has interesting implications. It may, he argues, lead to a view of diseases as static entities rather than dynamic processes; and if there is anything disease is not, it is not static (cf. also Hodgkin 1985; on what gets ex- pressed as a noun and what as a verb across languages, see Hopper and Thompson 1984, 1985).