Hospitalk: Politeness and hierarchical structures in interdisciplinary discharge rounds

Abstract

Although linguists have been exploring the nuances of politeness for decades, beginning with the pioneering works of Lakoff (1973), Brown and Levinson (1987) and Leech (1983), there has been little research focusing on impoliteness in medical interaction. Communication between various types of medical caregivers, too, is an under-researched area; most research on medical interaction involves doctor-patient discourse. Using an ethnographic discourse analytic approach, this study begins to address this gap by examining interactions during an interdisciplinary discharge rounds meeting at a major urban teaching hospital. In a teaching hospital, there is potential conflict between physicians-in-training and other members of caregiving teams; while physicians occupy a higher position on the administrative and social hierarchy of the hospital, other caregivers (e. g., registered nurses – who have sometimes had over 20 years of medical experience and spend much more time with patients than medical doctors) must determine how to be polite/politic in voicing their opinions and suggestions regarding patient care. I explore politeness strategies used by various members of caregiving teams (e. g., registered nurses, social workers) to negotiate patient care decisions within the hospital hierarchy. Results indicate that mitigating strategies are an integral part of the communicative process within the institutional hierarchy of a teaching hospital.