Categorizing and Quantifying Doctors’ Extended Answers and their Strategies in Teleconsultations: A Corpus-based Study
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Huaikui Kevin Li
Huaikui Kevin Li is professor of Linguistics and Applied Linguistics at Guangxi Normal University. His research interests include studies of pragmatics and second language acquisition.
Abstract
This study examined 210 teleconsultations to analyze doctors’ extended answers and communication strategies using corpus software. The results revealed seven categories of extended answers, with explanations for diseases and treatments being the most frequent at 39 %. Proposals for medical treatment had a proportion at 29 %. The remaining categories had lower rates ranging from 3 % to 9 %. The corpus derived four types of communication strategies: baldly on-record strategies (BORSs), positive politeness strategies (PPSs), negative politeness strategies (NPSs), and off-record strategies (ORSs), with NPSs being the most commonly used at 84 %. Except ORSs, these strategies encompassed multiple classes, with NPSs having as much as seven categories, in which offering justifications for definitive minimal responses was the most prevalent at 33 %. Making fuzzy proposals had a share of 32 %. Each of the remaining categories made up a far low rate. But when it comes to the specific category of extended answers, the most commonly used strategy in it is not always the one from NPSs. The study underscores the significance of clear explanations and justifications in teleconsultations. Implications for training programs in teleconsultation settings are discussed, with potential areas for further research suggested to enhance teleconsultation practices.
1 Introduction
Before the patient-centered clinical model was introduced by Stewart et al. (1995), research had focused on doctors’ communication techniques with patients and the organization of such techniques (Byrne and Long 1976; Cohen-Cole 1991; Ley 1988; Mishler 1984; Roter and Hall 1992). However, since the emergence of this new model as a standard clinical method, increased attention has been given to the patient’s discourse in medical interviews. One specific area of interest has been the examination of patients’ extended answers during face-to-face medical consultations or interviews and their interpersonal significance (Peräkylä 2006; Stivers and Heritage 2001; Wang and Yu 2021). While research in this area is relatively developed, studies on doctors’ extended answers in medical teleconsultations are still in their early stages. In exploring doctor-patient communication strategies during consultations, some researchers have sought to categorize patients’ strategies based on Brown and Levinson’s (1987) Face Theory (see Zhang and He (2021) for a review of linguistic studies on doctor-patient communications). However, limited attention has been given to doctors’ strategies in face-to-face consultations, and even less in teleconsultations. Therefore, the objective of this paper is to classify and quantify doctors’ extended answers and the communication strategies employed in these answers during clinical teleinterviews.
2 Literature Review
2.1 Extended Answers in Clinical Consultations
Before diving into the literature review, it is crucial to introduce the concept of adjacency pairs. Schegloff and Sacks (1973) posit that conversations are composed of closely related turns known as adjacency pairs, such as question-answer, greeting-greeting, offering-accepting or refusing. The second speaker can often provide a minimal response, like a simple yes or no, to an interrogative question, or accept or refuse an offer without elaborate commentary. In cases where expected response can be provided for a question, the answer may be (i) the only required information, or (ii) more is offered than what is required, while in cases where expected response cannot be provided, the answer may range from (iii) a simple I don’t know to providing additional information (iv) with or (v) without explanation (Yu and Guo 2020). Wang and Yu (2021, 109–110) define the case (ii) where more information than required is provided as the extended response. Peräkylä (2006, 234–235) observed in clinical consultations that patients of Finnish origin might offer more information than expected, particularly when doctors hesitate to make a diagnosis or when the diagnosis falls short of patient’s expectations. Peräkylä labels this additional information as the extended response, a concept that differs from Wang & Yu’s definition.
In this research, extended answers are defined as responses that provide additional information beyond the minimal required for patients’ direct questions regarding diseases, examinations and medications. For interrogative questions, a minimal answer consists of a simple yes or no with the asserted or negated proposition. Any additional information beyond this minimal answer is considered an extended answer. For example, in response to the question Do we need to have an examination in the hospital? the doctor’s response Go to the hospital for an examination if convenient. Specifically, he can have a chest X-ray and a blood test (患者: 需要去医院具体检查吗 ? 医生: 方便的话去医院检查一下, 拍个胸片、验个血 from Conversation 11) includes an extended answer of the underlined part, providing further details. In the case of wh-questions, the minimal answer provides information corresponding to the wh-word, and any additional proposition forms part of the extended answer. For instance, in the dialogue, Patient: What special problem need to pay for the baby? Doctor: Your premature baby has a not low birth weight and the birth date approaches full term. So no major problems need to pay attention to currently as long as he breathes steadily and breastfeeds regularly. (患者: (宝宝)需要特意注意什么 ? 医生: 早产宝宝现在出生体重也不低了, 接近足月儿, 目前看只要呼吸平稳正常吃奶, 通常不会有太大问题 from Conversation 22). The underlined extra information provided by the doctor constitutes the extended answer. Further clarifications of extended answers with examples can be found in Appendix 1 and 2.
Researchers have attempted to categorize patients’ extended answers based on face-to-face clinical consultations. Stivers and Heritage (2001, 156) identified three categories: addressing difficulties in responding, supporting answers by adding details, and preempting negative inference. Wang and Yu (2021, 112) proposed four categories: stating difficulties in giving expected responses, presenting prior medical treatment effectiveness, supporting answers by adding related details, and providing possible diagnosis-related information. Except the category of preempting negative inference, the two frameworks are somewhat similar.
While there is a wealth of literature on doctors’ discourse in clinical consultations (e.g., Cohen-Cole 1991; Ley 1988; Neighbour 1987), patient-centered care models (e.g., Brown et al. 1989; Mcwhinney 1989; Stewart et al. 1995), and principles doctors should follow in these models, specifically the optimization principle and the recipient design principle (see Boyd and Heritage 2006; Maynard 2003), limited information exists on categorizing doctors’ extended answers in medical interviews. This study aims to classify doctors’ extended answers and present the frequency of each category based on a corpus of clinical teleconsultations.
2.2 Communication Strategies in Extended Answers
The exploration of strategies used by patients and doctors in clinical interviews has been a key focus in the study of patient-doctor interactions (Zhang and He 2021). Previous research within the Chinese context has utilized Brown & Levinson’s (hereafter abbreviated as B & L) Face Theory framework (1987), which includes baldly on-record strategy (BORS), positive politeness strategy (PPS), negative politeness strategy (NPS), off-record strategy (ORS) and opting out strategy (OOS). Liu and Liu (2011) conducted a study based on outpatient consultations and identified fourteen categories of doctor strategies, including eight PPS categories, five NPS categories and one ORS category. Long, Wu and Wang (2012) studied inpatient consultations in the Internal Medicine department and found that doctors primarily employed PPSs and NPSs, with multiple categories under each. Hu (2016) analyzed consultations in the outpatient service, revealing the strategies used by both patients and doctors. Patients predominantly utilized PPS, NPS and ORS, with multiple categories under PPS and ORS, while doctors employed BORS, PPS, NPS and ORS, with multiple categories under each.
These studies demonstrate both similarities and differences in strategy usage. While PPS and NPS are consistently found to be among the more frequently used strategies, there is variability in the findings. Liu and Liu (2011) found doctors favored PPS, whereas Long, Wu, and Wang (2012) and Hu (2016) observed a preference for NPS.
Given the discrepancies in findings regarding the strategies used by doctors in clinical consultations, particularly in the context of extended answers during medical consultations, this study seeks to analyze and explore the distribution of these strategies further. By examining strategies employed by doctors in their extended answers, insights can be gained into the communication dynamics in medical teleconsultations.
3 Research Design
3.1 Research Questions
The first question focuses on the categories of doctors’ extended answers in clinical teleconsultations and the distribution of these categories. An extended answer in this context refers to a response that goes beyond providing minimal information in relation to patients’ direct questions for diseases and treatments.
The second question explores the categories of communication strategies used in these extended answers, and the extent to which each strategy is employed. Communication strategies are adapted from B & L’s (1987) five-category strategies that are utilized by speakers across cultures.
The third question checks how categories of extended answer are related to communication strategies.
By examining these three questions, we aim to gain a deeper understanding of the communication dynamics and patterns observed in clinical teleconsultations, particularly in terms of the types of responses given by doctors and the strategies employed in their interactions with patients.
3.2 Research Method
In this study, data analysis was conducted using discourse analysis and corpus linguistic method. Discourse analysis aids in extracting doctors’ extended answers by examining concepts such as adjacency pairs, minimal responses and turn-taking in clinical teleconsultations. This method allows for a detailed analysis of the interaction patterns between doctors and patients.
The corpus linguistic method involves annotating the corpus of data and utilizing concordance software to search for specific keywords or phrases related to extended answers and communication strategies (see Appendix 4 for a list of keywords for extended answers and communication strategies of this research). By leveraging this method, researchers can quantify the frequency of extended answers and communication strategies used by doctors in teleconsultations. This quantitative approach provides valuable insights into the prevalence and distribution of these communication patterns within the data set.
3.3 Corpus Collection
The corpus used for this study was primarily sourced from the clinical platform Helpful Doctors Online (www.chunyuyisheng.com), with additional data collected from the platform Good Doctors Online (www.haodf.com). The aim was to create a comprehensive corpus, but due to insufficient data from Helpful Doctors Online , samples were also obtained from other clinical platforms, with a focus on Good Doctors Online being another target source. Both platforms permitted the free download of medical interviews, and the samples were randomly selected for analysis.
The interviews included in the corpus were sourced from six clinical departments: paediatrics, orthopaedics, oral and maxillofacial surgery, ophthalmology, otolaryngology, and oncology. A total of 177 doctors interacting with various patients in 210 interviews were included in the corpus. The data covers a period of five years, from 2018 to 2022, with varying numbers of interviews extracted from each year (10 from 2018, 41 from 2019, 94 from 2020, 9 from 2021, and 56 from 2022). The total size of the corpus is 170,000 Chinese characters.
The interviews are evenly distributed across the six departments, with 35 interviews from each department. Of these, 30 interviews were sourced from Helpful Doctors Online and 5 from Good Doctors Online. This diverse corpus provides a rich data set for the analysis of communication patterns and strategies in teleconsultations across different medical specialties.
3.4 Data Analysis
First, the original corpus was proofread to correct spelling errors and eliminate repetitive content. Second, criteria for extended answers were established. Specifically, extended answers refer to doctors’ additional responses to patients’ direct questions for diseases and treatments. Indirect questions and those not pertaining to diseases and treatments will not be considered in this study. Additionally, the background questions posed at the beginning of interviews and questions repeated without responses from previous queries were excluded from patients’ questions. Furthermore, patients’ turns consisting solely a question mark was not counted as questions (see Appendix 1 for clarifications).
Based on the criteria outlined above, it was found that patients asked 1,283 questions related to diseases and treatments, with 157 remaining unanswered.[1] In 8 interviews, patients did not ask any questions meeting the specified criteria. 624 extended answers were identified from 177 medical interviews. The remaining 33 interviews did not include any extended answers.
In terms of classifying extended answers, the present author initially attempted to utilize frameworks proposed by Stivers and Heritage (2001) and Wang and Yu (2021). However, as the analysis progressed, it became apparent that these frameworks were not suitable for the corpus at hand. One challenge with these frameworks was the difficulty in defining the categories, particularly in Wang & Yu’s classification where terms like possible and related could make annotation challenging. Additionally, their frameworks were derived from patients’ extended answers, whereas the new categorization system was developed based on doctors’ extended responses. This difference in data source may lead to discrepancies in the categories identified.
As a result, a new categorization system was developed, and the annotation was reset. The present author read and annotated the first 30 conversations, resulted in the identification of nine initial categories which were later refined into a seven-category framework. The seven categories were then grouped into two overarching categories. An illustration of the extended answer categories can be found in Appendix 2. Each category was labeled as [EAx] in the annotation, with x representing a specific category.
Regarding communication strategies found in extended answers, I delved into B & L’s Face Theory to grasp the essence of each category, especially those within PPS and NPS. Drawing on classifications from Liu and Liu (2011), Long, Wu, and Wang (2012), and Hu (2016), a refined framework for categorization emerged throughout the corpus analysis. This framework evolved into a four-strategy system, namely: BORS, PPS, NPS, and ORS. Within this system, there were two categories of BORS, three of PPS, seven of NPS, and one of ORS, denoted as [BORx], [PPx], [NPx] or [NPx(y)], and [OR] respectively in the annotated system.
The identification of strategies was primarily based on cases of extended answers, with each unit of strategy typically corresponding to a single sentence within an extended answer. However, if an extended answer contained multiple sentences, it could encompass two or more categories of strategy.
Following the criteria outlined above, a total of 849 strategies were identified across all the extended answers, comprising 70 of BORS, 58 of PPS, 715 of NPS, and 6 of ORS. The annotated corpus was then transferred into a text file and imported into the BFSU Powerconc 1.0 corpus software, facilitating further analysis of Chinese corpus. Figure 1 presents a snapshot of the search results obtained through this software.
A snapshot of corpus analysis results.
4 Doctors’ Extended Answers: Categories and Frequencies
The seven categories of extended answers, their frequencies and the relative weights are shown in Table 1 and Figure 2.
Categories and frequencies of extended answers.
| Overarching categories | Subordinating categories | Freq. |
|---|---|---|
| Non-medical treatment proposals | 1: Living habit precautions (LHP) | 55 |
| 2: Non-medical treatments diagnoses (NMT) | 36 | |
| 3: Soothing words (SW) | 20 | |
| 4: Non-medication resources (NMR) | 35 | |
| Medical treatment proposals | 5: Disease and their symptom diagnoses (DS) | 52 |
| 6: Medical treatment diagnoses (MT) | 182 | |
| 7: Explanations for disease and treatment diagnoses (EDT) | 244 | |
| Sum | 624 | |
Weights of different extended answer categories.
The frequencies of each category shown in Table 1 reveal that doctors are more likely to offer information related to medical treatments, with their categories accounting for the most dominant frequencies of 478 cases out of the total 624 cases. To be specific to individual categories, as is presented in Figure 2, providing explanations for diseases and treatments (EDT) is the most frequent at 39 %, and proposals for medical treatment (MT) had a proportion at 29 %. Each of remaining categories is employed far less frequently than MT or EDT. LHP and DS hold similar weight at 9 % and 8 %. NMT and NMR have the same percentage of 6 %, and SW weighs only at 3 %.
The dominant frequencies of MT and EDT align with common diagnostic practices. During clinical interview, doctors often go beyond expected diagnoses by providing additional information on treatment options and disease determination. The lower frequency of LHP and DS may be linked to the corpus’s nature, predominantly originating from departments specializing in certain areas and teleconsultations. The limited frequency of NMT and NMR can be attributed to the challenge of remote consultations. The extremely low frequency of SW suggests that doctors may prioritize providing accurate medical advice due to constraints in teleconsultations.
In conclusion, doctors need to prioritize offering precise medical guidance during teleconsultations to ensure optimal patient care, especially given the limitations of remote interactions.
5 Strategies in Extended Answers: Categories and Frequencies
Four communication strategies have been identified in the corpus: BORS, PPS, NPS and ORS. Their frequencies are 70, 58, 715 and 6 respectively.
The pie chart in Figure 3 shows that NPSs are the most frequently used strategies, accounting for 84 % of the instances. BORSs rank second at 8 %. PPSs fall behind BORS at 7 %, and ORSs only have a rate of 1 %. Such distribution aligns with our intuition about diagnostic activities, as doctors have to impose certain treatments on patients. Consequently, they often employ various redresses like offering a mitigation, speculation, and explanation for diagnoses.
Weights of different strategies.
With the exception of ORS, these overarching strategies encompass multiple categories (see Appendix 3 for further illustration). Table 2 displays categories of PPS, BORS, and ORS, along with their corresponding frequencies.
Categories and frequencies of PPS, BORS, and ORS.
| Overarching categories | Subordinating categories | Freq. |
|---|---|---|
| PPS | 1: In-group markers (IGM) | 7 |
| 2: Consolation routines (CR) | 12 | |
| 3: Optimistic expressions (OE) | 39 | |
| BORS | 1: Direct medical treatment proposals (DMTP) | 32 |
| 2: Direct non-medical proposals (DNMP) | 38 | |
| ORS | Implicit treatment proposals (ITP) | 6 |
| Sum | 134 | |
Table 2 shows that in PPS, being optimistic when discussing aspects related to diseases and their treatments has more frequencies (39 cases) than total frequencies of IGM and CR (7 and 12 cases). This indicates that when trying to meet patients’ face wants of being respected during medical interviews, doctors are more attentive to provide comfort. The two categories in BORS have nearly the same frequencies (32 versus 38 cases). In ORS, our data only derive 6 cases of implicit proposals for treatments, suggesting that participants, such as doctors in this research, rarely employ highly implicit strategies because there is usually no need to hide their intentions when making diagnoses.
The categories of NPS, along with their corresponding frequencies are displayed in Table 3, and the weights of the categories listed in Tables 2 and 3 are shown in Figure 4.
Categories and frequencies of NPS.
| Overarching category | Subordinating categories | Freq. | |
|---|---|---|---|
| Providing redresses | 1: Apology and/or its reasons (AR) | 1 | |
| for impositions | 2: Deference for an imposition (DI) | 13 | |
| 3: Customary diagnostic practice (CDP) | 10 | ||
| 4: Minimization of imposition (MI) | (1) Option offer (OO) | 1 | |
| (2) Mitigating expressions (ME) | 73 | ||
| 5: Fuzzy proposals (FP) | (1) Use of approximators (UA) | 133 | |
| (2) Use of shields (US) | 47 | ||
| (3) Conditional proposals (CP) | 91 | ||
| Giving justifications | 6: Justifications for definitive minimal responses (JDR) | 288 | |
| for impositions | 7: Justifications for uncertainty in minimal responses (JUR) | 58 | |
| Sum | 715 | ||
Weights of different strategies.
In the realm of NPS categories, it is noteworthy that offering justifications for a definitive minimal response (JDR) stands out as the most commonly employed, having 288 cases (33 %). This rate of occurrence implies that some doctors tend to provide reasons and/or alternative information even if they offer the definitive required answers. Making fuzzy proposals (FP) has frequencies nearly the same as those of JDR, registering 271 cases (32 %). This high frequency could potentially be attributed to the constraints inherent in teleconsultations, which often necessitate the use of imprecise phrases like possibly, roughly, either … or …, and if … due to the lack of face-to-face interaction for comprehensive assessments.
Falling behind in frequency is minimizing impositions (MI) while recommending treatments, having 74 cases (9 %). This proportion shows that some few doctors take measures to reduce FTAs by granting patients autonomy in decision-making, and using mitigating language to suggest treatment options.
Stating justifications for uncertainty in minimal responses (JUR) holds the fourth position, representing 58 cases (7 %). The restrictions of teleconsultations may hinder doctors from reaching definitive diagnoses, prompting them to furnish patients with explanations in such cases.
Conversely, categories of apologies and their reasons (AR), deference for impositions (DI), and customary diagnostic practice (CDP) exhibit notably meager frequencies, only 1, 13 and 10 cases respectively, so that their proportions can be ignored as is shown in Figure 4. This discrepancy suggests that the majority of doctors refrain from issuing apologies to patients despite the challenge of accurate diagnoses in remote consultations, from prescribing specific treatment modalities as standard protocol within the medical community, and from showing inclination towards employing deferential language in their extended answers regarding diseases and treatments.
6 Interactions between Extended Answers and Communication Strategies
Table 4 shows the most frequently used strategy in a specific category of extended answers.
The dominant strategy used in different categories of extended answers.
| Extended answer | LHP | NMT | SW | NMR | DS | MT | EDT |
| Strategy | DNMP | ME | CR | JDR | JDR | JDR | JDR |
| Freq. (%) | 36 | 36 | 55 | 31 | 52 | 34 | 63 |
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The percentage is obtained by the division between the frequency of a specific strategy and the cases of a certain extended answer category.
In the extended answer category of providing living habit precautions for patients (LHP), the most prevalent strategy is the direct non-medical proposals (DNMP) in BORS, comprising 36 % of the total strategies in LHP. In proposing non-medical treatments (NMT), leveraging a mitigating expression (ME) in NPS emerges as the most favored approach, with a substantial 36 % utilization rate. Additionally, the extensive use of consolation routines (CR) in PPS attests to its effectiveness in conveying comforting messages in soothing words (SW), reaching an impressive 55 % representation. The strategic justifications for definitive responses (JDR) in NPS stands out as the most preference in providing non-medical resources (NMR), diagnosing diseases and their symptoms (DS) and medical treatments (MT), and offering explanations for disease and treatment diagnoses (EDT), capturing notable percentages at 31 %, 52 %, 34 %, and 63 %, respectively.
These insights underscore the nuanced selection of strategies tailored for specific communication purposes within extended answers, reflecting the diverse approaches adopted by medical professionals based on the context and intent of the interaction.
7 Discussions
Categorizing social phenomena presents a challenge as it can be difficult to adhere to the standard of complementarity and mutual exclusiveness. In this study, extended answers were found to fall into different strategy categories based on varying criteria of categorization, some based on lexical criteria while others on sentential basis. Additionally, some categories had to be adapted to align with the data. Initially, the strategy category of offering reasons and alternative information for minimal responses fell under the overarching category of providing justifications for impositions. However, as the analysis progressed, it became evident that this category was both too limited and too broad. It was too narrow as it failed to account for some extended answers resulting from minimal responses, and it was hard to categorize them elsewhere. Simultaneously, it was too general as minimal responses could be further delineated into certain and uncertain types. Consequently, it was restructured into two categories: presenting justifications for definitive minimal responses and offering justifications for the uncertainty in minimal answers. The first category encompassed reasons, alternative information for the minimal answer and results stemming from it.
The findings of this study shed light on medical training programs. Interestingly, while it may be intuitive to assume that doctors may hesitate in diagnosing diseases and prescribing treatments due to limitations in teleconsultations, few were willing to justify such hesitance, and even fewer extended apologies. Moreover, a minimal number of doctors allowed patients autonomy in decision-making. Therefore, in the language training for outpatient doctors, educators should not only focus on language skills but also encourage participants to discuss their perspectives on challenges in determining diseases and treatments, their willingness to communicate such limitations to patients, the extent of justifications they would provide, the likelihood of issuing apologies for diagnostic uncertainty, their perception of the relationship between apologies and authority as healthcare providers, and circumstances under which they would grant patients decision-making autonomy. It may be beneficial to involve psychology educators as addressing these issues may require more than just language skill training.
Theoretically, we have identified several key differences between our classification of doctors’ extended answers and previous frameworks by Stivers and Heritage (2001) and Wang and Yu (2021). Our framework includes seven categories, whereas the previous frameworks had three and four categories, respectively. One notable difference is the lack of emphasis on diagnosing diseases or symptoms in our classification, in contrast to the importance placed on providing justifications for treatment and proposals for medical treatments or medications. This may be due to the challenges posed by remote consultations, which make it difficult for doctors to confidently diagnose diseases or symptoms.
Additionally, our findings do not align with the don’t-do-the-act or opting-out strategy identified by Brown and Levinson (1987, 69). We find that doctors in our study do not avoid disclosing the truth, even in cases of terminal illnesses like cancer. This discrepancy may be because our data often involve individuals seeking advice on behalf of patients, rather than the patients themselves.
Another difference is the number of categories within PPS and NPS. Our framework has fewer categories than B & L’s framework, which may be attributed to linguistic difference in Mandarin Chinese. We also do not categorize all instances of deferential language as deference in NPS, as some form of honorific language such as nin (您) may be used in a positive politeness context (Shi 2006). The differences confirm the criticism that communication strategies are universals across cultures (Grundy 2020; Mao 1994; Matsumoto 1988).
Overall, the findings from this study provide important insights into the linguistic and discourse strategies used by doctors in clinical teleconsultations, highlighting how they communicate medical information and treatment recommendations to patients. The prevalence of categories such as providing justifications for disease and treatment diagnoses and giving proposals for medical treatments underscores the importance of clear and transparent communication between doctors and patients. The dominance of strategies like NPSs in conveying vague diagnoses and justifications emphasizes the intricate ways in which doctors convey information to patients.
Understanding the distribution of categories and strategies in doctors’ extended answers can enhance training programs for healthcare professionals, improving their communication skills and ultimately benefiting patient care. Future research could explore the factors influencing doctors’ tendencies to lack apologies and explanations for diagnostic difficulties in teleconsultations, and how linguistic and discourse patterns differ across various medical specialties or cultural contexts, expanding our knowledge of doctor-patient communication in teleconsultation environments.
8 Conclusions
This paper utilizes corpus linguistics and discourse analysis to categorize doctors’ extended answers in clinical teleconsultations and communication strategies used in these answers, as well as to quantify the frequency of each category. Our findings reveal seven categories of extended answers, with providing justifications for disease and treatment diagnoses being the most prevalent at 39 %. Giving proposals for medical treatments and/or medications ranks second at 29 %. The remaining categories have lower rates ranging from 3 % to 9 %. At a broader level, our analysis extracts four strategies from the corpus: BORS, PPS, NPS, and ORS. Among these, NPSs are the most frequently used, constituting 84 %. BORSs rank second, making up 8 %. PPSs account for 7 %, and ORS, the least utilized strategy, comprises 1 %. But such tendency does not necessarily mean that a certain category of NPSs is prevalent in all categories of extended answers. In providing living habit precautions and giving soothing words, for example, the BORS category of direct proposals on non-medical resources and the PPS category of conveying consolation routines respectively stand out as the most dominant strategies. Except ORS, the other three broad strategies, BORS, PPS and NPS have multiple categories. In NPSs, providing justifications for definitive minimal responses holds the largest share at 33 %, followed by delivering fuzzy proposals on diseases and their treatments at 32 %. Each of the remaining categories is considered low frequency as they are utilized less often. Within these low frequent categories, minimizing impositions comprises 9 %, and giving explanations for inability to offer definitive minimal responses account for 7 %. The other two categories, using deference for impositions, and stating customary medical diagnosis practice collectively represent 3 %. Apologizing for the inability of accurate diagnoses only consists of one case. Its weight, therefore, can be disregarded. In the context of BORS categories, the weight is nearly equal between directly requesting patients to accept specific medical treatments and non-medical rehabilitation. However, in PPSs, the frequency of being optimistic surpasses the combined frequency of the other two categories, which involve using in-group markers and consolidation routines.
About the author
Huaikui Kevin Li is professor of Linguistics and Applied Linguistics at Guangxi Normal University. His research interests include studies of pragmatics and second language acquisition.
Acknowledgements
I would like to thank two anonymous reviewers at Corpus-based Studies across Humanities (CSH) for insightful and stimulating comments on this article.
Appendix 1: Clarifications for Patients’ Questions and Doctors’ Extended Answers to Them
Doctors’ extended answers are the additional information provided for patients’ direct questions for diseases and treatments. Direct questions refer to,
Yes-no questions: Is it OK for him to be gotten vaccinated when he got a slight cough? (From Conversation 2: 之前有点咳, 又打了预防针没事吧?)
Abbreviated yes-no questions: (Does he need) intravenous infusion or oral medication? (From Conversation 16: 输液还是口服?),
Wh-questions: What is the cause of the disease? (From Conversation 9: 这病是什么原因得病的呀?).
Abbreviated wh-questions: (What medicine should be taken) for the cold? (From Conversation 1: 感冒呢?).
The following types of questions are not counted as the data:
Indirect questions: I’m wondering why it still hurts after so long? (From Conversation 100: 不知道为什么这么久还是疼?).
Questions not pertaining to diseases or treatments: Are you online? (From Conversation 41: 在吗, 医生?).
Background questions posed before the interviews started.
Questions repeated without responses from previous queries.
A turn consisting solely a question mark.
Doctors’ extended answers refer to the additional information when,
A positive minimal answer is provided. For example, the doctor’s answer for Can he continue to take azithromycin? is Yes, three days of its taking is not long. (From Conversation 3: 患者: 阿奇霉素还继续服用对吗？医生: 是的,三天时间不长的。) The minimal answer is yes. There are times when the positive particle yes is not provided. For the question Should he just take these two types of medicine? the doctor answered, These two are enough, as one is to treat a cold, and the other to suppress cough. (From Conversation 15: 患者: 就这两种药吗?医生: 这两种可以了,一个治疗感冒, 一个止咳。) The main clause is the minimal answer without yes.
A negative minimal answer is provided. For the question Can this be tongue cancer? the doctor answered, No. Don’t be sensitive. (From Conversation 100: 不是,不要紧张。) No is the minimal answer. There are cases where the negative particle no is not used. In answering Is it related to (the act of) eating? the doctor provided, It isn’t that much related to eating. It may be caused by saliva secretion. (From Conversation 98: 患者: 和吃饭有关吗?医生: 和吃饭关系不大,可能和唾液的分泌有关系。) The first part is the minimal answer without no. Sometimes a minimal answer is modified by an approximator. In the conversation, Patient: Is it necessary to use some eye drops to reduce my eye pressure? Doctor: It is typically not necessary. (From Conversation 131: 患者: 我这个眼压这样需要点降压眼药水吗?医生: 一般不需要。) typicallly is an approximator.
A conditional positive or negative minimal answer is provided. Connectives such as if, on condition that, in case, or in case of (equivalent to 如果, 要是, 假如) are used in these answers. For example, for the question, Do I need to go to the hospital for a check-up? the doctor replied, If you are worried about it, go to the otolaryngology department for a check-up. (From Conversation 94: 患者: 需要去医院检查吗？医生: 如果不放心, 也可以去耳鼻喉科检查一下。) Sometimes, such connective is omitted. Patient: Do I need to take antibiotics? Doctor: You can use it (if) you feel obvious pain. (From Conversation 78: 患者: 不需要消炎药吧？医生: 疼痛明显可以配合用的。)
A minimal answer is not provided. The answer to question Can he have eggs? is They are not easily to be digested. (From Conversation 13: 患者: 鸡蛋能吃吗?医生: 不太好消化。) The answer is an extended one because the implicit minimal answer is No, he can’t.
As to patients’ wh-questions, doctors’ minimal answers are the information provided for the wh-word, and any additional contents beyond this minimal answer are regarded as extended answers. In the dialog, Patient: How should I do with my child? Doctor: It is currently uncertain whether there is bronchitis or not. You can start by feeding him cold medicine and cough suppressants. Children’s Cold Clearing Granules or Children’s Rejuvenation Granules are effective treatments for cold. Yitanjing Cough Suppressant Granules has a good effect on suppressing cough and resolving phlegm. (From Conversation 12: 患者: 那怎么办?医生: 目前不能确定有没有支气炎,可以先喝上感冒药和止咳药,小儿豉翘清热颗粒或儿童回春颗粒治疗感冒效果不错,易坦静止咳化痰止咳效果不错。) the second sentence in the reply is the minimal answer.
Such minimal answers can be modified by conditional moods and shields. For example, Patient: Then how should I do with it? Doctor: If it is caused by tooth decay, go to the dental department for filling treatment. If it is due to tartar falling off, then getting a teeth cleaning at the dental department can help remove it completely. (From Conversation 93: 患者: 我怎么办那？医生: 如果是蛀牙引起的, 那就需要去口腔科补牙治疗。如果是牙结石脱落, 那去口腔科洗牙就可以清除干净的了。) The if-clauses are the conditions for the diagnoses. The answer for the question How possible is it to be cured at my age? is I think it is not so possible. (From Conversation 89: 患者: 像我的年龄这样的概率是多少？医生: 我觉得概率比较小。) In the answer, the shield I think affects the degree of the doctor-commitment. Therefore, such answer can be called a modifiable one.
Information not considered as extended answers is,
Doctors inquiring about patients’ treatment history, such as the underlined part in the answer like Only one. Is he allergic to cephalosporins? Take Amoxicillin clavulanate potassium.。(From Conversation 31: 就一种啊。 头孢不清楚有过敏情况不? 口服阿莫西林克拉维酸钾就可以。) for the question How many anti-inflammatory drugs does he need to take?
Information that is difficult to determine its relevance to the questions. In answering the question Should he continue to take this? the doctor offered It’s OK to continue pullulan and fluconazole. The latter is sufficient for treating cough. Don’t take Qingfei granules . (From Conversation 31:蒲地蓝, 福尔可定继续口服就可以。福尔可定就是治疗咳嗽的。吃这一种咳嗽药就可以了。清肺不吃了。) The underlined part is excluded from categories of extended answers due to ambiguity regarding its relevance to this in the question.
Doctors’ responses consisting solely of non-linguistic signs such as question marks or smiling faces (
).
Appendix 2: Illustrations on Categories of Doctors’ Extended Answers
Providing non-medical proposals,
Living habit precaution proposals, including restrictions of diets (e.g. keeping light diets, and consuming more warm water), footwear choices (e.g. not wearing high heels), the use of certain household items (e.g. fluoride-free toothpaste), and certain lifestyle habits (e.g., washing one’s hand before having the meal, not watching TV while eating, and not staying up late), and justifications for keeping these precautions. For example, He can have some meats, as they have many essential amino acids and trace elements which vegetables and fruit can’t offer . (From Conversation 188: 肉类也可以适量吃, 毕竟肉类中很多必需氨基酸和微量元素是蔬菜水果比 不上的。)
Non-medical treatment proposals, consisting of inhalation of oxygen and nebulized water, warm or cool water compress, massage, exercises (e.g. calisthenics, yoga), mechanical traction therapy, and the use of assistive devices such as walkers, protective gears and (near- or far-sighted) glasses, effectiveness and side effects of such treatments, and justifications for the diagnoses, e.g., Don’t be picky on food. Do more exercises and take more sunbath. (From Conversation 34: 不要偏食, 多运动, 多晒太阳。)
Soothing words, including consolation routines such as Don’t worry (别担心), It’s all right (不要紧), Don’t be sensitive (别紧张), optimisms encompassing giving positive evaluations of treatment and medication, praising the quality of medical institutions, emphasizing the trustworthiness of doctors or medical teams, or encouraging patients to accept a certain treatment proposal, and apologies for the inability to make an accurate diagnosis, e.g., I didn’t learn about the studies in this field. I’m sorry I don’t know the exact data. (From Conversation 89: 没关注过这方面的文献。不清楚数据, 实在抱歉。)
Non-medication resource proposals, comprising information like hospitals and experts specializing in the treatment of certain diseases, treatment expenses (including time and money costs), and the formation of organs or tissues and/or their functions, e.g., General anesthesia usually costs over 5,000 yuan. (From Conversation 92: 全麻一般也得五千多吧。).
Providing medical treatment proposals,
Disease and its symptom diagnoses, in which a doctor told a patient what disease he or she had and what its symptoms were, explained difficulties in diagnosing a disease if the patient did not provide specific information about the symptoms or medical history, and determined the severity of a disease and its progression, for example, It is similar to glaucoma symptoms like aches in the eyes and head. (From Conversation 137: 眼疼, 头疼, 类似青光眼的症状。)
Medical treatment diagnoses, encompassing examinations (e.g. the test of blood, tissues, body fluids, eyesight, blood pressure which are assisted by equipment, and the observation of one’s complexion and posture, taking one’s pulse and hand pressing the body part without assistance of equipment), medication (e.g. Western, Chinese and medicated plaster), treatment procedures of surgery and recovery, the effectiveness of medications (including the side effect), explanations of difficulties in determining treatments, and precautions of treatments and medications, for example, It may affect the effectiveness of the vaccine at most. (From Conversation 2: 最多会使疫苗减弱。).
Explanations for disease and treatment diagnoses, in which doctors explained why they made a certain medical diagnosis, e.g., In general, getting vaccinated requires good physical health, mainly due to fear of vaccine reactions . (From Conversation 2: 一般情况下打预防针是需要身体健康, 主要是怕有疫苗反应。).
The counting of extended answers is necessarily turn based, but in some turns with multiple utterances, there can be more than one case of extended answers. For example, in the turn Doctor: Some people need to be injected with this medicine several times, and its cost is relatively higher. It costs about 8,000 yuan to get a shot if it is domestically produced. (From Conversation 123:医生: 有些人他需要注射好几次, 而且这个费用相对会贵一点, 它这个打一针下来的话, 如果是国产的, 加起来大概八千块钱左右。), the underlined part is one case of medical treatment and medication proposals, and the remaining parts are another case of non-medication resource information.
Appendix 3: Illustrations on Categories of Communication Strategies
Definitions on BORS, PPS, NPS and ORS are derived from B & L’s (1987, 69) concept of strategies for face-threatening acts. BORS focuses on propositional content of the message without considering any mitigating redress. Our data derived two categories of BORS,
Directly requesting patients to accept specific medical treatments
Treatments here include examinations, medication and/or surgeries, with examinations encompassing both equipment-assisted and non-equipment-assisted procedures. For example, Provide timely anti-inflammatory treatment for your baby. (From Conversation 22: 及时给宝宝消炎治疗。)
Directly requesting patients to accept non-medical rehabilitation and/or precautions
Precautions refer to measures beneficial for disease non-medical rehabilitation, such as dietary restrictions (e.g., light diet, and drinking more warm water), appropriate footwear choices (e.g., avoiding high-heels), using specific daily household items (e.g., fluoride-free toothpaste), and adopting healthy lifestyle habits (e.g., not watching TV while eating, avoiding late nights).
PPS requires people to use solidarity language to show others their respect. People can also achieve this by avoiding disagreements, critics, threat and so on. There are three categories of PPS.
Using in-group markers
In-group markers include expressions like let’s (咱, 咱们), baby (宝宝, referring to a child in Mandarin Chinese).
Employing consolation routines
Consolation routines consist of expressions such as Don’t worry/Don’t be worried (不用担心), It’s all right (没事), Take it easy (不要紧张), and among other similar terms.
Being optimistic
It involves providing positive evaluations of treatment and medication, praising the quality of medical institutions, or emphasizing the trustworthiness of doctors or medical teams. And justifications for such optimism are also included in this category. For example, But the effect of Stulln Mono eye-drops is better (From Conversation 118: 只是施图伦滴眼液效果较好。).
NPS reveals that people should take redresses and/or justifications for impositions. Our data derived seven categories of NPS, and they can be put into two groups.
Providing redresses for impositions
Apologizing and/or reasons
The apologies (sometimes along with a reason for them) here are made for not answering patients on time or the inability to make an accurate diagnosis. The expression used is I apologize (抱歉). However, not all instances of apologizing expressions in the corpus convey an actual apology. For example, in Conversation 170, excuse me (不好意思) is used with a denial meaning, and in Conversations 180 and 196, I’m sorry (抱歉) is used to indicate refusal to offer diagnoses. Therefore, these cases are not treated as apologies defined in this research.
Using deference in a speech act of imposition
Deference here refers to the use of the honorific term nin (您). However, it is essential to note that if nin is employed in a greeting or consolation routine, such as Don’t worry (您放心), it is not counted as a NPS strategy.
Emphasizing a diagnosis as customary treatment practice
Diagnoses in this category include those of a disease, treatment and medication.
Minimizing impositions while making medical and non-medical proposals
Offering patients an option
It involves the sentence pattern such as It’s up to you … (你自己决定 … … ).
Using mitigating expressions
Mitigating expressions here include verb phrases like try one’s best (尽量), had better (最好), and ought to (可以), and sentence-ending particles like ba (吧), o (哦), ne(呢). For example, Take medicine first (From Conversation 21: 你就先用药吧).
Making fuzzy proposals for diagnoses
Using aproximaors
Doctors use aproximaors when they are not so certain about a disease and its treatment, including an adaptor showing a degree of disease seriousness like some/a few (一些), sort/kind of (有点), most (大部分), among other expressions, and a rounder showing the range of some figure such as about/around (大概, 左右).
Using shields
Such shields include plausibility shields of doctors’ personalized advice like I think … (我觉得 ⋯ ⋯ ), I tend to … (我倾向于 ⋯ ⋯ ), I suggest … ((我)建议 ⋯ ⋯ ), attribution shields like according to … (根据 ⋯ ⋯), speculative expressions such as I considered it … ((我)考虑是 ⋯ ⋯ ), I estimate … ((我)估计 ⋯ ⋯ ), It may be … (应该 ⋯ ⋯), and reduplicated verbs such as kankan (看看), shishi (试试), for example, in the sentences Use Futalin ointment externally to see if it works. (From Conversation 44: 外用扶她林软膏看看) and Have a try on hot compress (From Conversation 64: 热敷试试).
Offering conditional proposals for diagnoses
It involves conditional, and disjunctive clauses. The explicit conditional clauses includes expressions like If … , … on the condition that … , … in case that … , equivalent to 如果 ⋯ ⋯ , 假如 ⋯ ⋯ , 只要 ⋯ ⋯ , 要是 ⋯ ⋯. Implicit conditional clauses are sentences having conditional mood without a conditional connective. For example, (If) the pain is severe, take some Xilebao. (If) it isn’t severe , don’t take it. (From Conversation 44: 疼的厉害就吃点西乐葆, 不厉害就不吃。) Disjunctive clauses refer to sentence patterns like Either … or … (⋯ ⋯ 或/或者 ⋯ ⋯, ⋯ ⋯ 还是 ⋯ ⋯).
Giving justifications for impositions
Offer of justifications for definitive minimal responses
This category is limited to reasons and alternative information for an unambiguous minimal response. In some few cases, it involves consequence resulting from a minimal response. The keywords for reasons supporting a definitive minimal answer are explicit and implicit conjunctions like because, since, as (因为), among similar expressions. For instance, in the turn Don’t feed him yogurt for the time being because he has diarrhea so badly, and yogurt can stimulate lactose intolerance . (From Conversation 5:酸奶也暂时不要吃, 因为这个大便这么稀, 它会激发乳糖不耐受。)The underlined part functions as a reason for the required minimal response Don’t feed him yogurt for the time being. The keywords of alternative information for minimal responses are both explicit and implicit but, however, and nevertheless (但, 但是, 不过). For example, in answering the question Can the seven-year old child recover by eating probiotics? (From Conversation 28: 孩子七岁了, 吃益生菌可以调理过来吗?) the doctor answered, He surely can. (But) the seven-year old children are suggested to orally take Xinpi Yanger granule because the Mommy-love probiotics is too weak in effect. (From Conversation 28: 可以的啊。七岁还是建议口服醒脾养儿颗粒。妈咪爱吃的量小。) Being definitive is a matter of degree. Besides the absolute definite responses, those approximating or conditional minimal responses are also considered definitive answers.
Providing justifications for the difficulty of offering a definitive minimal responses
When doctors can not give the expected answer to patients, they may try to explain such difficulty. For example, It’s hard to give you definite answer. Some people actively seek treatment, have good blood sugar control, and can live longer . (From Conversation 133: 这个不好说。有些人积极治疗, 血糖控制好。能时间长。)
ORS involves subtle reminding patients about specific medical and/or non-medical treatments, including examinations, medications and surgeries, without directly mentioning them. For instance, in saying The price of Yisaipu is much cheaper currently (目前益赛普价格便宜了很多from Conversation 55), the doctor implied that the patient should buy the medicine Yisaipu.
The counting of strategies are based on cases of extended answers. That is, a case of strategy generally corresponds to a case of extended answer. But sometimes there can be more than one case of strategy in an extended answer. For example, for the question What is the telephone number? the doctor replied, Sorry, please search it online by yourself, (Form Conversation 124: 抱歉, 您自行到网上查询一下吧) there are four strategies in the reply: apology (sorry), deference (nin), fuzziness (yixia), and mitigating (ba). However, if a certain keyword appears in a sentence twice or more than twice, it is treated as one case of that category. For instance, in You need to consult your attending doctor for this. (From Conversation 203:这个需要您咨询您那边的主治医生。), there are two honorifics nin, but according to our criteria, it is one case of deference in NPS. Similarly, if more than one keyword of the same category is used in an extended answer, it is counted as one case of a strategy. In the extended answer But because of the previous surgery, it will cause an adhesion, making the operation more difficult (From Conversation 209:但因为之前手术过, 会引起粘连, 难度会增加), but and because are keywords in the NP strategy of giving justifications for definitive minimal answers. Therefore, one case is recorded for this category.
Appendix 4: Keyword List
| Overarching | Subordinating categories | Covered | ||
|---|---|---|---|---|
| categories | and their keywords | keyword | ||
| Extended | Living habit precautions: 0 (“0” means no keyword, and the same below.) | EA1 | ||
| answers | Non-medical treatment proposals: 0 | EA2 | ||
| Soothing words: Consolation expressions:没有问题*, 不要紧*, 安心*, | EA3 | |||
| 不用担心*, 没事*, 别吓自己*, 放心*, 不要紧张*, apologies: 抱歉*, | ||||
| optimisms: 0 | ||||
| Non-medication resource proposals: 0 | EA4 | |||
| Disease and symptom diagnoses: 0 | EA5 | |||
| Medical treatment diagnoses: 0 | EA6 | |||
| Explanations for disease and treatment diagnoses: 0 | EA7 | |||
| Communication | BORS | Direct medical treatment proposals: 0 | BOR1 | |
| strategies | Direct non-medical proposals: 0 | BOR2 | ||
| PPS | In-group markers: 宝宝*, 咱*, 咱们* | PP1 | ||
| Consolation routines: 没有问题*, 不要紧*, | PP2 | |||
| 安心*, 不用担心*, 没事*, 别吓自己*, 放心*, 不要紧张* | ||||
| Optimisms: positive evaluation: 效果不错*, 安全*, 便宜*, | PP3 | |||
| encouragement: 0 | ||||
| NPS | Apologies: 抱歉* | NP1 | ||
| Deference: 您* | NP2 | |||
| Customary treatment practice: 0 | NP3 | |||
| Imposition | Offer of options: 你自己决定* | NP4(1) | ||
| minimization | Mitigating expressions: Modal verbs: 最好*, 可*, 可以*, 尽量*; sentence-ending particles: 吧*, 哦*, 呢* | NP4(2) | ||
| Fuzzy proposals | Approximators: 下*, 一下*, 才*, 一般*, 点*, 有点*, 些*, 有些*, 一些*, 较*, 比较*, 基本*, 基本上*, 大部分*, 主要*, 可能*, 好像*, 酌情*, 少*, 适当*, 大概*, 左右* | NP5(1) | ||
| Shields: Personal advice: 建议*, 我觉得*, 我倾向于*; speculation: 考虑是*, 应该*, 估计*, 根据*; repetitive verb adverbials: 看看*, 试试* | NP5(2) | |||
| Conditional proposals: Explicit conditional clauses: 若*, 如*, 如果*, 假如*, 只要*, 即便*, 的话*, 要是*; implicit conditional clauses: 0; disjunction: 或*, 或者*, 还是* | NP5(3) | |||
| Overarching | Subordinating categories | Covered | ||
|---|---|---|---|---|
| categories | and their keywords | keyword | ||
| Justifications for definitive minimal responses: cause:因为*; | NP6 | |||
| effect: explicit: 所以*, implicit: 0; alternative proposal: | ||||
| Explicit: 但*, 但是*, 不过*, implicit: 0 | ||||
| Justifications for uncertainty in minimal responses: 0 | NP7 | |||
| ORS | Implicit proposals for treatments: 0 | OR | ||
-
The data was identified by a two-step annotation. The first step was marking out the extended answers. They were underlined in the Word file. The second step was identifying categories of extended answers and communication strategies used in these extended answers. Therefore, the keywords were attached to an asterisk “*”. That is, those keywords not in extended answers are not counted as the data. Since some subordinating categories are identified from the sentence level, and some others are even context dependent, their keywords are covered terms for the category itself. When searching for the frequency of a category in the concordance system, we used the cover term as the keyword. For example, in searching for conditional clauses, we used NP5(3) as the keyword.
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Articles in the same Issue
- Frontmatter
- Research Articles
- Medicines as Subjects: A Corpus-Based Study of Subjectification in Antimicrobial Resistance (AMR) Policy
- Adjusting Mood in Mandarin Chinese: A Game Theory Approach to Double and Redundant Negation with Entropy
- Charting the Trajectory of Corpus Translation Studies: Exploring Future Avenues for Advancement
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