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Understanding misunderstandings. Presuppositions and presumptions in doctor-patient chronic care consultations

  • Fabrizio Macagno

    Fabrizio Macagno (Ph.D. in Linguistics and Communication, Università Cattolica, Milan, 2008) works as a researcher (Investigador FCT) and auxiliary professor at the Universidade Nova de Lisboa. He authored several papers published on international peer-reviewed journals including Journal of Pragmatics, Intercultural Pragmatics, Argumentation, and Pragmatics and Cognition. His most important publications include the books Argumentation Schemes (CUP 2008) and Emotive language in argumentation (CUP 2014). He also works as a forensic linguistic consultant.

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    and Sarah Bigi

    Sarah Bigi (Ph.D. in Linguistics, Università Cattolica, Milan, 2007) works as Assistant Professor of Linguistics at Università Cattolica in Milan (Italy). Since 2008 she has been working on doctor-patient interactions and argumentative strategies in doctor-patient decision making. She has authored several papers on these subjects, published in international peer-reviewed journals such as Journal of Pragmatics, Communication and Medicine, Frontiers in Psychology, Discourse Studies and Journal of Argumentation in Context. She has recently published the book, Communicating (with) Care. A linguistic approach to doctor-patient interactions. She collaborates with the Association of Italian Diabetologists (www.aemmedi.it) as a consultant on communication issues.

Published/Copyright: March 9, 2017
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Abstract

Pragmatic presupposition is analyzed as grounded on an implicit reasoning process based on a set of presumptions, which can define cultural differences. The basic condition for presupposing a proposition is represented as a reasoning criterion, namely reasonableness. Presuppositions, on this view, need to be reasonable, namely they need to be the reasonable conclusions of an underlying presumptive reasoning, which does not or may not contain contradictions with other presumptions. Presumptions are in turn analyzed considering their nature and their hierarchy, namely their subject matter and their possible contextual backing, which eliminates some of their possible defaults. This analysis of presupposition brings to light the relationship between misunderstandings deriving from presuppositional failures and the underlying system of presumptions. This approach is applied to the investigation of communicative issues within the medical context, and more precisely doctor-patient communication in diabetes cases.

About the authors

Fabrizio Macagno

Fabrizio Macagno (Ph.D. in Linguistics and Communication, Università Cattolica, Milan, 2008) works as a researcher (Investigador FCT) and auxiliary professor at the Universidade Nova de Lisboa. He authored several papers published on international peer-reviewed journals including Journal of Pragmatics, Intercultural Pragmatics, Argumentation, and Pragmatics and Cognition. His most important publications include the books Argumentation Schemes (CUP 2008) and Emotive language in argumentation (CUP 2014). He also works as a forensic linguistic consultant.

Sarah Bigi

Sarah Bigi (Ph.D. in Linguistics, Università Cattolica, Milan, 2007) works as Assistant Professor of Linguistics at Università Cattolica in Milan (Italy). Since 2008 she has been working on doctor-patient interactions and argumentative strategies in doctor-patient decision making. She has authored several papers on these subjects, published in international peer-reviewed journals such as Journal of Pragmatics, Communication and Medicine, Frontiers in Psychology, Discourse Studies and Journal of Argumentation in Context. She has recently published the book, Communicating (with) Care. A linguistic approach to doctor-patient interactions. She collaborates with the Association of Italian Diabetologists (www.aemmedi.it) as a consultant on communication issues.

Acknowledgments

Fabrizio Macagno would like to thank the Fundação para a Ciência e a Tecnologia for the research grants no. IF/00945/2013, PTDC/IVC-HFC/1817/2014, and PTDC/MHC-FIL/0521/2014.

Sarah Bigi would like to thank the Italian Ministry of Education, University and Research for a 3-year grant supporting her current research. Grant no.: RBFR13FQ5J. Project website: http://www.unicatt.it/healthyreasoning-eng.

References

Abusch, Dorit. 2002. Lexical alternatives as a source of pragmatic presuppositions. In Brendan Jackson (ed.), Proceedings of SALT (Vol. 12), 1–19. Ithaca: CLC. doi:10.3765/salt.v0i0.2867.10.3765/salt.v0i0.2867Search in Google Scholar

Allan, Keith. 2013. What is common ground? In Alessandro Capone, Franco Lo Piparo & Marco Carapezza (eds.), Perspectives in pragmatics, philosophy & psychology Volume 2, 285–310. Cham: Springer. doi:10.1007/978-3-319-01014-4_11.10.1007/978-3-319-01014-4_11Search in Google Scholar

Angelelli, Claudia. 2004. Medical interpreting and cross-cultural communication. Cambridge: Cambridge University Press.10.1017/CBO9780511486616Search in Google Scholar

Anscombre, Jean-Claude & Oswald Ducrot. 1977. Deux mais en français? Lingua 43(1). 23–40. doi:10.1016/0024–3841(77)90046–8.10.1016/0024–3841(77)90046–8Search in Google Scholar

Asher, Nicholas & Alex Lascarides. 1998. The semantics and pragmatics of presupposition. Journal of Semantics 15(3). 239–300. doi:10.1093/jos/15.3.239.10.1093/jos/15.3.239Search in Google Scholar

Atlas, Jay David. 2008. Presupposition. In Laurence Horn & Gregory Ward (eds.), The handbook of pragmatics, 29–52. Oxford: Blackwell Publishing Ltd. doi:10.1002/9780470756959.ch2.10.1002/9780470756959.ch2Search in Google Scholar

Atlas, Jay David & Stephen Levinson. 1981. It-clefts, informativeness and logical form: Radical pragmatics (revised standard version). In Peter Cole (ed.), Radical pragmatics, 1–62. New York: Academic Press.Search in Google Scholar

Austin, John Langshaw. 1962. How to do things with words. Oxford: Oxford university press.Search in Google Scholar

Bach, Kent. 1999. The myth of conventional implicature. Linguistics and Philosophy 22. 237–366.10.1023/A:1005466020243Search in Google Scholar

Bigi, Sarah. 2011. The persuasive role of ethos in doctor-patient interactions. Communication and Medicine, vol. 8, 67–75. doi:10.1558/cam.v8i1.67.10.1558/cam.v8i1.67Search in Google Scholar

Bigi, Sarah. 2014a. Key components of effective collaborative goal setting in the chronic care encounter. Communication and Medicine 11(21). 1–13. doi:10.1558/cam.v11i2.21600.10.1558/cam.v11i2.21600Search in Google Scholar

Bigi, Sarah. 2014b. Healthy reasoning: The role of effective argumentation for enhancing elderly patients’ selfmanagement abilities in chronic care. In Giovanni Riva, Paolo Ajmone Marsan & Claudio Grassi (eds.), Active ageing and healthy living: A human centered approach in research and innovation as source of quality of life, 193–203. Amsterdam: IOS Press.Search in Google Scholar

Bigi, Sarah. 2016. Communicating (with) care. A linguistic approach to the study of interactions in chronic care settings. Amsterdam: IOS Press.Search in Google Scholar

Boyd, Elizabeth & John Heritage. 2006. Taking the history: Questioning during comprehensive history taking. In John Heritage & Douglas Maynard (eds.), Communication in medical care interaction between primary care physicians and patients, 151–184. New York: Cambridge University Press. doi:10.1017/cbo9780511607172.008.10.1017/cbo9780511607172.008Search in Google Scholar

Brennan, Patricia & Indiana Strombom. 1998. Improving health care by understanding patient preferences: The role of computer technology. Journal of the American Medical Informatics Association : JAMIA 5(3). 257–62. doi:10.1136/jamia.1998.0050257.10.1136/jamia.1998.0050257Search in Google Scholar

Burton-Roberts, Noel. 1989. On Horn’s dilemma: Presupposition and negation. Journal of Linguistics 25. 95–125. doi:10.1017/S0022226700012111.10.1017/S0022226700012111Search in Google Scholar

Capone, Alessandro. 2012. Indirect reports as language games. Pragmatics & Cognition 20(3). 593–613. doi:10.1075/pc.20.3.07cap. http://www.jbe-platform.com/content/journals/10.1075/pc.20.3.07cap.10.1075/pc.20.3.07capSearch in Google Scholar

Capone, Alessandro. 2013. The pragmatics of indirect reports and slurring. In Alessandro Capone, Franco Lo Piparo & Marco Carapezza (eds.), Perspectives on linguistic pragmatics, 153–183. Heidelberg: Springer. doi:10.1007/978-3-319-01014-4_6.10.1007/978-3-319-01014-4_6Search in Google Scholar

Chewning, Betty, Carma L. Bylund, Bupendra Shah, Neeraj K. Arora, Jennifer A. Gueguen & Gregory Makoul. 2012. Patient preferences for shared decisions: A systematic review. Patient Education and Counseling 86(1). 9–18. doi:10.1016/j.pec.2011.02.004.10.1016/j.pec.2011.02.004Search in Google Scholar

Coleman, Dorothy. 2001. Baconian probability and Hume’s theory of testimony. Hume studies 27(2). 195–226.Search in Google Scholar

Dascal, Marcelo. 2003. Interpretation and understanding. Amsterdam: John Benjamins Publishing Company.10.1075/z.120Search in Google Scholar

Ducrot, Oswald. 1966. “Le roi de France est sage”. Implication logique et Présupposition linguistique. Etudes de linguistique appliquée 4. 39–47.Search in Google Scholar

Ducrot, Oswald. 1968. Le structuralisme en linguistique. In Oswald Ducrot & Tzvetan Todorov (eds.), Qu’est-ce que le structuralisme?, 13–96. Paris: Seuil.Search in Google Scholar

Ducrot, Oswald. 1972a. Dire et ne pas dire. Paris: Hermann.Search in Google Scholar

Ducrot, Oswald. 1972b. De Saussure à la philosophie du langage. In John Searle (ed.), Les actes de langage, 7–34. Paris: Hermann.Search in Google Scholar

Elwyn, Glyn & Talya Miron-Shatz. 2010. Deliberation before determination: The definition and evaluation of good decision making. Health Expectations 13(2). 139–147. doi:10.1111/j.1369-7625.2009.00572.x.10.1111/j.1369-7625.2009.00572.xSearch in Google Scholar

Epstein, Ronald & Robert Gramling. 2012. What is shared in shared decision making? Complex decisions when the evidence is unclear. Medical Care Research and Review 70(1). 94–112. doi:10.1177/1077558712459216.10.1177/1077558712459216Search in Google Scholar

Ferguson, Warren & Lucy Candib. 2002. Culture, language, and the doctor-patient relationship. Family Medicine 34(5). 53–61.Search in Google Scholar

Fintel, Kai von. 2008. What is presupposition accommodation, again? Philosophical Perspectives 22(1). 137–170. doi:10.1111/j.1520-8583.2008.00144.x.10.1111/j.1520-8583.2008.00144.xSearch in Google Scholar

Flores, Glenn. 2000. Culture and the patient-physician relationship: Achieving cultural competency in health care. The Journal of pediatrics 136(1). 14–23. http://dx.doi.org/10.1016/S0022-3476(00)90043-X.Search in Google Scholar

Giora, Rachel. 2003. On our mind: Salience, context, and figurative language. Oxford: Oxford University Press.10.1093/acprof:oso/9780195136166.001.0001Search in Google Scholar

Green, Georgia. 1996. Pragmatics and natural meaning understanding. New York: Erlbaum.Search in Google Scholar

Grice, Paul. 1975. Logic and conversation. In Peter Cole & Jerry Morgan (eds.), Syntax and semantics 3: Speech acts, 41–58. New York: Academic Press.10.1163/9789004368811_003Search in Google Scholar

Hamblin, Charles Leonard. 1970. Fallacies. London: Methuen.Search in Google Scholar

Ifantidou, Elly. 2001. Evidentials and relevance. Amsterdam: John Benjamins Publishing Company.10.1075/pbns.86Search in Google Scholar

Karttunen, Lauri. 1973. Presuppositions of compound sentences. Linguistic Inquiry 4(2). 169–193.Search in Google Scholar

Kecskes, Istvan. 2008. Dueling contexts: A dynamic model of meaning. Journal of Pragmatics 40(3). 385–406. doi:10.1016/j.pragma.2007.12.004.10.1016/j.pragma.2007.12.004Search in Google Scholar

Kecskes, Istvan. 2015. Intracultural communication and intercultural communication: Are they different? International Review of Pragmatics 7. 171–194. doi:10.1163/18773109-00702002.10.1163/18773109-00702002Search in Google Scholar

Kecskes, Istvan & Fenghui Zhang. 2009. Activating, seeking, and creating common ground: A socio-cognitive approach. Pragmatics & Cognition 17(2). 331–355. doi:10.1075/pc.17.2.06kec.10.1075/pc.17.2.06kecSearch in Google Scholar

Kecskes, Istvan & Fenghui Zhang. 2013. On the dynamic relations between common ground and presupposition. In Alessandro Capone, Franco Lo Piparo & Marco Carapezza (eds.), Perspectives on linguistic pragmatics, perspectives in pragmatics, philosophy & psychology 2, 375–395. Cham: Springer. doi:10.1007/978-3-319-01014-4_15.10.1007/978-3-319-01014-4_15Search in Google Scholar

Keenan, Edward. 1973. Presupposition in Natural Logic. (Ed.) Sherwood J. B. Sugden. The Monist 57(3). 344–370. doi:10.5840/monist197357314.10.5840/monist197357314Search in Google Scholar

Kempson, Ruth. 1975. Presupposition and the delimitation of semantics. Cambridge: Cambridge University Press.Search in Google Scholar

Kissine, Mikhail. 2012. Sentences, utterances, and speech acts. In Keith Allan & Kasia Jaszczolt (eds.), Cambridge handbook of pragmatics, 169–190. New York: Cambridge University Press. doi:10.1017/cbo9781139022453.010.10.1017/cbo9781139022453.010Search in Google Scholar

Krabbe, Erik. 2003. Metadialogues. In Frans van Eemeren, Anthony Blair, Charles Willard & Francisca Snoeck Henkemans (eds.), Anyone who has a view, 83–90. Amsterdam: Springer. doi:10.1007/978-94-007-1078-8_7.10.1007/978-94-007-1078-8_7Search in Google Scholar

Levin, Samuel. 1977. The semantics of metaphor. Baltimore: The Johns Hopkins University Press.10.1353/book.71828Search in Google Scholar

Levinson, Stephen. 1983. Pragmatics. Cambridge: Cambridge University Press.10.1017/CBO9780511813313Search in Google Scholar

Levinson, Stephen. 2000. Presumptive meanings: The theory of generalized conversational implicature. Cambridge, MA: MIT Press.10.7551/mitpress/5526.001.0001Search in Google Scholar

Lewis, David. 1979. Scorekeeping in a language game. Journal of Philosophical Logic 8(1). 339–359. doi:10.1007/BF00258436.10.1007/BF00258436Search in Google Scholar

Macagno, Fabrizio. 2011. The presumptions of meaning: Hamblin and equivocation. Informal Logic 31(4). 367–393.10.22329/il.v31i4.3326Search in Google Scholar

Macagno, Fabrizio. 2012. Reconstructing and assessing the conditions of meaningfulness: An argumentative approach to presupposition. In Henrique Ribeiro (ed.), Inside arguments: Logic and the study of argumentation, 247–268. Newcastle upon Tyne: Cambridge Scholars Publishing.Search in Google Scholar

Macagno, Fabrizio. 2015. Presupposition as argumentative reasoning. In Alessandro Capone & Jacob Mey (eds.), Interdisciplinary studies in pragmatics, culture and society, 465–487. Cham: Springer. doi:10.1007/978-3-319-12616-6_18.10.1007/978-3-319-12616-6_18Search in Google Scholar

Macagno, Fabrizio & Sarah Bigi. 2017. Analyzing the pragmatic structure of dialogues. Discourse Studies 19(3).10.1177/1461445617691702Search in Google Scholar

Macagno, Fabrizio & Alessandro Capone. 2016a. Uncommon ground. Intercultural Pragmatics 13(2). 151–180. doi:10.1515/ip-2016-0007.10.1515/ip-2016-0007Search in Google Scholar

Macagno, Fabrizio & Alessandro Capone. 2016b. Interpretative disputes, explicatures, and argumentative reasoning. Argumentation 30(4). 399–422. doi:10.1007/s10503-015-9347-5.10.1007/s10503-015-9347-5Search in Google Scholar

Macagno, Fabrizio & Aikaterini Konstantinidou. 2013. What students’ arguments can tell us: Using argumentation schemes in science education. Argumentation 27(3). 225–243. doi:10.1007/s10503-012-9284-5.10.1007/s10503-012-9284-5Search in Google Scholar

Macagno, Fabrizio & Douglas Walton. 2014. Emotive language in argumentation. New York: Cambridge University Press.10.1017/CBO9781139565776Search in Google Scholar

Moeschler, Jacques. 2013. Is a speaker-based pragmatics possible? Or how can a hearer infer a speaker’s commitment? Journal of Pragmatics 48(1). 84–97. doi:10.1016/j.pragma.2012.11.019.10.1016/j.pragma.2012.11.019Search in Google Scholar

Naess, Arne. 1966. Communication and argument. London: Allen & Unwin LTD.Search in Google Scholar

Rescher, Nicholas. 2006. Presumption and the practices of tentative cognition. Cambridge: Cambridge University Press.10.1017/CBO9780511498848Search in Google Scholar

Roberts, Celia & Srikant Sarangi. 2005. Theme oriented discourse analysis of medical encounters. Medical Education 39(6). 632–640. doi:10.1111/j.1365-2929.2005.02171.x.10.1111/j.1365-2929.2005.02171.xSearch in Google Scholar

Robinson, Jeffrey. 2006. Soliciting patients presenting concerns. In John Heritage & Douglas Maynard (eds.), Communication in medical care: Interaction between primary care physicians and patients, 22–47. New York: Cambridge University Press. doi:10.1017/cbo9780511607172.004.10.1017/cbo9780511607172.004Search in Google Scholar

Schouten, Barbara & Ludwien Meeuwesen. 2006. Cultural differences in medical communication: A review of the literature. Patient education and counseling 64(1). 21–34. doi:10.1016/j.pec.2005.11.014.10.1016/j.pec.2005.11.014Search in Google Scholar

Searle, John. 1976. A classification of illocutionary acts. Language in society 5(1). 1–23. doi:10.1017/s0047404500006837.10.1017/s0047404500006837Search in Google Scholar

Searle, John & Daniel Vanderveken. 1985. Foundations of illocutionary logic. Cambridge: Cambridge University Press.10.1007/1-4020-3167-X_5Search in Google Scholar

Simons, Mandy. 2003. Presupposition and accommodation: Understanding the Stalnakerian picture. Philosophical Studies 112(3). 251–278.10.1023/A:1023004203043Search in Google Scholar

Simons, Mandy. 2006. Presupposition without common ground. Unpublished manuscript.Search in Google Scholar

Soames, Scott. 1982. How presuppositions are inherited: A solution to the projection problem. Linguistic Inquiry 13(3). 483–545.Search in Google Scholar

Stalnaker, Robert. 1973. Presuppositions. Journal of philosophical logic 2(4). 447–457. doi:10.1007/bf00262951.10.1007/bf00262951Search in Google Scholar

Stalnaker, Robert. 1974. Pragmatic presuppositions. In Milton Munitz & Peter Unger (eds.), Semantics and philosophy, 197–214. New York: New York University Press. doi:10.1093/0198237073.003.0003.10.1093/0198237073.003.0003Search in Google Scholar

Stalnaker, Robert. 1984. Inquiry. Cambridge, MA: MIT Press.Search in Google Scholar

Stalnaker, Robert. 1998. On the representation of context. Journal of Logic, Language and Information 7(1). 3–19. doi:10.1023/A:1008254815298.10.1023/A:1008254815298Search in Google Scholar

Stalnaker, Robert. 2002. Common ground. Linguistics and Philosophy 25. 701–721. doi:10.1023/A:1020867916902.10.1023/A:1020867916902Search in Google Scholar

Strawson, Peter. 1964. Identifying reference and truth-values. Theoria 30(2). 96–118. doi:10.1111/j.1755-2567.1964.tb00404.x.10.1111/j.1755-2567.1964.tb00404.xSearch in Google Scholar

Street, Richard, Glyn Elwyn & Ronald M. Epstein. 2012. Patient preferences and healthcare outcomes: An ecological perspective. Expert Review of Pharmacoeconomics & Outcomes Research 12(2). 167–180. doi:10.1586/erp.12.3.10.1586/erp.12.3Search in Google Scholar

Street, Richard & Paul Haidet. 2011. How well do doctors know their patients? Factors affecting physician understanding of patients’ health beliefs. Journal of General Internal Medicine 26(1). 21–27. doi:10.1007/s11606-010-1453-3.10.1007/s11606-010-1453-3Search in Google Scholar

Thomason, Richmond. 1990. Accommodation, meaning, and implicature: Interdisciplinary foundations for pragmatics. In Philip Cohen, Jerry Morgan & Martha Pollack (eds.), Intentions in communication, 325–364. Cambridge: MIT Press.Search in Google Scholar

Wagner, Edward H., Brian T. Austin, Connie Davis, Mike Hindmarsh, Judith Schaefer & Amy Bonomi. 2001. Improving chronic illness care: Translating evidence into action. Health Affairs 20(6). 64–78. doi:10.1377/hlthaff.20.6.64.10.1377/hlthaff.20.6.64Search in Google Scholar

Walton, Douglas. 1996. Argumentation schemes for presumptive reasoning. Mahwah: Lawrence Erlbaum Publishers.Search in Google Scholar

Walton, Douglas. 2007. Metadialogues for resolving burden of proof disputes. Argumentation 21(3). 291–316. doi:10.1007/s10503-007-9056-9.10.1007/s10503-007-9056-9Search in Google Scholar

Walton, Douglas. 2016. Argument evaluation and evidence. Cham: Springer.10.1007/978-3-319-19626-8Search in Google Scholar

Weinstock, Charles, John Goodenough & Ari Klein. 2013. Measuring assurance case confidence using Baconian probabilities. In Ewen Denney, Ganesh Pai, Ibrahim Habli, Tim Kelly & John Knight (eds.), Proceedings of the 1st international workshop on assurance cases for software-intensive systems, 7–11. San Francisco: IEEE Press.10.1109/ASSURE.2013.6614264Search in Google Scholar

Wilson, Deirdre. 1975. Presupposition and non-truth-conditional semantics. London: Academic Press.Search in Google Scholar

Published Online: 2017-3-9
Published in Print: 2017-3-1

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