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Source: University of Waterloo

Prof studies language usage by health-care professionals

October 16, 2006

Ont. (Monday, Oct. 16, 2006) -- A University of Waterloo expert in rhetoric
heads a study into links between language and how health-care professionals
conduct themselves in their dealings with patients and other professionals.

Catherine Schryer, a professor of English language and literature, is
researching the impacts of health-care communications, asking if something
vital gets lost when a doctor explains an illness to a patient.

Schryer said the research project, Crossing Borders: Sites of Discursive
Negotiation in Healthcare Practice, consists of three case studies, each
investigating the role that a genre or a distinctive pattern plays in
facilitating or not communication between different health-care

As a rhetorician (a specialist in the study into how we use language),
Schryer does not confine her academic activities to the works of the great
poets, dramatists and novelists. Rather, she has extended the field of
English studies to include among other things, research into how language is

Schryer, who is also director of UW's teaching resources office, is the
principal investigator of the project, sponsored by the Social Sciences and
Humanities Research Council of Canada. Project co-investigators are Dr.
Lorelei Lingard, of the University of Toronto's faculty of medicine, and Dr.
Marlee Spafford, of UW's school of optometry.

The project's first case study explores the production and reception of
referral letters between optometrists and ophthalmologists.

The second one investigates the production of reports by pediatricians in a
child abuse prevention clinic and the reception of those reports by social
workers, police, lawyers and judges. The third studies the role that
electronic medical records play in team communication situations in a cancer
care clinic.

"Our program of study aims to connect research in health professions
education to recent research in the role of language practices in the
professional workplace," Schryer said. "What we are finding is that when the
members of these professions transfer information from their patients or
clients to other professionals, they rearrange it."

She said that doctors, for instance, ask patients to describe their problems
and then restate that information in professional terms as they pass it on
to consulting specialists, such as internists, oncologists and cardiac

Medical practitioners have special ways of relaying information about their
observations, results of lab tests and diagnoses, to other practitioners,
along with outlining the plans they have formulated for patients, including
drug prescriptions, fitness programs, dietary changes and surgical

For example, a patient tells the doctor about an illness. The doctor
immediately translates what the patient says into language that would be
more meaningful to a medical professional, including a specialist to whom
the patient may subsequently be referred. Such case reports differ
considerably from the way in which a patient first gives information to his
or her doctor.

"They almost never present cases in the order in which the patients have
reported on their health or injury problems," Schryer said, adding that
medical professionals only deal with details that have clear relevance to
the case.

"The entire process has become something of a genre -- a distinctive
pattern," she said. "The advantage of the translation done by the doctor is
that it enables him or her to transmit information rapidly and accurately to
other doctors."

But something always gets lost in the translation, including sometimes the
ability to explain to the patient in their own terms the nature of their
illness or injury.

Schryer wonders about some of the consequences such as: Is something lost,
at times, when the patient's story is reconstructed? Or, might there be
problems later on because the patient fails to understand what the doctor is
telling him or her to do?

When her research team looked at the way language is used in doctors' case
reports, they noticed language that seemed to turn the patient into a kind
of object.

"Doctors do need to keep some distance between themselves and their
patients," Schryer said. "However, the case presentation system may tend to
objectify patients. The medical professional may refer to patients not as
the 'people in such-and-such ward' but as the 'cystic fibroses in
such-and-such ward' or refer to child patients' mothers collectively as 'the

Schryer sees her role as that of a rhetorician who can step back and ask
questions, including What is language all about? How do we use it now? And
how can we make better use of it in the future?

She adds that this could lead to more effective ways of using language and
to a better appreciation of the significance of language in all aspects of
our lives.



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