Any questions? An analysis of questions initiated by native and non-native English speaking patients and their parents during paediatric consultations

Deposited on behalf of the author. © 2002 Dr. Anne KanarisGood medical care depends on effective communication between patient and health professional. Misunderstandings can occur in any medical setting but can be further compounded by language and cultural factors in those interactions which occur in a cross-cultural context. The medical consultation is an institutional interaction and as such can involve additional, taken-for-granted evaluative and interpretive criteria which are applied by interactants automatically, without conscious reflection. Non-native speakers who may have a good functional control of the language and have few problems at the level of propositional content may experience significant difficulties at the necessary interpretative level. Questions act to allow the questioner a degree of interactional control and when patients ask questions they not only increase their access to information but also indicate to the doctor that they wish to play a more active role in the consultation. This thesis examines the discourse of doctor-patient interactions and in particular the ways in which questions are framed and presented by patients and, because the patients in this case are children, their parents. Fifty three medical consultations were observed from both public and private pediatric clinics with patients and their parents comprising 33 native and 20 non-native speakers of English. Data for the study comprise 28 of those consultations. The data include post-consultation interviews with patients and their parents, and interviews with the treating doctors. The analysis indicates that there are considerable differences in the patterns of questioning behaviour of native speakers and non-native speakers, and that the questioning behaviour of patients and parents seems to be influenced by the communication style of the doctor. These findings indicate that the questioning behaviour of non-native speaking parents in medical consultations has the potential to lead to less access to information, fewer explanations about their child's condition and a less active role overall in the medical consultation. This in turn can lead to different outcomes for those parents such as lower levels of satisfaction and, potentially, lower levels of compliance with medical advice and directives. These findings also indicate that the needs of non-native speakers in such circumstances are more successfully addressed by a doctor-centred approach. Finally, this study argues that the observed differences in the patterns of questioning behaviour between native speakers and non-native speakers is more than simple lack of linguistic resources but rather is a result of the clash between the often subtle differences in communicative competence of non-native speakers and the specialised inferential frameworks inherent in institutional discourse