A Study of Pragmatic Competence: International Medical Graduates\u27 and Patients\u27 Negotiation of the Treatment Phase of Medical Encounters

Despite advances in medical technologies, interpersonal communication remains the primary tool physicians use to exchange information, make diagnoses, and treat patients (Cameron & Williams, 1997; Groopman, 2007; Ong, de Haes, Hoos, & Lammes, 1995). In the medical encounter effective communication between physician and patient is essential so that beneficial health and wellbeing outcomes are achieved for patients. Taking a discourse analytic approach, this study examined interactions occurring between international medical graduate (IMG) residents, attending physicians, and patients during the treatment advice phase of the supervised medical encounter. The aim of the study was to examine the co-constructed nature of the delivery and receipt of treatment advice and the ways in which physicians and patients managed interpersonal relations through the negotiated activity. The theoretical framework of pragmatic competence was utilized to underpin the study. Physician-patient interactions served as the primary data source. Medical encounter interactions between five different IMG residents and 31 patients were observed and audio-recorded. Observations and a post-medical encounter survey completed by patients served as secondary data sources. The analysis of the data revealed that this medical speech activity embedded within the medical encounter was realized through the use of a variety of discourse strategies and contributions from multiple participants as they attended to the interpersonal and transactional goals associated with the delivery and receipt of treatment advice. Findings provided insights into how multi-party discourse worked to jointly construct and negotiate treatment recommendations. Findings indicated that IMG residents utilized indirect advice giving strategies. Additionally, both IMG residents and patients utilized interrogatives in various ways to engage actively in the treatment decision-making process. Finally, the data revealed how the participants attended to each other\u27s face needs as they worked to enhance, maintain, or challenge face through the dynamic process of negotiating relationships