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摘要
外文摘要
引文資料
題名:
情境寒暄語與病人回應量之關係:以醫老互動為例
書刊名:
清華學報
作者:
黃聖媖
/
陳怡伶
/
蔡美慧
/
曹逢甫
作者(外文):
Huang, Shen-ying
/
Chen, I-ling
/
Tsai, Mei-hui
/
Tsao, Feng-fu
出版日期:
2008
卷期:
38:3
頁次:
頁451-484
主題關鍵詞:
醫病溝通
;
寒暄語
;
言談分析
;
三人行老年門診
;
Doctor-patient communication
;
Discourse analysis
;
Greetings
;
Geriatric triads
原始連結:
連回原系統網址
相關次數:
被引用次數:期刊(
1
) 博士論文(
1
) 專書(0) 專書論文(0)
排除自我引用:
1
共同引用:0
點閱:26
以病人為主問診強調蒐集病人的全盤性資訊;醫師的溝通技巧是促使病人主動發言的關鍵,而問候病人是醫病互動的開端。醫師使用適當的寒暄語和話題能促進病人發言。本研究目的在於檢視臺灣醫師使用情境寒暄語與病方回應發言量之間的關係:情境寒暄語的哪些次類可引發病人較多的發言量?引發病人較多發言量之情境寒暄語,其話題有何特點?我們根據44個錄影語料,分析醫師在問診開場階段中,對初診老年病人和病人陪同者(合稱病方)所使用的寒暄語。根據病方發言音節多寡,我們將寒暄語分為 「低回應率寒暄語」(病方發言量小於1個音節)、「中回應率寒暄語」(病方發言量2-6.5個音節)和「高回應率寒暄語」(病方發言量20.5-67.5個音節)。其中,以高回應率寒暄語可引發的語意與資訊內容最豐富,醫病間有較多的問答互動(定位;grounding),所以我們又將「高回應率寒暄語」稱為「高延展寒暄語」。話題特性不同也是發言量不同的原因;高回應率寒暄語多屬於「社會關係話題」(例如詢問病人職業),中回應率寒暄語屬於「問診準備談話」(例如詢問老年病人聽力狀況)。病人最熟悉自己的社會關係狀態,因此,此類話題可以引發較多發言量;而問診準備談話僅是醫療過程一環,所引發發言量有限。最後,我們認為醫師使用社會關係話題與老年病人寒暄不僅可以建立關係,病人所透露的訊息也是醫師在評估病人社會心理狀態的重要參考。
以文找文
As in most social interactions, affective and referential goals are essential in doctor-patient communication: doctors need to establish a trusting relationship with patients so that they can collect holistic health information from them. Although good rapport should be established early in the greeting stage of the medical interview, exactly how doctors' greetings facilitate patient participation has not yet been fully explored. By examining 44 triadic medical encounters among doctors, elderly patients, and patient companions collected in a teaching hospital in southern Taiwan, we examine three research questions. First of all, what greeting topics are commonly observed? Among these topics, which ones encourage more verbal participation from patients? And, how do they achieve this goal in terms of discourse structure and under the context of Taiwanese geriatric interaction? Three categories of doctors' greeting topics were identified according to the average number of syllables they elicited in response from patients' response: greetings with low response (eliciting 0.46 syllables), mid-response greetings (eliciting 4.8 syllables), and high-response greetings (eliciting 41.1 syllables). We find that low- and mid-response greetings dealing mainly with topics related to the preparatory sequences of the interview, such as seating arrangements and name exchanges (low-response), and the patients' hearing ability or language background (mid-response). High-response greetings, such as those touching on a patient's occupation or medical history, are social-relational (Coupland 1994). These topics extend the conversation structure by developing subtopics and establishing 'grounding' (Paek and Horvitz 2000), i.e., background knowledge between doctors and patients. The patient is the expert on, and has exclusive access to, his/her social-relational aspects. We argue that it is the patient who holds the key to high participation and extensibility of topics. Other high-response greeting topics, such as the patient's age and the patient's companions, reflect the unique and complicated relationships between age and health status (Coupland et al. 1991, Giles et al. 1994) and between patients and caregivers. Since social-relation information is as important as biophysical information in evaluating a patient's health, we suggest that doctors facilitate the use of social-relational topics at the greeting stage. This will help doctors establish rapport with patients and encourage patient participation during the medical interview.
以文找文
期刊論文
1.
Coupland, J.、Robinson, J. D.、Coupland, N.(1994)。Frame Negotiation in Doctor-Elderly Patient Consultations。Discourse and Society,5(1),89-124。
2.
Street, R. L. J.、Gordon, H. S.、Ward, M. M.、Krupat, E.、Kravitz, R. L.(2005)。Patient participation in medical consultations: why some patients are more involved than others。Medical Care,43(10),960-969。
3.
Hong-Fincher, Beverly(1985)。Politeness in Chinese: impersonal pronouns and personal greetings。Anthropological Linguistics,27(2),204-213。
4.
石翀(2004)。英漢稱謂語與寒暄語對比研究。湖南人文科技學院學報,4,75-77。
延伸查詢
5.
陳秋娜(2005)。漢語寒暄語的語用闡釋。柳州職業技術學院學報,5,60-65。
延伸查詢
6.
Alikndele, F.(1990)。A Sociolinguistic Analysis of Yoruba Greetings。African Languages and Cultures,3,1-14。
7.
Boden, D.、Bielby, D. D.(1986)。The Way It Was: Topical Organization in Elderly Conversation。Language and Communication,6,73-89。
8.
Coupland, N.、Coupland, J.、Giles, H.(1989)。Telling Age in Later Life: Identity and Face Implications。Text,9,129-151。
9.
Ishikawa, H.、Hashimoto, D.、Roter, D. L.、Yamazaki, Y.、Takayama, T.、Yano, E.(2005)。Patient Contribution to the Medical Dialogue and Perceived Patient-Centeredness: An Observational Study in Japanese Geriatric Consultations。Journal of General International Medicine,20(10),906-910。
10.
Kellermann, K.、Palomares, N. A.(2004)。Topical Profiling: Emergent, Co-Ocurring, and Relationally Defining Topics in Talk。Journal of Language and Social Psychology,23(3),308-337。
11.
Larivaara, P.、Kiuttu, J.、Taanila, A.(2001)。The Patient-Centred Interview: The Key to Biopsychosocial Diagnosis and Treatment。Scand J Prim Health Care,19(1),8-13。
12.
Li, H. Z.(1999)。Grounding and Information Communication in Intercultural and Intracultural Dyadic Discourse。Discourse Processes,28(3),195-215。
13.
Lin, M. C.、Hummert, M. L.、Harwood, J.(2004)。Representation of Age Identities in On-line Discourse。Journal of Aging Studies,18,261-274。
14.
Lowes, R.(1998)。Patient-Centered Care for Better Patient Adherence。Family Practice Management,5(3),46-52。
15.
Maynard, Douglas W.、Zimmerman, Don H.(1984)。Topical Talk, Ritual and the Social Organization of Relationships。Social Psychology Quarterly,47(4),301-316。
16.
Platt, F.、Gaspar, D.、Coulehan, J.、Fox, L.、Adler, A.、Weston, W.、Smith, R.、Stewart, M.(2001)。"Tell Me about Yourself": The Patient-Centered Interview。Annals of Internal Medicine,134(11),1079-1085。
17.
Robinson, J. D.(1998)。Getting Down to Business: Talk, Gaze, and Body Orientation during Openings of Doctor-Patient Consultations。Human Communication Research,25(1),97-123。
18.
Schilling, L. M.、Scatena, L.、Steiner, J. F.、Albertson, G. A.、Lin, C. T.、Cyran, L.(2002)。The Third Person in the Room: Frequency, Role ,and Influence of Companions during Primary Care Medical Encounters。Journal of Family Practice,51(8),685-690。
19.
Schneider, K. P.(1987)。Topic Selection in Phatic Communication。Multilingua,6(3),247-256。
20.
Smith, R. C.、Marshall-Dorsey, A. A.、Osborn, G. G.(2000)。Evidence-Based Guidelines for Teaching Patient-Centered Interviewing。Patient Education and Counseling,39,27-36。
21.
Street, R. L.、Millay, J. A. B.(2001)。Analyzing Patient Participation in Medical Encounters。Health Communication,13(1),61-73。
22.
Tsai, M. H.(2005)。Opening Stages in Triadic Medical Encounters in Taiwan。Communication and Medicine,2,53-68。
23.
Walter, A.、Bundy, C.、Dornan, T.(2005)。How Should Trainees Be Taught to Open a Clinical Interview?。Medical Education,39,493-496。
24.
Zandbelt, L.、Smets, E.、Oort, F.、Godfired, M.、Haes, H. de(2007)。Patient Participation in the Medical Specialist Encounter: Does Physicians' Patient-Centred Communication Matter?。Patient Education and Counseling,65,396-406。
會議論文
1.
Traum, D.、Heeman, P.(1996)。Utterance Units and Grounding in Spoken Dialogue184-1887。
研究報告
1.
Paek, T.、Horvitz, E.(2000)。Grounding Criterion: Toward a Formal Theory of Grounding。
學位論文
1.
Tsai, M. H.(2000)。Companions of Elderly Patients: A Sociolinguistic Study of Triadic Medical Encounters in Southern Taiwan,Washington, D. C.。
圖書
1.
劉樹泉(1991)。老人學與老人醫學。臺北:合記圖書出版社。
延伸查詢
2.
Labov, William、Fanshel, David(1977)。Therapeutic Discourse: psychotherapy as conversation。New York:Academic Press。
3.
Tsai, M. H.(2006)。Opening Hearts and Minds: A Linguistic Framework for Analyzing Open Questions in Doctor-Patient Communication。Taipei:The Crane Publishing Company。
4.
沙依仁(1996)。高齡學。臺北市:五南圖書出版有限公司。
延伸查詢
5.
Billings, J. A.、Stoeckle, J. D.(1999)。The Clinical Encounter: A Guide to the Medical Interview and Case Presentation。The Clinical Encounter: A Guide to the Medical Interview and Case Presentation。St. Louis。
6.
Clark, Herbert H.、Brennan, S. E.(1991)。Grounding in Communication Perspectives on Socially Shared Cognition。Perspectives on Socially Shared Cognition。Washington, D. C.。
7.
Coupland, J.(2000)。Small Talk。Small Talk。New York。
8.
Greene, M. G.、Adelman, R. D.、Rizzo, C.、Friedmann, E.(1994)。The Patient's Presentation of Self in an Initial Medical Encounter。Interpersonal Communication in Older Adulthood。London。
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