Language, context & communication

I am learning Italian.  A new language is difficult at my age but also a good exercise for the brain. The app I am using is a fun way to tackle the basics, with exercises that include listening to sentences and then translating them.  

This reminds me how easy it may be to listen but difficult to understand.  I may pick up some words, but the overall meaning is not clear.  Phrases used colloquially convey something different from the literal translation.  In addition, the same word may have several usages, for example il paese is a country, town, land, village or region.  The app helpfully suggests that the meaning will be apparent from the context. 

As a medical student I learned a new language that I was keen to try out with my peers and patients.  I saw this eagerness of learners when I became an educator. Students no longer talked of heart attacks but myocardial infarctions; they threw around abbreviations that require context to unravel. For example, PID is both pelvic inflammatory disease and prolapsed intervertebral disc; the former is more likely to be the diagnosis in the context of a gynaecologist’s notes.  In addition, English has many words that have similar meanings. 

A patient came to see me to discuss the result of his recent colonoscopy, a check-up following a previous diagnosis of bowel cancer.  I went through the surgeon’s report with him.  He asked me at the end if large intestine and colon meant the same as bowel.   It is easy to forget that what I think of as commonplace words within a professional context are not part of everyday conversation. 

In linguistics, context is an important part of pragmatics, one simple definition of which is the study of the relations between languages and their users. (For a complex definition see below*). These relations are influenced by such contexts as location, the social situation, the nature of the interaction, and the purpose of a conversation.  

Clinical consultations are a specific type of professional interaction in which patient and professional take turns to talk.  This context allows the health professional to ask sensitive and probing questions that would be out-of-place in a more social setting, particularly on a first meeting.  I feel comfortable discussing intimate details about health and illness in the clinic but awkward answering or asking questions about someone’s symptoms in a non-clinical environment. 

At medical school, in the days before specific training in communication skills, the emphasis was on history taking.  As most of my patient contacts took place in hospital, the purpose of the interactions was primarily to make a diagnosis.  In my four weeks in general practice, there was more emphasis on management as patients came more frequently with chronic rather than acute conditions.  Consultations flowed differently in this context and the standard history-taking structure was less useful – in fact it impeded rather than facilitated the sharing of information. Students need to understand the role of context as part of communication.  

Contemporary health professional curricula focus more on long term and complex conditions than they have in the past.  However, for most students and recently qualified health professionals, there is an imbalance between hospital-based and community-based education.  This may lead to thinking that all consultations should follow the same structure whereas good communicators are able to vary the content and process of their interactions to suit the context. 

*Cruse’s definition: …pragmatics can be taken to be concerned with aspects of information (in the widest sense) conveyed through language which (a) are not encoded by generally accepted convention in the linguistic forms used, but which (b) none the less arise naturally out of and depend on the meanings conventionally encoded in the linguistic forms used, taken in conjunctions with the context in which the forms are used. (Alan Cruse in Meaning in Language. Oxford University Press, 2000)

Note that to complicate matters even more, the above definition refers to pragmatics within the fields of linguistics and the philosophy of language.  Pragmatism has definitions within politics and philosophy, and states that theories and beliefs are only meaningful if they can be applied in practice. 

Further reading about context and communication

Cox & Li.  The medical consultation through the lenses of language and social interaction.  Advances in Health Science Education 2020; 25: 241-257.  Open access.

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