Discourse Analysis, nice to meet you

[this entry is from May 2013]

I have a concern for how medical professionals learn their trade and how institutions and individuals attempt to educate them. And so now I am studying, learning, and playing in the field of medical education. This experience has been humbling. It has reminded me that I understand very little of the world around me. The opportunity to discuss ideas with people from fields of thinking different from my own has shown me how narrow my concept of reality has been. Sometime later, I intend to elaborate on this experience of having my reality challenged. But today, I am interested specifically in discourse analysis.

I am a beginner in this area, and I am initially being guided by Nicola Wood's "Describing Discourse - A Practical Guide to Discourse Analysis." I have worked my way through the introduction and first chapter. My understanding thus far is that discourse analysis refers to the careful examination of language use in real life contexts in an attempt to identify and describe what various characteristics and components of the discourse (verbal, written or otherwise) are doing. Examples of characteristics and components are such things as sound, word choice, and semantics. Perhaps this all sounds extremely boring. But it definitely is not.

In English, as is I'm sure in many other languages, we commonly say things we don't mean. It's not that we intend to lie (sometimes we do). But we expect our audience to get the intended message, even if the literal meaning of what we are saying is different. Greetings are an obvious example. The grocery store check-out conversation of "how are you today?" "good/fine, thanks," is a funny phenomenon, reminding us that the function of what is spoken is not necessarily contained in the literal meanings of the words. In fact, any word itself doesn't actually contain meaning in its own right. Any word only means whatever the speaker and the audience agree it means at that moment.

What does any of this have to do with medical education? Well, it seems we all have job-speak: the language we employ while at work. This is the way we speak to our boss, to our clients, our patients, possibly our colleagues as well. In most cases, this is noticeably different from how we speak to our friends at the bar, or the beach, or to our family at home. Why the difference? All kinds of reasons. But clearly, as a person becomes indoctrinated into a discipline, that person picks up the speech patterns of that specialty.

To be blunt, doctors do a lot of bluffing. But the practice of bluffing starts long before independent medical practice. Trainees are pressured to know the answers and be independent long before they are actually capable. And so, sometimes, they bluff. I happen to be interested in the language of this bluffing in the medical context.