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Exploring Health Communication

Exploring Health Communication brings together many of the various linguistic strands in health communication, while maintaining an interdisciplinary focus on method and theory.

It critically explores and discusses a number of underlying themes that constitute the broad field of health communication including spoken, written and electronic health communication. The rise of the internet has led to an explosion of interactive online health resources which have profoundly affected the way in which healthcare is delivered, and with this, have brought about changes in the relationship between provider and patient. This textbook uses examples of real life health language data throughout, in order to fully explore the topics covered.

Exploring Health Communication is essential reading for postgraduate and upper undergraduate students of applied linguistics and health communication.

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Extended Glossary

Active voice
a form of grammatical representation whereby the action of a verb is attributed to a particular person or thing. In the active voice, the agent is present and therefore responsibility for an action is clear. For instance, in the following example, the nurse is the agent of the active verb ‘take’: ‘the nurse took the patient’s temperature’. Compare passive voice.

Adjacency pairs
central to conversational organisation, adjacency pairs are sequences of paired utterances that are bound together, the first part of the pair cueing the second part. Adjacency pairs perform a range of functions, such as question–answer, greeting–greeting, invitation–acceptance, blame–denial.

in linguistics, affect denotes attitude or emotion that a speaker brings to an utterance, such as disgust, wonder, or sympathy. It can be conveyed lexically, for example, through pejorative or approbatory expressions, or paralinguistically through facial expressions and intonation.

the person or thing responsible for an action or process, the ‘doer’ of a verb.

minimal tokens such as hm, mm, uhuh produced by hearers to indicate that they are actively listening to a fellow interlocutor, encouraging further verbal traffic. Backchannelling can also be realised by certain gestures, such as nods of the head.

see frontstage.

Community of practice
is a term created by cognitive anthropologists Jean Lave and Etienne Wenger (Wenger 1998) to refer to a group of people who have a common interest in a particular domain or area. In the process of sharing information and their experiences, group members can learn from each other, and in this way have an opportunity to develop themselves personally and professionally.

Content/lexical words
are words that provide informational content, such as injection, disease, suffer, recovery. Content words are always being added to the language and as such form an open class of words. The total number of content words appearing in a text in relation to the number of functional words is a measure of lexical density – a means of evaluating the readability of a stretch of discourse. See functional/grammatical words.

Concordances/concordance lines
are lines of text from a corpus that present all the occurrences of a particular (node) word. Concordance lines present the surrounding linguistic context in which the node word is situated, allowing the analyst to identify what patterns it is part of and how it relates to other words.

Cooperative Principle
the principle formulated by Paul Grice (1991: 78–9) which accounts for verbal cooperation between speakers. The Cooperative Principle is resolved into four maxims: quantity, quality, manner and relevance. Language users observe these maxims if they wish to communicate meaning. Cooperation in this sense relates to understanding, making sense of each other’s talk, not to verbal concord.

a corpus is a collection of texts (spoken, written or both) that are stored electronically. These texts are made up of naturally occurring language and can be subjected to a range of computational analyses (such as frequency, keyword, concordance and collocation analyses).

Democratisation (of discourse)
a process identified and described by Fairclough (1992) which involves the reduction of asymmetry and power in discursive encounters between professionals and clients (be it in healthcare or other institutional contexts). But according to Fairclough, however, democratisation is somewhat of an ignis fatuus: in reality, the old unequal relations of power continue to persist. For example, in the context of healthcare, the interactional symmetry that is apparent in certain practitioner–patient exchanges is not necessarily a reflection of genuine patient empowerment. During such encounters agendas are still set by professionals, as are the broader parameters of the interaction, and thus patients’ actions and contributions are, as they ever were, constrained. See also naturalisation.

Diagnostic and Statistical Manual of Mental Disorders (DSM)
is an authoritative document produced by the American Psychiatric Association which characterises psychiatric diagnoses. Currently in its fourth edition (DSM-IV), the manual comprehensively accounts for a wide spectrum of psychiatric conditions, with each subsequent edition of the publication including ever more disorders which have since been identified and classified. Given its scope and authority, the text is often considered to be the ‘bible’ for any professional who makes psychiatric diagnoses in the United States (and many other countries besides). Yet despite its pervasive utility, the DSM has been (and continues to be) subjected to various criticisms, not least the argument that it fails to place emphasis on people’s personal experiences of emotional turmoil.

Discourse and discourses
the concept of discourse is a complex and often contested one; accordingly no brief gloss can do it justice. Broadly speaking, discourse, linguistically conceived, at least, relates to stretches of either spoken or written language that extend beyond the sentence. In this sense, discourse is a substantial linguistic unit that involves language in use in social settings. Discourse also has another use common to social theorists, who take it to mean a way of constructing knowledge and beliefs. People draw on discourses to make sense of and present a certain version of the world. Consequently people often possess competing discourses.

Discourse marker
is a word or phrase (okay, right then, now, etc.) that is used to signal some phase or change in spoken discourse. Discourse markers ‘mark’ out stages in interaction, for example the beginning or end of a particular sequence of talk.

is a technical, medical formulation that refers to biological malfunctioning. Disease, in this sense, is rather a narrow notion; it is objective, purely biomedical in scope – something that is both defined and treated by health practitioners. Disease is divorced from personal experience of suffering. Compare with illness.

with regard to politeness theory, face relates to the projection of one’s self-image to others. Face can be considered from two angles: positive and negative. Positive face concerns one’s desire to be appreciated, to a feel a sense of belonging to others, whereas negative face concerns one’s desire to be free from imposition. In order to promote positive face people use politeness strategies such as claiming common ground. When attending to negative face, linguistic strategies involve showing deference to others, and mitigating the burden involved in making requests of others.

Face-threatening acts
acts that threaten one’s positive self-image (positive face) or autonomy (negative face) are called face threatening acts. Face threatening acts require politeness techniques (such as hedging and indirectness) in order to avoid disruptions and awkwardness during social encounters.

an interactional device whereby a participant in conversation indirectly solicits information from a fellow interlocutor. Fishing is a subtle activity: instead of expressly putting a question to someone, a speaker offers a statement (about a co-participant’s personal state of affairs, for example), provoking a response. In the context of medical encounters (psychiatric interview and counselling sessions especially), fishing invites (rather than overtly obliges) patients and clients to disclose private feelings and discuss their predicaments.

is the activity of sending rude, abusive or threatening messages to other Internet users, particularly in chat rooms and forums.

are alignments that speakers step in and out of during interaction. Participants in talk adopt various social roles, the occupation of which affects the direction and nature of talk. For example, at the beginning of a medical interview (before the official business of the consultation proper) both doctor and patient might adopt an informal footing and engage in small talk. These footings will change once the consultation progresses past the opening phase and the participants align themselves to the forma roles of doctor and patient.

the term frontstage and its counterpart, backstage, are concepts conceived by Goffman (1959). Used to describe a region from which social activities (such as interaction) can be analysed, the two concepts are based on the dramaturgical metaphor of performance. Frontstage activities involve some kind of public display (in the sense that they involve, or are visible to, an audience). For example, the doctor–patient encounter, a particular realisation of the public face of medicine, is a frontstage encounter. Conversely, interaction between medics during tea breaks (where there is no public audience to perceive events) constitutes a backstage activity. Needless to say, backstage activities involve different uses of language to frontstage activities. Goffman (1959: 129) provides a long, near-breathless, list of attributes that comprise backstage discourse, including, to name but several: ‘reciprocal first-naming, cooperative decision-making, profanity, open sexual remarks, elaborate griping, smoking, rough informal dress, ”sloppy” sitting and standing posture, use of dialect or sub-standard speech . ’. If these and many other traits constitute backstage behaviour, then their absence, according to Goffman, can be taken to characterise frontstage discourse.

Functional/grammatical words
are words that belong to a closed class. Rather than conveying discrete information (like content/lexical words), they have a grammatical function. We speak of such words as being part of a closed class because they belong to fixed, finite categories, categories such as prepositions, pronouns, auxiliary and modal verbs, determiners, and conjunctions. The higher the proportion of functional words in a text, the lower the lexical density will be. See content/lexical words.

Functional texts
are texts designed to help individuals perform a workaday task or provide information/instruction about a certain subject. Examples of functional texts include patient information leaflets, recipes, assembly instructions.

General practitioner
a doctor who works in the primary care sector. The general practitioner (GP for short) will typically be the first point of contact for patients accessing medical services. Most of a GP’s work involves consultations with patients in surgeries, but GPs also visit and treat patients at their homes.

a term which refers to a certain kind of communicative event. Genres, in a linguistic sense, can be distinguished from one another by their distinct structures and patterns of discourse and the particular contexts in which they occur. Thus, occurring in a unique (primary care) setting, and realising distinct phases of interaction, the GP–patient consultation as a genre is distinguishable from other genres of practitioner–patient interview, such as the nurse–patient admission interview.

abbreviation of general practitioner.

A term coined by the literary critic Mikhail Bakhtin (1981)to describe the presence of two or more distinct voices in a text – voices potentially in conflict with one another. The presence of such plurality voices might not be readily apparent: only close textual scrutiny reveals their presence and operation.

Ideal Sequence
a recurring sequence of six phases in the doctor–patient consultation, consisting of:

  1. opening
  2. complaint
  3. examination or test
  4. diagnosis
  5. treatment or advice
  6. closing

Although the order of the sequence is liable to variation (not every consultation adheres strictly to this arrangement), the sequence usefully accounts for the structural unfolding of a typical consultation.

an individual’s particular language habits, their unique ‘thumbprint’ of linguistic style and behaviour.

whereas disease describes objective biomedical entities, illness is an innately human phenomenon that relates to an individual’s personal experience of suffering. Illness accounts for how sick people respond to disease and the common sense ways in which they try to make sense of disease, such as the personal judgements they make about symptoms and ailments. Illness, therefore, takes into account the personal, social and cultural context of disability and suffering. Compare disease.

Illocutionary act
in contrast to a perlocutionary act, an illocutionary act refers to intended meaning regardless of the resulting effect. For example, ‘Do not drink this wine’ is a warning to an addressee not to drink the wine (an illocutionary act). If this warning is heeded then the speaker is successful in persuading the interlocutor not to drink the wine (a perlocutionary act).

an implied meaning produced by speakers (and writers). An implicature is an additional unstated meaning which is different from the literal meaning of an utterance. Implicatures arise when language users flout one or more of the conversational maxims (quantity, quality, manner or relevance).

are words that are statistically significant. They are words that appear in one corpus with a significantly higher frequency when compared with another corpus. Keywords indicate saliency and are therefore words that can be seen to characterise a particular language variety, offering researchers a useful point of analytical entry into a corpus.

Lexical density
see content/lexical words.

Lifeworld/voice of medicine
lifeworld issues relate to patients’ personal and social attitudes towards health and illness. The lifeworld encapsulates natural attitudes of everyday life and, according to Mishler (1984), is often in conflict with technical, biomedical formulations of illness (the voice of medicine).

is the activity (or rather lack of it) of spending time in an Internet health forum without contributing to the discussion at hand or otherwise failing to interact with other forum users.

Locutionary act
is the basic action of uttering, writing or making public by other means a meaningful sequence of words. It is part of a speech act theory that places emphasis on the perfomative role of language according to which to say something (locutionary act) is to do something. See illocutionary and perlocutionary act.

literally meaning the process of making something medical or falling under the medical gaze, medicalisation is commonly associated with the increasing encroachment of medical authority on areas not commonly considered to be the domain of clinical science. One example of medicalisation considered in this book (see Chapter 5) concerned sleep (disorder) and the range of wakefulness drugs that have recently become available.

is another contested and variously defined term. It refers to non-literal meaning, signalling to the reader or listener that they should treat something as something else (make links between, say, a house and a battlefield). Previously seen as a mere figure of speech and an ornament to language, metaphors are now increasingly recognised as foundational, and discursively powerful, tools used by people to make sense of the world.

concerns a speaker’s or writer’s commitment to, or certainty about, an utterance. Modality formulations encode opinions about likelihood and obligation through the use of dedicated modal verbs (may, can, will, shall, etc.). Modality can also be expressed in other ways, for example, through the use of adverbs (certainly, possibly, maybe) and verb phrases (think, believe, suggest).

Narrative turn
is used to refer to a widespread adoption of narrative and narrative analysis (originating from literary studies) across a range of social science disciplines, as well as in law, health studies and theology.

Naturalisation (of discourse)
relates to discursive practices which have, through routine and convention, come to seem natural to the individuals who take part in them. In the medical interview, for example, the participants involved may not be aware of the exercise of power, or consider it to be unexceptional and unproblematic: a neutral way of pursuing things. See democratisation.

Online disinhibition effect
the process whereby people, while communicating online, show less restraint and partake in more candid expressive behaviour than they would do in other communicative contexts, such as face-to-face interaction. The effect is brought about by a number of factors, though anonymity plays a central part in causing individuals to express themselves in this way.

Passive voice
a form of representation whereby the grammatical subject receives or suffers the action of a verb. For instance, ‘He was removed from the ward’. In this example, ‘He’ is the subject who suffers or experiences the action of the verb ‘remove’. The passive voice provides the option of deleting the agent (the entity responsible for performing an action). In the aforementioned example, for instance, the agent is not present and hence it is not clear who performs the act of removing the patient. Compare active voice.

Patient-centred care/medicine
although a term common in contemporary healthcare, the meaning of patient-centred medicine is not so well understood. The advent of patient-centred medicine in the 1970s accompanied a rise in consumerism (Gwyn, 2002), a philosophy which emphasises the importance of the individual and personal choice. Broadly speaking, patient-centred medicine revolves around integrating the patient’s world – their voice, their whole person, their psychological needs – into medical care. For example, in the practitioner–patient encounter, this means, or is supposed to mean, greater patient involvement in clinical consultations. Critics of patient-centred care point out that medicine is not a consumer service or product, and is therefore not a guiding philosophy that can be appropriately applied to the delivery of healthcare. See patient empowerment.

Patient empowerment
reflective of broader political, cultural trends emphasising individual choice, patient empowerment philosophies are widespread in contemporary healthcare. A facet of patient-centred care, patient empowerment involves individuals being empowered by health professionals to take more control over their conditions and treatment. For example, during medical consultations patients may well be expected to set goals for themselves or take part in shared decision making regarding their treatment plans.

Perlocutionary act
is a speech act performed by saying something, and not in saying something, for example, comforting, persuading, annoying or inspiring. In other words, such acts are performed to produce a further effect.

refers to the act of ascribing human qualities to animals or objects, for example, when talking about ‘dancing sun rays’ or ‘smiling cats’.

Phatic (talk)
involves language being used for sociability purposes rather than for meaningful information exchange. Phatic talk is commonly used to build and maintain social relations, to establish rapport between speakers. Common, classic examples of small talk include questions and statements about the weather and enquiring after fellow interlocutors’ general well-being.

Politeness/politeness theory
in general terms, refers to socially appropriate behaviour. When used in linguistics or specifically pragmatics (see below), it involves attention to the effects of socially appropriate or (inappropriate) behaviour on language use.

an area of linguistic study that investigates speaker meaning. Pragmatics is concerned with the context in which language is produced and the background knowledge that speakers draw on in order to infer meaning. Politeness, Relevance Theory, cooperation and speech acts are, among others, all aspects of language study that fall under the concern of pragmatics.

Primary care
refers to a level of medical care first accessed by patients. Primary care services are provided by general practitioners (GPs), dentists, community pharmacies and optometrists. Most people’s contact with healthcare providers is with these services.

the process whereby patients take on an increasingly active role in their pursuit of healthcare rather than depending on professionals. Proletarianisation has arisen in the age of the Internet where lay personnel now have unrivalled access to health information, while, at the same time, organisational and managerial changes have divested professions of some the control they once had over their work.

a cognitive theory of communication that considers language in terms of relevance. Relevance Theory overhauls all four of Grice’s conversational maxims (1991: 78–9), subsuming them under the one principle of relevance. Language users look for the relevance in one another’s utterances and, accordingly, aim to make their utterances as relevant as possible. See weak and strong communication.

Secondary care
this level of health provision typically involves medical care provided by clinical specialists. Secondary care typically takes place in hospitals, but not all health specialists providing secondary care are hospital-based: they may operate outside of hospitals.

Sick role
a socially sanctioned role that legitimates illness. Broadly speaking, the sick role involves ill people complying with certain obligations, for example: their recognising that they cannot recover by themselves and their accessing professional medical care in order to get better.

Social support
in studies of social work and policy, the term is used to refer to support available to individuals through the channels of family, larger groups and other networks.

Speech act
the function performed by a particular utterance, such as requesting, complaining, instructing and apologising. See locutionary, illocutionary and perlocutionary act.

Strong communication
with regard to Relevance Theory, strong acts of communication involve instances of language use which require little processing effort on the part of hearers. The less effort required to make sense of an utterance, the more relevant it is. Strong communication enables listeners to readily identify speakers’ intentions concerning the meaning of an utterance. Compare weak communication.

the arrangement of words in a sentence – the componential structure of sentences.

Vague language
is language which is purposely vague. Vague language is not unhandy, sloppy language but has a deliberate communicative function. For instance, vague language plays an important interpersonal role in social interaction, allowing language users to mitigate speech acts such as requests and directives.

Weak communication
A concept in Relevance Theory relating to language use that requires significant processing effort on the part of hearers. In contrast to strong communication, which is comparatively clear, weak communication is vague and open to interpretation, involving speakers presenting listeners with a range of inferences to choose from. Compare strong communication.

Additional Task Commentaries

Chapter 1

Task 1.1 Identifying phases of the consultation

According to Byrne and Long (1976: 133), the sequence of phases is I-II-III-V-VI-IV-VI, each of which is represented in bold in the consultation below.

  1. D:      (I) Come in. Hello. (II) How are you?
  2. P:      I feel shocking. You know, when I came to see you last week and you knocked those capsules off – well, every morning when I get up, and my head – Doctor you could have amputated it. It was a terrible headache and it was as if someone was dragging my eyeballs out. So I took more tablets, I haven’t had anything since. . .swollen, I’ve had bags under my eyes and all snuffly and watery, and at the moment, all the top of my head here feels as though there’s pressure on it and I feel this stuff going down the back of my throat.
  3. D:      (III) Are you coughing any of it out?
  4. P:      No, I can’t cough it out as. . .when I blow my nose it’s clear.
  5. D:      Is your nose blocked? Lie your head back and I’ll have a look.
  6. P:      Just here and inside of my throat is always very tender and all under here. . .and with both my hands tucked underneath my ribs and my head feels as if it’s going to fall off.
  7. D:      (V) Well, I’ll give you a change of tablets for that and when you’re over this I’ll start you back on the capsules.
  8. P:      Well, all the aches and pains have gone, apart from under my ribs.
  9. D:      (VI) Well, leave it a week and come and see me again. (IV) It sounds as if it’s the cold that’s affecting your sinuses. (VI) Right, so a week from today.
  10. Bye-bye, now.

As the coding indicates, the doctor initiates – in rather rapid fashion – all of the six phases of the consultation. The phases that the doctor spends less time on are II and IV (respectively: ascertaining the reasons for attendance and a consideration of the patient’s condition).

In a follow up interview with this particular GP, Byrne and Long (1976: 133) asked him about the brevity of the consultation, and were particularly interested in why he had volunteered the remark: ‘It sounds as if it’s the cold that’s affecting your sinuses’ (line 9).

Here is the doctor’s reply. It is an intriguingly revealing response in which he details the problems he had interacting with the patient and the reasons why he conducted the interview so quickly:

I was very angry that my attempt to get her off that stuff wasn’t working. She had not followed her instructions and had taken too many at once and then suffered for a week. I should have given her a right piece of my mind. Instead I decided not to upset her and to get her out as soon as possible. I thought I had got rid of her with the ‘come and see me again’ but she just sat. It was really meant to reassure her so that she would go away. In fact, it was a useless consultation because we were both running away from the reality of her condition. Unless there’s a miracle, she’s only got a few months. I have not told her but I’m sure she knows.

Chapter 2

Task 2.2 Patient empowerment or nurse control?

On the face of it, it would appear that the patient exhibits a substantial degree of power, and the nurse, to some degree, facilitates this empowerment. For example, in both extracts she encourages the patient to openly disclose his feelings, giving him substantial access to the conversational floor: ‘How did you feel in yourself when all this was happening’ (lines 1–2: Extract 1) as well as validating his feelings and encouraging further disclosures: ‘yeah it must have been very hard for you that happening and then getting sick yourself’ (lines 6–8: Extract 2). The patient, in response to the nurse’s elicitations, takes extensive turns at talk, providing a detailed and highly personal (not to mention painful) account of his life situation. He appears to be able to fashion his responses very much in his own terms.

Yet is this a truly accurate assessment? Although the nurse, in her desire to elicit disclosures from the patient, cedes control of the floor to him, she nevertheless sets the parameters of the discussion: despite the seemingly open, unbounded nature of the interaction, the participants still follow an agenda: the talk is restricted to the patient and his concerns and, as Candlin (2000: 235) points out, neither participant deviates from these parameters.

Moreover, just how empowering is the patient’s account of himself? Candlin argues that, for all the autonomy and self-determination the interaction affords him, he is effectively powerless. Consider, for example, the way he represents himself linguistically. Lexically and grammatically the patient positions himself in a passive way, a linguistic encoding which reflects his lack of control over his situation: ‘I still couldn’t see it happening to me’, ‘I suppose there’s nothing I could do’, ‘I suppose that’s the lot that’s dealt out to you’. Here, the recurring use of the verb ‘suppose’ conveys a relatively low modality (commitment to an utterance). The patient appears to be uncertain about what he is saying and accordingly hedges his statements. Rarely does he present himself in a dynamic way. Note, for instance, his use of the passive voice which emphasises that things are done to him rather than his performing actions or taking control, e.g. ‘But it was after I was retrenched’.

Candlin argues that, for all the current emphasis on patient-empowerment in healthcare policy, the asymmetry which has traditionally characterised much practitioner–patient talk still obtains in the nurse–patient relationship, but is manifested in far less discrete ways. Following Fairclough (1992), Candlin refers to this linguistic phenomenon as the ‘democratization of discourse’. A feature of much contemporary institutional talk (not just talk confined to the context of healthcare), the democratisation of discourse involves the

removal of inequalities and asymmetries in the discursive and linguistic rights, obligations and prestige of groups of people. Democratization in discourse, like democratization more generally, has been a major parameter of change…but in both cases…there are questions about how real or how cosmetic the changes have been. (Fairclough, 1992 cited in Candlin, 2000: 234)

Readers interested in pursuing the notion of the democratisation of discourse in greater detail, particularly in relation to recent changes in healthcare, might wish to consult Fairclough’s (1992) Discourse and Social Change, a seminal text which has had a significant influence on critical studies of contemporary discourse.

Chapter 8

Task 8.1 Computer-mediated communication: a linguistically impoverished medium?

Many of the so-called errors – the irregular spellings and fragmentary sentences, for instance – that feature in electronic discourse are not unintentional mistakes (because of inattention or lack of knowledge of standard language forms), but deliberate stylistic choices on the part of users to economise on typing, mimic spoken discourse features or express themselves creatively (Herring, 2001: 617). Errors also arise due to the temporal pressures of online message construction (communicating by way of instant messaging, for example, involves participants creating text synchronously, with little time to revise and edit their messages). But even in such cases where errors arise, it is unlikely that they will prove fatal to understanding.

Of the three short stretches of language featured in this task, the first is taken from Crystal’s (2001) personal corpus of emails, the second and third from a collection of requests for advice posted on an internet advice column. They illustrate two different communicative settings in which misspellings, be they accidental or deliberate, might well occur. These unorthodox forms are not by any means ambiguous: reference to the linguistic context in which the messages were produced makes it a straightforward process to recover their meanings and appreciate their stylistic effect. For instance, in the first example, the seemingly accidental ‘Hav eyou’ corresponds to ‘Have you’ (a similar orthographical shuffle provides the semantic solution to example 2), while, in example 3, the writer produces certain stylistic effects, employing capitalisation and repeated vowels to mimic the speech sounds of increased and drawn out vocal emphasis, effects which emphasise the urgency of the writer’s problem and his/her appeal for advice. Thus, despite the extent of their orthographic irregularity, the semantics of these messages remain undeniably intact.
Therefore the appearance of such non-standard linguistic forms (which commonly occur in online health exchanges) do not necessarily distract from the contents of the messages themselves. Nor, according to Crystal (2001), are readers likely to make social judgements about the writers and question the credibility of their concerns. This is because the recipients of ‘error-strewn messages’ are commonly aware of the situational circumstances and constraints under which email is composed and, therefore, the concomitant attendance of errors. Respondents are aware of this ‘because, several times a day, they know they write under the same constraints themselves’ (Crystal, 2001: 112).

Further Reading and Resources

We hope that readers, as part of their continuing journey into the fascinating realm of health communication, will endeavour to pursue the various references that appear throughout this book. Alternatively, readers seeking a starting point with which to begin their further reading might wish to pursue the titles in the following list. We have given attention to some of these publications already, but our consideration of these texts is certainly no substitute for an intimate consultation with the original source.

Corpus software

WordSmith Tools http://www.lexically.net/wordsmith/
An accessible and easy to use program which has been widely employed in discourse analytic corpus-based research.

AntConc http://www.antlab.sci.waseda.ac.jp/index.html
Another extremely accessible program which features all the staple corpus tools. Can be downloaded and used free of charge.

Wmatrix http://ucrel.lancs.ac.uk/wmatrix/
Allows users to conduct a range of corpus operations. The program will also tag data into semantic themes and parts of speech. Comes with a useful tutorial which provides an effective introduction to the software. The program is free to use for the first month.

BNCweb http://bncweb.info/
Like AntConc this is a freely available and easy to use piece of software which gives access to the British National Corpus (BNC). It also has a useful tutorial for beginners.


Baker, P. (2006) Using Corpora in Discourse Analysis. London, UK: Continuum.
A practical and accessible introduction to using corpus linguistic tools in the pursuit of discourse analysis, a text teeming with ideas about how to conduct one’s own analysis. An essential text for researchers interested in using corpus techniques to interrogate health discourse.

Brown, B., Crawford, P. and Carter, R. (2006) Evidence-Based Health Communication. Berkshire, UK: Open University Press.
An illuminating text that adopts a multidisciplinary perspective in exploring a wide range of health communication issues.

Cameron, D. (2001) Working with Spoken Discourse. London, UK: Sage.
Provides an excellent and practical guide to using and analysing spoken language. Covers a range of themes and approaches to discourse analysis.

Carter, R. and McCarthy, M. J. (1997) Exploring Spoken English. Cambridge, UK: Cambridge University Press.
An accessible book that examines language use in a range of interactive contexts. Among other linguistic themes, contains insightful commentaries on narrative and vague language.

Charteris-Black, J. (2004) Corpus Approaches to Critical Metaphor Analysis. London, UK: Palgrave Macmillan.
One of the first book-length discussions on the study of metaphor use within the framework of corpus linguistics.

Conrad, P. (2007) The Medicalization of Society. Baltimore, USA: John Hopkins University Press.
An insightful sociological work investigating how human conditions and problems come to be defined and treated as medical phenomena and disorders.

Cook, G. (2000) Language Play, Language Learning. Oxford, UK: Oxford University Press.
A book that highlights the significance of language play, particularly with regard to applied linguistics and language learning.

Crystal, D. (2011) Internet Linguistics: A Student Guide. London, UK: Routledge.
A highly accessible text that examines the linguistic properties of a range of online modes of communication. Also explores the differences and distinctions between speech and writing and the hybrid nature of Internet discourse.

Fairclough, N. (1992) Discourse and Social Change. Cambridge, UK: Polity Press.
An engaging and persuasive manifesto for critical discourse analysis that also presents some extremely insightful analyses of medical discourse.

Gwyn, R. (2002) Communicating Health and Illness. London, UK: Sage.
Placing a firm emphasis on the role of discourse, this text serves as an elegantly accessible and informative introduction to health communication.

Heritage, J. and Maynard, D. (eds) (2006) Communication in Medical Care: Interaction between Primary Care Physicians and Patients. Cambridge, UK: Cambridge University Press.
A comprehensive collection of in-depth conversation analysis studies that examine doctor–patient consultations in the primary care setting.

Hunter, K. M. (1991) Doctor’s Stories: The Narrative Structure of Medical Knowledge. Princeton, USA: Princeton University Press.
Considers the types of texts that doctors produce when communicating information about patients. Contains a detailed chapter about the linguistic content of patient records.

Iedema, R. (ed.) (2007) The Discourse of Hospital Communication: Tracing Complexities in Contemporary Health Care Organizations. Hampshire, UK: Palgrave Macmillan.
An enlightening collection of innovative and inter-disciplinary articles that explore a number of under-researched themes in the hospital setting.

Karp, D. (1996) Speaking of Sadness: Depression, Disconnection and the Meaning of Illness. Oxford, UK: Oxford University Press.
An excellent, sustained analysis of personal narratives of depression which effectively integrates linguistic and social science insights.

Kleinman, A. (1988) The Illness Narratives: Suffering and the Human Condition. New York, USA: Basic Books.
A classic treatise on personal narratives of illness: one of the first texts to give due consideration to patients’ personal experiences of suffering and illness.

Locher, M. (2006) Advice Online: Advice-Giving in an American Internet Health Column. Philadelphia, USA: John Benjamins.
One of few texts solely dedicated to a discursive analysis of online health advice giving and seeking between patients and professionals.

Lupton, D. (2003) Medicine as Culture (2nd Edition). London, UK: Sage.
A wide-ranging introduction to medical sociology – a text that also possesses many insights into the interface between health and discourse.

Mishler, E. (1984) The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, NJ, USA: Ablex.
This is a classic and still influential study of the doctor–patient consultation. Now sadly, pointlessly, out of print, we nevertheless recommend it to anyone interested in knowing more about the interactional dynamics of the practitioner–patient relationship.

Sarangi, S. and Roberts, C. (eds) (1999) Talk, Work and Institutional Order. Berlin, Germany: Mouton de Gruyter.
Brings together a range of insightful chapters concerning language and the workplace, a number of which examine medical discourse.

Thomas, J. (1995) Meaning in Interaction: An Introduction to Pragmatics.
London, UK: Longman.
An excellent and highly readable introduction to pragmatics that provides a detailed account of both politeness and Grice’s theory of conversation.

Journal articles and book chapters

Adolphs, S., Brown, B., Carter, R., Crawford, P. and Sahota, O. (2004) ‘Applied clinical linguistics: corpus linguistics in health care settings’, Journal of Applied Linguistics, 1: 9–28.
One of the first studies to demonstrate the facility of keywords as an analytical resource in health communication. The research also offers insights into combining quantitative and qualitative discourse analysis.

Brown, B., Nerlich, B., Crawford, P., Koteyko, N. and Carter, R. (2009) ‘Hygiene and biosecurity: The language and politics of risk in an era of emerging infectious diseases’, Sociology Compass, 2: 1–13.
The article reports on research based on metaphor analysis and corpus linguistics, revealing how metaphorical concepts were used as framing devices by different groups to advocate disease management.

Candlin, C. and Candlin, S. (2003) ‘Health care communication: A problematic site for applied linguistic research’, Annual Review of Applied Linguistics, 23: 134–54.
Provides a succinct and detailed review of health communication from an applied linguistic perspective. The issues it raises are still extremely pertinent, particularly the discussion of intercultural research in healthcare settings.

Clerehan, R. and Buchbinder, R. (2006) ‘Toward a more valid account of functional text quality: The case of the patient information leaflet’, Text & Talk, 26: 39–68.
This article systematically sets out a linguistic framework for examining the text of the patient information leaflet.

Coveney, C., Nerlich, B. and Martin, P. (2009) ‘Modafinil in the media: Metaphors, medicalisation and the body’, Social Science & Medicine, 68: 487–95.
Based on collaboration between a linguist and sociologists, the article is an in-depth analysis of the structure and content of media discourse on the sleep drug modafinil.

Dorfman, L., Wallack, L. and Woodruff, K. (2005) ‘More Than a Message: Framing Public Health Advocacy to Change Corporate Practices’, Health Education & Behaviour, 32: 320–36.
The article combines frame analysis with reflection on lessons for health education practitioners on how to devise communication strategies in contemporary public health battles.

Drew, P., Chatwin, J. and Collins, S. (2000) ‘Conversation analysis: a method for research into interactions between patients and health-care professionals’, Health Expectations, 4: 58–70.
Presents a practical account of how conversation analysis can be used to interrogate practitioner–patient interaction.

Jones, A. (2003) ‘Nurses talking to patients: Exploring conversation analysis as a means of researching nurse–patient communication’, International Journal of Nursing Studies, 40: 609–18.
An accessible study of nursing interaction conducted using conversation analysis, teeming with practical insights.

Morrow, P. (2006) ‘Telling about problems and giving advice in an internet discussion forum: some discourse features’, Discourse Studies, 8: 531–48.
Focussing on emotional health issues, this article is a succinct and insightful analysis of online problem and advice messages.

Pilnick, A. and Dingwall, R. (2011) ‘On the remarkable persistence of asymmetry in doctor/patient interaction: A critical review’, Social Science & Medicine, 72: 1374–82.
Provides a fascinatingly penetrating up-to-date interactional assessment of the doctor–patient consultation.

ten Have, P. (1991) ‘Talk and institution: A reconsideration of the
‘asymmetry’ of doctor–patient interaction’, in D. Boden and D. Zimmerman (eds) Talk and Social Structure: Studies in Ethnomethodology and Conversation Analysis. Cambridge, UK: Polity.
Provides an appraisal of interactional control in doctor–patient communication, arguing that asymmetry in medical discourse is achieved in interaction rather than being an inherent feature of the consultation.

Segal, J. (1997) ‘Public Discourse and Public Policy: Some Ways That Metaphor Constrains Health (Care)’, Journal of Medical Humanities, 18: 217– 31.
The author provides an insightful analysis of metaphor use in the health policy discourse, calling for more attention to rhetoric work done by metaphors and the ways in which they constrain what can be argued at the outset.

Skelton, J. and Hobbs, F. (1999a) ‘Descriptive study of cooperative language in primary care consultations by male and female doctors’, British Medical Journal, 318: 576–579.
This article (and the one below by the same authors) presents a useful illustration of how corpus tools can facilitate analysis of doctor–patient encounters.

Skelton, J. and Hobbs, F. (1999b) ‘Concordancing: use of language-based research in medical communication’, Lancet, 353: 108–11.

Zinken, J. (2003) ‘Ideological imagination: Intertextual and correlational metaphors in political discourse’, Discourse & Society, 14: 507–23.
A detailed study of metaphors from the perspective of cognitive linguistics, elucidating their important role in ideological discourse.