Abstract
This study seeks to investigate how Chinese doctors construct their professional identities in the context of medical consultations in mainland China. It follows a qualitative research paradigm that entails the collection of spoken interactional data; in particular 41 authentic medical consultation sessions were observed and 5 semi-structured interviews were conducted with participating doctors. The data were collected over a six-month period from late 2020 to early 2021 in a general public hospital in mainland China. Agha’s theory of ‘figures of personhood’ functions as the theoretical base for this study. For audio-recordings of medical consultations, an interactional sociolinguistic approach to discourse analysis was adopted when investigating the communication strategies used in doctors’ construction of different professional identities in relation to alignment with certain figures of personhood. For audio-recordings of interviews, content analysis drawing on the grounded theory approach was adopted to explore participating doctors’ perceptions, attitudes, and personal experiences of being a healthcare provider and of communicating with patients (and their family).The overarching figure that doctors align with is the healthcare provider authoring voices of competency and care. Doctors construct their identities of doctor and medical information provider in authoring the voice of competency, and the ordinary person identity in authoring the voice of care. Functions related to the construction of the doctor identity include: 1) eliciting medical information; 2) monitoring and adjustment; 3) alignment with institutional authority. These functions are realized through doctors’ following and deviating from the checklist of questioning, summarizing prior talk, topical control, alternative uses of first-person pronouns. In constructing the medical information provider identity, doctors refer to knowledge that patients can relate to and use first-person singular and the institutional ‘we’ alternatively to interpret medical conditions, communicate therapeutic interventions and procedures, and clarify Internet-based medical information. In authoring a voice of care, doctors construct their identity as an ordinary person through temporarily putting aside the instrumental goals of medical consultations for building therapeutic relationships. Functions related to the construction of ordinary person involve: 1) demonstrating attention to and interest in patients’ illness stories; 2) posing questions unassociated with patients’ health; 3) reconciling decisional conflicts between patient and family. These functions are realized through doctors’ repetition of patient and family utterances, engagement in small talk, a combination of summary and question about both patient and family opinions, and the use of the first-person plural ‘we’.
Post-consultation interviews support the observational data collected from authentic medical consultations. The professional identities as well as the communication strategies adopted do not seem to require doctors to consciously choose certain behaviors, but are part of the meaning of being a healthcare provider. These professional identities are not distinctly separate but closely related, constituting this overarching figure of personhood. Within the competency voice, the doctor identity is constructed to gather information related to disease and intervention, and the medical information identity is constructed to address the knowledge gap and misperceptions. These two professional identities work in collaboration to maintain doctors’ control in the communication on one hand, and to strengthen and safeguard doctors’ professional credibility and alignment to the hospital on the other. The two voices of competency and care complement each other in gaining an integrated understanding of the patient’s illness experience as well as of the patient as a whole person. The identities of doctor, medical information provider, and ordinary person can be understood with regards to the ways in which doctors adopt the patient-centered approach, which prioritizes a proper balance between management of biological diseases and establishment of relationship.
| Date of Award | 19 Mar 2024 |
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| Original language | English |
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| Supervisor | Jack PUN (Supervisor) |