Elena Semino is Professor of Linguistics and Verbal Art in the Department of Linguistics and English Language at Lancaster University, and Director of the ESRC Centre for Corpus Approaches to Social Science. She holds a Visiting Professorship at the University of Fuzhou in China. She specializes in health communication, medical humanities, corpus linguistics, stylistics, narratology and metaphor theory and analysis. Since 2010, she has worked primarily on narratives of autism and schizophrenia, communication about pain, and communication about cancer and the end of life. Her work usually involves a combination of qualitative and quantitative analysis, drawing from the tools and techniques of corpus linguistics. She has (co-)authored over 80 academic publications, including: Metaphor in Discourse (Cambridge University Press, 2008) and Metaphor, Cancer and the End of Life: A Corpus-based Study (Routledge, 2018).
Language, illness and healthcare
Language is central to the practice and provision of healthcare. It mediates how illness is understood, diagnosed and experienced. Effective and sensitive communication improves information-provision, diagnosis, support, self-management and self-esteem; poor or insensitive communication can cause misunderstandings, misdiagnoses, frustration, anxiety, stigma, and even death. In this talk I provide two examples of how linguistic research (and particularly corpus-assisted discourse analysis) can produce findings that are directly relevant to challenges in communication about illness. The first study concerns metaphors in communication about cancer. Metaphor is central to how we make sense of and communicate our experiences. This is particularly the case with subjective and sensitive experiences such as illness. Drawing from a corpus-based study of online writing by people with cancer, I show how a variety of metaphors are used creatively by patients as framing devices to express their lived experience of illness, and particularly to present themselves as more or less (dis)empowered within that experience. I then introduce a resource based on the findings of the research – the Metaphor Menu for people with cancer. The second study concerns communication about pain. It is well known that the experience of pain is difficult to communicate verbally. This is particularly problematic in the case of chronic pain, where diagnosis and treatment often rely on the patient’s ability to articulate his or her own experiences, and on clinicians’ ability to make the most of what patients say. I introduce a series of projects in which patients co-produced visual representations of their pain in collaboration with an artist, and then present the results of a study that explored the difference that the availability of these images can make in specialist consultations about chronic pain. I conclude with some reflections on opportunities and challenges in conducting linguistic research on communication about illness.
Jim Parle MBChB DRCOG FRCGP MD is Professor of Primary Care and is Course director for the Physician Assistant PGDip progamme at Birmingham University Medical School. Jim entered General Practice in 1982 and was Senior Partner from 1983 to 2000, continuing part-time General Practice alongside academia since then. Jim’s main activity in his 20 years as an academic has been in education, leading on the introduction of a major community based teaching strand within the MBChB course; championing the place of non-biosciences such as ethics and law and behavioural science in the medical curriculum; establishing the PA PGDip; and leading innovative educational approaches such as using lay women to teach medical students how to perform female pelvic examinations. His research interests have been predominantly in thyroid epidemiology and in education. He has received grants from, among others, the RCGP, PPP (now the Health Foundation) and the NIHR.
Looking back over 40 years as a doctor: what have I learned about communication?
It’s a long career; 15 years full time followed by 25 years split between doctoring and academia. No-one really taught about communication at medical school in my day: the patient was an object, from which a history was ‘taken’, clinical signs were ‘elicited’, tests were ‘performed’ and by a magical process a diagnosis was ‘made’ and treatments were ‘administered’ (or even, for some medicines, ‘exhibited’). We certainly weren’t taught about ICE (the rubric now routinely used by medical students by asking the question ‘What are your ideas, concerns and expectations?’) Nor were we taught to ask the patient what they thought was wrong (as if they would know!). But now of course they are indeed taught about communication, and indeed assessed on their ability to communicate. I doubt there is a medical school in the world which doesn’t ‘teach’ communication, with batteries of advice. Thus we should use ‘sighting shots’ when breaking bad news (and that’s typical medical arrogance; how often are we truly ‘breaking’ bad news as opposed to merely confirming it?). We should ask about suicidal ideation. We should provide all the information for a patient to make an informed decision. And so on. And yet, and yet …
I see again and again medical and other clinical students busy asking questions when, as Balint said ‘If you ask questions all you get is answers’. They aren’t listening, they certainly aren’t building a therapeutic relationship. In Neighbour’s terms they are having an inner consultation or discussion, or as he described it, they are listening to the additional head on their shoulders. They certainly aren’t listening to the patient. In my talk I will explore how we have changed our thinking about communication skills in medicine. And how, in my view, we have gone wrong. I will mix experience and literature, anecdote and speculation. And challenge!