의료대화와 의료통역 - 대화의 비대칭성에 따른 환자의 저항반응 관행 비교-

Abstract

The medical conversation has unique characteristics as a type of institutional talk because it is carried out within the framework of the Medical Institution. The medical staff, as an agent representing the Medical Institution, has superior epistemic authority(A+), and professional knowledge (K+) and control (C+) which are sufficient to lead the conversation, vis-a-vis the patient, as the medical care recipient, who has less authority (A-), less professional knowledge (K-) and also insufficient control (C-) for the conversation. Due to these differences in power, medical staff - patient interactions tend to be organized asymmetrically. Patients, however, often resist the authority of the medical staff, and the resistance reaction practices of the patients will vary depending on the degree of asymmetry of the power. In the doctor-patient interactions of the pronounced asymmetry of epistemic authority, it is observed that the patient tries to lead the conversation to his orienting direction by the nonconforming responses which are dispreferred with the type of YNIs (Yes / No Interrogatives) or question design, and choose the resistant response practice which is less aggressive. In the nurse-patient interactions, in which the power asymmetry is somewhat reduced, the patient often resists the nurse’s directives by casually appealing to the nurse for the possibility of letting her forego the need to follow them, by initiating repair, and/or by employing an informal style/register that may not be congruent with the degree of formality expected of the given interactional context. In the doctor-patient interactions with an interpreter, the patients do not even acknowledge the epistemic authority of the doctor in taking up the treatment proposed by the doctor and the control of doctor in the medical conversation. This is accounted for as the patient’s practice of using the interpreter, who is constituted as their co-member of the same team, as the ‘buffer’ over the course of addressing the sensitive task of resisting the doctor’s treatment. And rather tries to reduce the asymmetry of power by various methods like evoking the categories “we” vs. “you” vis-à-vis the doctor.