The purpose of this paper is to examine use of English discourse markers in otherwise Spanish language consultations. Data is derived from an audio-recorded corpus of Spanish language consultations that took place in a small community clinic in the United States as well as postconsultation interviews with patients and providers. Through quantification of the use of discourse makers in the corpus and discourse analysis of transcripts, we demonstrate that English-speaking dominant medical providers use English discourse markers more frequently and with a broader range of functions than do Spanish-speaking dominant medical providers and patients. We argue that such use of English discourse markers serves to exacerbate the power relationship between providers and patients even though the use of English discourse markers does not cause overt miscommunication in the ongoing interaction. Implications for providers who use a second language in their medical consultations are discussed.

The purpose of this paper is to examine the micro-interactional co-construction of power within Spanish language concordant medical consultations in California involving a third party family member. Findings indicate the third party instigates code-switching to English on the part of medical providers, a language that the patient does not understand, rendering the patient a non-participant in the medical consultation. In these consultations involving a third party family member, monolingual Spanish-speaking patients are stripped of control in ways that are similar to other powerless groups in medical consultations. Implications include the need to further examine how micro-level interactions reproduce societal ideologies and shape policy on the ground.

The purpose of this paper is to examine patient-provider narrative co-construction of symptoms, diagnosis, and treatment in the medical consultation. Narrative scholarship has demonstrated that conversational narratives, including those that take place in medical consultations, are typically co-constructed by all participants within the conversation. In the context of the medical consultation, this means that patient narratives are co-constructed with providers, and that at times, provider contributions to the patient narrative can hide patient contributions. The inherent power asymmetry that exists between patient and provider facilitates the possibility for provider contributions to obscure those of the patient. Based on audio-recorded data from medical consultations between two different nurse practitioners and one patient, findings from this study demonstrate that such narrative co-construction leads to differential information regarding the patient's symptoms, diagnosis, and treatment. Implications include the need for providers to relinquish control over to the patient to allow the patient to fully articulate narrative accounts of their medical issues.

No abstract

The purpose of this study is to examine the construction of language normativity as medical providers interact with patients and animate stance within Spanish language medical consultations. The context of the study is a clinic in which providers use Spanish to communicate with monolingual Spanish-speaking patients. This clinic is in the United States, an English-speaking macro-societal context. Findings indicate that providers who are second language users of Spanish animate stance and interact with patients in ways that English is constructed as normative and Spanish as marked. Implications include the need to consider how the construction of language normativity within medical consultations affects health outcomes.