Spoel Philippa, McKenzie Pamela, James Susan, Hobberlin Jessica
Professor, Department of English, Laurentian University, Sudbury, ON.
Healthc Policy. 2013 Oct;9(Spec Issue):71-85.
This paper uses a discourse-rhetorical approach to analyze how Ontario midwives and their clients interactionally accomplish the healthcare communicative process of "informed choice." Working with four excerpts from recorded visits between Ontario midwives and women, the analysis focuses on the discursive rendering during informed choice conversations of two contrasting kinds of evidence - professional standards and story-telling - related to potential interventions during labour. We draw on the concepts of discursive hybridity (Sarangi and Roberts 1999) and recontextualization (Linell 1998; Sarangi 1998) to trace the complex and creative ways in which the conversational participants reconstruct the meanings of these evidentiary sources to address their particular care contexts. This analysis shows how, though very different in their forms, both modes of evidence function as hybrid and flexible discursive resources that perform both instrumental and social-relational healthcare work.
本文采用话语修辞方法，分析安大略省的助产士及其客户如何通过互动完成“知情选择”这一医疗沟通流程。通过研究安大略省助产士与产妇之间的四段录音访谈内容，分析聚焦于在关于分娩期间潜在干预措施的知情选择对话中，两种截然不同的证据——专业标准和故事讲述——的话语呈现方式。我们借鉴话语混合性（萨兰吉和罗伯茨，1999）和重新语境化（林内尔，1998；萨兰吉，1998）的概念，来追溯对话参与者以复杂且富有创造性的方式重构这些证据来源的意义，以适应其特定护理情境的过程。该分析表明，尽管这两种证据形式差异很大，但它们都作为混合且灵活的话语资源发挥作用，既承担工具性医疗工作，又承担社会关系性医疗工作。
