Please join the Socio crew for Sociolunch, May 21, 11:30-1:00, in the Greenberg Room, where Ashley Hesson (Michigan State University) will be presenting.
Medically speaking: Mandative Adjective Extraposition in Physician Speech
Abstract: Clinical recommendations are central features of physician-patient interaction. Mandative adjective extraposition (henceforth MAE; Van Linden & Davidse 2009, Van Linden & Verstraete 2010) is one of many linguistic forms used by physicians in providing recommendations (e.g., it’s important to exercise, it’s critical that you take these pills). This study decomposes MAE, a relatively unexplored sociolinguistic variable, into features that contribute both to its pragmatic interpretation as a deontic semi-modal and its social interpretation in the context of physician-patient interaction. These features include MAE’s inherent, variable structural components—mandative adjective, complement type, embedded verb type, etc—as well as MAE’s suprasegmental hitchhikers (ala Mendoza-Denton 2011), such as intonational contours and creaky voice. The study considers the contributions of these features, in isolation and in concert, to physicians’ attempts at balancing their institutional and interpersonal goals when managing consultations. In doing so, it provides a base for understanding how doctors use clusters or layers of linguistic resources (Podesva 2008) to construct their professional personae.
Imperative force is proposed as the central dimension across which MAE forms vary and the object of MAE’s social/stylistic evaluation. In an experiment in which participants evaluated doctors’ recommendation style, some structural and suprasegmental features were perceived as ‘strong’ (i.e. were highly mandative) while others were perceived as ‘weak’ on a scale of imperative force. Strong forms were associated with perceptions of confidence and trustworthiness. Conversely, weak forms were viewed as markers of uncertainty. In particular, physician speech featuring rising intonation (one of the weak variants) was further judged to be apathetic.
Quantitative analysis was conducted on a large dataset (1,857 tokens) of physicians’ MAE-type recommendations. The recommendations were naturally-occurring productions from a US-wide corpus of audio-recorded, transcribed medical consultations (the Verilogue corpus; Kozloff & Barnett 2006). Strong and weak feature variants were found to consistently co-vary in this data, providing support for listeners’ intuitions in the perception experiment. Fittingly, strong forms were more likely to be employed by physicians in making recommendations to severely ill patients. Strong forms were also positively correlated with physicians’ years in practice, indicating that physicians may become more direct with experience. However, intriguingly, physicians with more years in practice were more likely to layer rising intonation onto their MAE forms. This suggests that physicians continue to negotiate their often competing goals of reinforcing expertise with direct, confident-sounding forms and mitigating said forms to meet interpersonal expectations, where semantic and syntactic resources become more central to the construction of authoritativeness over the professional lifespan. Within specific practice settings, based on either physician specialty or patient medical condition, MAE production was additionally constrained by patient race and physician gender, alluding to in-group professional pressures that further shape physician recommendation patterns.
The integrated production and production results collectively point to socialization into medical practice as the major social force impacting MAE variation. Medically relevant categories (e.g., specialty), classifications (e.g., disease severity), and experience are all shown to influence MAE variation in physician-patient interaction, where these factors represent concepts and social distinctions that are specific to the context of medicine. Physicians use strong MAE forms as one of many potential sociolinguistic resources in the construction of an authoritative (confident and trustworthy) professional persona, while using weak forms to construct situationally appropriate indirectness.
Overall, this work provides a novel approach to the study of variation in context. It explores stylistically meaningful variability within a single construction, examining patterns of use and perception that define the construction’s significance within a professionally constrained subset of transactional discourse. Moreover, it illustrates the value of cross-disciplinary applications of variationist methodology, quantifying and characterizing patterns of interest to both sociolinguistics and medicine.