医患话语中的重复

发布时间：2019-02-08 20:51

【摘要】：学者们从不同的角度对重复进行了研究,但较少从语篇理解和加工的角度分析重复对于交际双方社会关系的影响。医患关系一直是人们关注的社会焦点问题,双方的交际涉及心理因素,因此,从语篇理解和加工的角度,本文以在三家甲级医院实地采集共计约25小时的医患对话录音转写为语料,以会话分析和批评性话语分析理论为框架,通过定性和定量分析相结合的方式,对医患话语中医生和患者双方重复使用的形式和功能进行描写和分析,从话语产出和理解的角度分析双方对于重复使用的不同,探讨医患双方各自的心理过程和心理图示,以及其对于双方社会关系构建的影响。本文首先将医患对话中重复从修辞行为和结构两个角度分类,并对双方的重复进行形式化描写,发现医患在重复使用的不同。在修辞行为上,医生涉及所有共计十一种修辞行为,而患者主要集中在症状上；在结构重复上,医生更倾向使用全部重复及连续重复,而患者大多使用补充重复和间隔重复。在功能上,医生的重复用于明确问题寻求准确信息,解释治疗方案以期患者同意,确认信息和要求患者更细致的描述,而患者的重复用于详细描述症状引起医生重视,评价医生先前的治疗,要求更多解释及寻求医生的确认。然后从话语理解和产出的角度揭示了双方在局部连贯和整体连贯两方面上的不同。在在局部连贯上,医生大量的全部重复和连续重复使用,反映出其采用直接匹配和寻找己知和未知信息的方式,在话题内部和医患对话不同阶段使用平行处理模式和非循环式处理模式；而患者的补充重复和间隔重复,反映其采用重新恢复已知信息的方式,使用串行处理模式和循环式处理模式。在整体连贯上,医生为自上而下的心理模式,而患者为自下而上的心理模式。最后由于话语理解和加工上的不同,导致双方对于医患对话中两者间社会关系的期待(传统的家长主义和消费主义)也不同,进而引起了两者交流的障碍。若患者不配合医生自上而下的处理模式和演绎式陈述方式,或医生不考虑患者自下而上的处理模式和归纳式表达方式,两者交流便会出现障碍。从重复这一言语行为入手,分析双方在语篇理解和加工上的不同,进而反映两者社会关系的构建,在语篇、心理和社会三个层面逐一探讨,不仅加深了对于重复本身的理解,并且尝试性探索了以往批评性话语分析直接从语篇层面到社会层面却忽略交际双方心理因素的研究,为理解医患社会关系提供了新的视角。
[Abstract]:Scholars have studied repetition from different perspectives, but have rarely analyzed the impact of repetition on social relations between communicative and communicative parties from the perspective of discourse comprehension and processing. The relationship between doctors and patients has always been the focus of attention. The communication between the two sides involves psychological factors. Therefore, from the perspective of text understanding and processing, Based on the data collected in three A-grade hospitals for about 25 hours of doctor-patient dialogue recording, and using the theory of conversational analysis and critical discourse analysis as the framework, this paper combines qualitative and quantitative analysis. This paper describes and analyzes the forms and functions of repeated use by doctors and patients in doctor-patient discourse, analyzes the differences between the two sides in terms of utterance output and understanding, and probes into the psychological process and psychological diagrams of both doctors and patients. And its influence on the construction of bilateral social relations. This paper first classifies the repetition in doctor-patient dialogue from two aspects of rhetorical behavior and structure, and formalizes the repetition of both sides, and finds out the difference of the repeated use between doctors and patients. In rhetorical behavior, doctors involve all 11 rhetorical behaviors, while patients mainly focus on symptoms. In structural repetition, doctors tend to use total repetition and continuous repetition, while most patients use complementary repetition and interval repetition. Functionally, the doctor's repetition is used to identify the problem, to seek accurate information, to explain the treatment plan with the patient's consent, to confirm the information and to require a more detailed description of the patient, while the repeated use of the patient's repetition to describe the symptoms attracts the attention of the doctor. Evaluate the doctor's previous treatment, ask for more explanation and seek doctor's confirmation. Then it reveals the differences between the two sides in local coherence and global coherence from the perspective of discourse comprehension and output. In local coherence, doctors use a large amount of complete repetition and continuous reuse, reflecting the use of direct matching and searching for self-knowledge and unknown information. Using parallel processing mode and non-circular processing mode in different stages of topic and doctor-patient dialogue; The complementary repetition and interval repetition of the patient reflect the way of restoring the known information, the serial processing mode and the cyclic processing mode. In overall coherence, the doctor is a top-down mental model, while the patient is a bottom-up psychological model. Finally, due to the differences in discourse comprehension and processing, the expectation of social relations between the two parties (traditional paternalism and consumerism) is different, which leads to the obstacles of communication between the two parties. If the patient does not cooperate with the top-down treatment model and the deductive statement, or the doctor does not consider the bottom-up treatment model and the inductive expression, the communication between the two will be hindered. Starting with the speech act of repetition, this paper analyzes the differences between the two sides in the comprehension and processing of the text, and then reflects the construction of the social relations between the two parties. In the discourse, the psychological and social aspects are discussed one by one, which not only deepens the understanding of the repetition itself. It also tries to explore the previous studies of critical discourse analysis from the discourse level to the social level, but neglects the psychological factors of both sides of communication, which provides a new perspective for the understanding of doctor-patient social relations.
【学位授予单位】：南京理工大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：H15

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