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Narratives of personal and vicarious experience are part and parcel of being a doctor, as doctors routinely (re)interpret and (re)tell patients' narratives when reflecting on clinical cases. Taking an interest in migrant doctors' self-initiated narratives about patients in doctor-researcher interviews about cultural transitions, this study examines over thirty hours of audio-recordings of forty semi-structured interviews conducted as part of a collaborative project in Chile and Hong Kong. The study explores how migrant doctors construct their professional 'self' through narratives about patients, and how these narratives help migrant doctors legitimise their arguments and professional stance in criticizing cultural and societal attitudes towards health and illness, and the professional practices of local doctors. Finally, the paper reflects on the ways in which migrant doctors' identity positionings provide space for the creation of a "symbolic territory" in which the practices of migrant doctors co-exist within the boundaries of the practices of local doctors in the host culture. [ABSTRACT FROM AUTHOR]

This article illustrates some of the ways in which the notion of (paid) work is actively being gendered, and how these gendering processes take place not only through organizational practices but also in discourses that circulate outside an organization in the private domain. Drawing on 15 in‐depth interviews with women who opted out of their own professional career in order to accompany their husbands on their overseas work assignment to Hong Kong, we demonstrate some of the benefits of using a discourse analytical approach to capturing and identifying the processes through which these women actively (although not necessarily consciously) gender the notion of work, thereby reinforcing the gender order and its male bias. We argue that identifying and making visible these gendered and gendering practices is an important component of, and a potential trigger for, change both in organizations as well as private contexts. [ABSTRACT FROM AUTHOR]

Background: In the clinical dental consultation, multi-party configurations predominate with the presence of parents/ primary caregivers in pediatric dentistry adding another layer of complexity. In managing child oral healthcare, parents/ primary caregivers are critical, especially in dental caries prevention. This study aimed (1) to identify the structure of oral health literacy (OHL) talk in interpreter-mediated pediatric dentistry and (2) to analyze interpreter contributions to the communication strategies: patient-centered direct interpreting (PC-DI), patient-centered mediated interpreting (PC-MI), clinician-centered direct interpreting (CC-DI), and clinician-centered mediated interpreting (CC-MI). Methods: Visual text analysis (VTA) of video recorded pediatric clinical consultations in Hong Kong utilized Discursis™ software to illustrate temporal and topical structures and their distribution across turns-at-talk. Conversation analysis (CA) was applied to analyze turn-taking of the identified OHL talk qualitatively. The mixed-method approach of combining VTA and CA was applied to analyze the patterns and features of the recorded OHL talk. Results: The conceptual recurrences of the 77 transcribed video recordings were plotted visually. CC- and PC-OHL talk were identified by the recurrence patterns of monochromatic and multi-colored triangular clusters formed by off-diagonal boxes, respectively. CA of interpreter-mediated turns supported earlier findings regarding patterns of MI in multilingual adult dental consultations; however, the role of the interpreter in parent/ primary caregiver education and patient management was more distinctive in the pediatric dentistry. Conclusions: The mixed-method approach assisted in unpacking the complexities of the multi-party interactions, supported identification of effective communication strategies, and illustrated the roles of the dental professionals in initiating CC- and PC-OHL talk in pediatric dentistry. The intervention showed the implication of the professional education of evidence-based practices for clinicians in balancing agenda management and the communicative dimension of OHL with the help of VTA and CA in multilingual consultations. [ABSTRACT FROM AUTHOR]

B Olga Zayts: b The first question comes from one of your former PhD students, and it relates to your early work in pragmatics. For me, having studied philosophy, pragmatics was Charles Sanders Peirce (1931-1961), who called his philosophy pragmatics. Kenneth Pike (Kenneth Lee Pike) wrote an enormous book "Language in Relation to a Unified Theory of Human Behaviour" ([33]). We talked about Jacob Mey, we talked about Kenneth Pike, who are the most influential people, the most influential theories that had impact on your own work, and that, in your opinion, essentially moved the field of pragmatics forward?. [Extracted from the article]

This Introduction to the special issue "Narratives of Vicarious Experience in Professional and Workplace context" presents the first dedicated collection of papers on NoVE in professional and workplace contexts. It begins with a brief overview of the origins of Narrative Pragmatics (NP) that accounts for the breadth of analytic interests NP currently pursues. While traditionally NP focused on Narratives of Personal Experience (NoPE), namely stories about the teller himself/herself, more recently a number of studies have begun to examine Narratives of Vicarious Experiences (NoVE), that is stories about others. The Introduction summarizes some key structural and functional similarities and differences between NoPE and NoVE, focusing on the idiosyncratic features of NoVE with regard to teller perspective, story introduction, epistemic authority, and function. The second part introduces the contributions to the special issue that span different workplaces and professional contexts (from a pharmaceutical company, to a newsroom, to job interviews), and include face-to-face interactions and other media. Consistent across the contexts are several functions of NoVE. They serve as a powerful tool in constructing one's personal and professional identity. They also serve as 'shared repertoire' of experiences told through stories that foster group identity and the sense of belonging. • Narrative Pragmatics studies the forms and functions of narratives. • NoVE encompass narrative practices about figures other than the teller him/herself. • NoVE differ in terms of teller perspective, story introduction, epistemic authority. • NoVE are omnipresent in professional and workplace contexts. • NoVE serve to construct professional, personal and group identity. [ABSTRACT FROM AUTHOR]

Healthcare encounters involving participants from diverse linguistic backgrounds are becoming more common due to the globalisation of health care and increasing migration levels. Research suggests that this diversity has a significant impact on health outcomes; however less is known about how it is managed in the actual consultation process. This article presents an analysis of antenatal screening consultations video recorded in Hong Kong, using conversation analysis. We consider how the use of a second or subsequent language impacts on these consultations, and on discussions and decisions about further action. The presence or absence of shared first language did not appear to affect the extent to which particular courses of action were promoted or recommended. Recommendations were a common occurrence across consultations with and without shared first language. However, we argue that the routine use of recommendations can be consequential, as second language speakers may have more limited resources to interrogate or contest these. This finding has implications for the ability for professionals to maximise patient involvement in decision‐making. [ABSTRACT FROM AUTHOR]

This paper examines the discursive processes involved in the construction and negotiation of face in Chinese business interactions. Drawing on 20 hours of authentic video- and audio-recorded business meetings in two companies in Hong Kong, we analyse how interlocutors do facework while orienting to and actively constructing their interpersonal relationships. Our particular focus is disagreements upwards, i. e., those, potentially very face-threatening, disagreements that are uttered by subordinates targeted at their superiors. Findings illustrate that some disagreements are relatively strong but face and relationship maintaining, while others are relatively weak but face and relationship challenging. We not only argue that the processes of doing facework and managing relationships are closely interwoven, but we also illustrate the important role of identity in these processes, and argue that the notion of identity should be incorporated into theories of face and relationship management as it constitutes an integral aspect of how interlocutors construct and negotiate face. [ABSTRACT FROM AUTHOR]

In this article we examine commodification and marketisation of genetic testing by companies offering direct-to-consumer (DTC) genetic testing to the general public through online platforms in Hong Kong. Recently, offers of genetic testing have expanded from scientific and clinical genetic settings to general medicine (e.g. in hereditary cancer) and non-medical domains (e.g. aptitude tests). The wider availability of tests, however, has raised concerns about the currently available scientifically proven utility of these tests. Using theme-oriented discourse analysis, we analyse the specific discursive modalities through which the DTC companies in Hong Kong make inflated claims about the value of genetic tests to pursue their marketing agenda. We show that in this way the companies are selling ‘more’ than specific products to consumers: they are selling ‘hope’ and ‘increased autonomy’, that is, an opportunity to buy commodities online that promise consumers control of their health and wellbeing. [ABSTRACT FROM AUTHOR]

Patients’ perceived satisfaction is a key performance index of the quality health care service. Good communication has been found to increase patient’s perceived satisfaction. The purpose of this study was to examine the impact of the prominent themes arising from clinician-patient conversations on the caregiver’s perceived quality of communication during paediatric dental visits. 162 video recordings of clinical dental consultations for 62 cases attending the Paediatric Dentistry Clinic of The Prince Philip Dental Hospital in Hong Kong were captured and transcribed. The patients’ demographic information and the caregiver’s perceived quality of communication with the clinicians were recorded using the 16-item Dental Patient Feedback on Consultation skills questionnaires. Visual text analytics (Leximancer™) indicated five prominent themes ‘disease / treatment’, ‘treatment procedure related instructions’, ‘preparation for examination’, ‘positive reinforcement / reassurance’, and ‘family / social history’ from the clinician-patient conversation of the recorded videos, with 60.2% of the total variance in concept words in this study explained through principal components analysis. Significant variation in perceived quality of communication was noted in five variables regarding the prominent theme ‘Positive reinforcement / reassurance’: ‘number of related words’ (p = 0.002), ‘number of related utterances’ (p = 0.001), ‘percentage of the related words in total number of words’ (p = 0.005), ‘percentage of the related utterances in total number of utterances’ (p = 0.035) and ‘percentage of time spent in total time duration’ (p = 0.023). Clinicians were perceived to be more patient-centered and empathetic if a larger proportion of their conversation showed positive reinforcement and reassurance via using related key words. Care-giver’s involvement, such as clinicians’ mention of the parent, was also seen as critical to perceptions of quality clinical experience. The study reveals the potential of the application of visual text analytics software in clinical consultations with implications for professional development regarding clinicians’ communication skills for improving patients’ clinical experiences and treatment satisfaction. [ABSTRACT FROM AUTHOR]

In this paper we examine one type of intraprofessional collaborative activity, namely case conferences in a specialist genetics clinic. Our specific focus is on how clinical geneticists manage decision-making through team talk in the event of diagnostic uncertainty which is mainly attributable to limitations in the current state of genomic knowledge, 'uncertain significances' associated with genetic test results, and a lack of information/ evidence pertaining to cases under discussion. The case conference then becomes a means to minimise the uncertainty and arrive at decisions that optimise the significance of the results in terms of clients' life trajectories. Adopting theme-oriented activity analysis, we examine video-recorded data from five case conferences in Hong Kong. Beginning with a prototypical structural mapping of the case conference activity type, our analysis focuses on what we call 'uncertain cases'. Our findings highlight three discourse types constitutive of team talk: pedagogic talk, diagnostic talk and decisional talk. In paying particular attention to how uncertainty is formulated and negotiated, we suggest that access to and assessment of different kinds of evidence as well as the activity-specific expert role-positions of the participants are crucial with regard to establishing a correct diagnosis and/or striving towards a minimisation of current uncertainties. [ABSTRACT FROM AUTHOR]

This paper investigates the use of grammatical forms in directive sequences by drawing on daily interactions between colleagues in a medical laboratory in Hong Kong. From a conversation analytic perspective, we focus on how directives in Cantonese are commonly formulated and how the force of a directive is mitigated. Our analysis shows that (1) the imperative seems to be the most frequently used syntactic form for giving directives and there is no apparent hierarchical ('power') differentiation, (2) the imperative-formulated directives are frequently mitigated by the use of a range of linguistic forms as well as interactional resources. [ABSTRACT FROM AUTHOR]

This article aims to explore narratives as sites for identity construction by employing the concept of positioning to analyse some of the discursive processes through which identity construction is accomplished in institutional contexts. Our specific foci are i) the ways in which individuals position themselves in relation to larger collectivities in their narratives about being expatriates living and working in Hong Kong, and ii) how they construct their professional identities in the tension that may arise due to their membership in different social groups. Drawing on data from a corpus of interviews with professionals in multicultural workplaces in Hong Kong, we provide an in-depth analysis of two case studies of expatriates who take very different stances towards their company and the cultural groups with whom they interact, and who, as a consequence, construct remarkably different identities for themselves, the people they work with and also their organisation. Our analyses illustrate some of the intricate ways in which identities are closely intertwined with and feed off individuals' membership in different collectivities, which surfaces especially when zooming in on the different levels of positioning in the interviewees' narratives. [ABSTRACT FROM AUTHOR]

This paper contributes to research on genetic counseling by exploring the complexity of this activity from the angle of identity construction. We argue that an analysis of the processes through which healthcare providers construct and negotiate their roles and identities in these encounters may contribute to a better understanding of the complexities of genetic counseling. Drawing on more than 150 video-recorded genetic counseling encounters between nurses and clients in Hong Kong, we illustrate that the discursive processes involved in the construction of the nurses' identities are complex, overlapping and at times contradictory as the nurses respond to the (sometimes) competing norms and expectations of their institution, their clients and their own. They manage to solve these tensions by drawing on the roles traditionally assigned to nurses in these encounters such as information provider and counselor, as well as creating the new roles of co-decision maker and cultural broker/mediator. [ABSTRACT FROM AUTHOR]

In this article, we examine the ‘risk of knowing’ talk (Sarangi, S.,et al., 2003. ‘Relatively speaking’: relativisation of genetic risk in counselling for predictive testing.Health, risk&society, 5 (2), 155–170, p. 155) in prenatal screening for Down’s syndrome in Hong Kong. The ‘risk of knowing’ talk refers to the consequences of learning about a health condition, such as the psychosocial and interpersonal implications of testing, and the subsequent management of the condition. The stigma of eugenics and that the termination of pregnancy is the only available ‘medical intervention’ imply that the risk talk and decision-making in prenatal screening carry serious ethical, moral and social implications (Pilnick, A. and Zayts, O.A, 2012. ‘Let’s have it tested first’: choice and circumstances in decision-making following positive antenatal screening in Hong Kong.Sociology of health and illness, 34 (2), 266–282). This issue has not attracted much attention in the previous literature. This study is part of a larger project on prenatal screening conducted in one Prenatal Diagnostics and Counselling Department of a Hong Kong hospital in 2006–2013. It draws on 20 video-recorded consultations with pregnant women who had received a ‘positive’ (high risk) screening result and were invited to consider further diagnostic testing. Using theme-oriented discourse analysis (Roberts, C. and Sarangi, S., 2005. Theme-oriented discourse analysis of medical encounters.Medical education, 39 (6), 632–640), we show that in these consultations, the ‘risk of knowing’ talk was not initiated by the health care professionals. It might, however, be evoked by the women. We examine the impact of the ‘risk of knowing’ on decision-making, and discuss specific discourse (linguistic and rhetorical) devices that the participants employed to negotiate three competing agendas: the health care professionals’ preference of diagnostic testing, clients’ concerns of having a baby with Down’s syndrome and the overarching professional goal of these encounters of facilitating the clients’ informed choice regarding further testing. [ABSTRACT FROM AUTHOR]

This paper explores how refusals are constructed and negotiated in multicultural workplaces in Hong Kong. A particular focus is on the ways in which Hong Kong Chinese subordinates negotiate issues of face and power relations when refusing their expatriate superiors. Despite abundant research on refusals in a variety of contexts across cultures, there are very few studies of multicultural workplaces. This is particularly surprising considering that refusals have been described as a frequent ' 'sticking point' in cross-cultural communication' (Beebe et al. 1990). This paper addresses this gap by drawing on more than 80 hours of authentic audio- and video-recorded spoken workplace discourse and a corpus of emails collected in multicultural workplaces in Hong Kong. Findings of this exploratory study indicate that refusals are complex communicative activities that are carefully negotiated among participants. We argue that in contrast to earlier studies, participants' socio-cultural backgrounds do not appear to be the main determining factor of how issues of face and power relations are negotiated in upward refusals. Rather, a range of other factors, including media of communication, normative ways of interacting in a workplace, the relationship between interlocutors, as well as the content of the refusal, are more relevant for explaining participants' communicative behavior. [ABSTRACT FROM AUTHOR]

In this paper we apply the framework of relational work, or the work individuals invest in maintaining their relationships (Locher and Watts 2005), to the analysis of prenatal screening (PS) for Down Syndrome of Chinese clients in Hong Kong. PS has traditionally followed a nondirective principle that calls for an unbiased presentation of information and women's autonomous decision- making regarding testing. However, in Chinese contexts, healthcare providers appear extremely directive; and women, in turn, explicitly express their expectations of being led in decision-making (Zayts et al. 2013). These observations lend support to previous politeness studies of Chinese institutional contexts wherein hierarchical communication has been described as 'listening-centered, asymmetrical and differential' (Gao and Ting-Toomey 1998: 48). More recent politeness studies, however, warn against such stereotyping at a cultural level (Eelen 2001; Mills 2003, 2004; Watts 2003). In this paper, rather than using culture as an a priori explanatory variable to account for the directive stance of the healthcare providers, we argue that using the framework of relational work enables researchers to focus on how meaning is created and negotiated at the micro-level of an interaction, and to move away from 'grand generalizations' about culture specific behaviors and expectations. [ABSTRACT FROM AUTHOR]

In this article, we examine the ‘risk of knowing’ talk (Sarangi, S.,et al., 2003. ‘Relatively speaking’: relativisation of genetic risk in counselling for predictive testing.Health, risk&society, 5 (2), 155–170, p. 155) in prenatal screening for Down’s syndrome in Hong Kong. The ‘risk of knowing’ talk refers to the consequences of learning about a health condition, such as the psychosocial and interpersonal implications of testing, and the subsequent management of the condition. The stigma of eugenics and that the termination of pregnancy is the only available ‘medical intervention’ imply that the risk talk and decision-making in prenatal screening carry serious ethical, moral and social implications (Pilnick, A. and Zayts, O.A, 2012. ‘Let’s have it tested first’: choice and circumstances in decision-making following positive antenatal screening in Hong Kong.Sociology of health and illness, 34 (2), 266–282). This issue has not attracted much attention in the previous literature. This study is part of a larger project on prenatal screening conducted in one Prenatal Diagnostics and Counselling Department of a Hong Kong hospital in 2006–2013. It draws on 20 video-recorded consultations with pregnant women who had received a ‘positive’ (high risk) screening result and were invited to consider further diagnostic testing. Using theme-oriented discourse analysis (Roberts, C. and Sarangi, S., 2005. Theme-oriented discourse analysis of medical encounters.Medical education, 39 (6), 632–640), we show that in these consultations, the ‘risk of knowing’ talk was not initiated by the health care professionals. It might, however, be evoked by the women. We examine the impact of the ‘risk of knowing’ on decision-making, and discuss specific discourse (linguistic and rhetorical) devices that the participants employed to negotiate three competing agendas: the health care professionals’ preference of diagnostic testing, clients’ concerns of having a baby with Down’s syndrome and the overarching professional goal of these encounters of facilitating the clients’ informed choice regarding further testing. [ABSTRACT FROM AUTHOR]

Risk explanations are a crucial part of clinical encounters that concern clients’ genetic risk status. The ways in which risk explanations are delivered may impact on clients’ decision-making and outcomes of these clinical encounters. In this article, we examine risk explanations in telephone consultations in Hong Kong between genetic nurses and parents whose infants have been diagnosed with a mild hereditary disorder, G6PD deficiency, commonly known as favism. Using discourse analytic methods, we focus on 50 audio-recorded telephone consultations. First, we show the distribution of different types of risk explanation in terms of their volume and sequential positioning in the study corpus. The two predominant explanation types – physiological explanations and hereditary explanations – are then discussed in relation to their respective functions in these telephone consultations, namely serving as warrants for advice-giving and providing reassurance. We then examine how the genetic nurses interactionally orient themselves to the parents’ existing knowledge regarding G6PD deficiency while delivering these risk explanations. The differences in explanation trajectories are linked to the presence or absence of prior knowledge of the condition on the part of the parents; and these differences are displayed at the interactional rather than at the substantive level, that is parents with prior knowledge of the condition occupy a different participant status in eliciting and responding to the risk explanations. [ABSTRACT FROM PUBLISHER]

In spite of the increasing globalisation of the work domain and the mobilization of the workforce (Wong et al. 2007) only very little attention has been paid to the interplay between culture and professional identities in workplace contexts. This paper addresses this gap by exploring some of the ways through which professionals are required to construct and negotiate their various identities in increasingly multicultural contexts where notions of culture may become particularly salient. We focus on multicultural workplaces where, we believe, the intricate and complex relationship between culture and identity is particularly well reflected: In these contexts members are on a daily basis exposed to culture-specific perceptions, assumptions, expectations, and practices which may ultimately be reflected in workplace communication, and which impact on how professional identities are constructed. Drawing on a corpus of more than 80 hours of authentic workplace discourse and follow-up interviews conducted with professionals we explore how expatriates who work in Hong Kong with a team of local Chinese construct, negotiate and combine aspects of their professional and cultural identities in their workplace discourse. Our particular focus is on two issues that have been identified in participants' interviews: Sharing decision making responsibilities and negotiating a work-life balance. Our analysis of these two aspects illustrates the complex processes of identity construction from two different but complementary perspectives: i) the ways in which participants portray themselves as adapting to, negotiating or rejecting the new culture in which they work and live; and ii) the ways in which these perceived identity construction processes are actually reflected in participants' workplace discourse. [ABSTRACT FROM AUTHOR]

This article aims to challenge the perception that in medical encounters laughter is an interactional resource primarily employed by patients. Drawing on 34 video-recorded prenatal genetic counseling (PGC) sessions collected in a Hong Kong hospital, and combining quantitative and qualitative methods, we illustrate that laughter is in fact frequently employed by the medical providers in our data. The particular focus of the article is on the ways in which laughter initiated by the medical providers assists interlocutors in negotiating informed choice, a crucial aspect of PGC sessions. Findings indicate that laughter initiated by the medical providers performs at least two PGC-specific functions: It assists the medical providers in 'laughing off' and overcoming patients' resistance, and it helps them in dealing with patients' direct questions. Laughter is thus an important resource for the medical providers in pursuing the institutional goals of the interaction, namely negotiating informed choice with their patients. [ABSTRACT FROM AUTHOR]

Data from multicultural contexts add more complexity to many findings regarding healthcare practices that have been reported in the literature. For example, patient participation has been reported to contribute to the enhancement of healthcare results (e.g. Candlin, 2006; Thompson, 2008). However, patient participation may be problematic when participants in the medical encounter face sociocultural and linguistic barriers. In this paper we focus on interactional difficulties that non-native speakers of English encounter in prenatal genetic counseling sessions. These difficulties, we argue, may place limitations on the extent of patient participation, when patient participation is narrowly defined in terms of verbal contributions. The data for the study come from a prenatal genetic counseling clinic in Hong Kong, and the participants of the interactions originate from various countries in the Asia region. Using a conversation analytic approach, we examine interactional difficulties in an attempt to capture the specific challenges faced by healthcare providers and patients in an increasingly diverse healthcare context. We also argue for an ethnographic perspective to examine patient participation in the multilingual context and to highlight dimensions of second language use and cultural diversities as observable evidence of patient participation. [ABSTRACT FROM AUTHOR]

An introduction is presented for this issue which includes articles about communication in medicine, the physician-patient relationship, and patient participation.

This paper examines the interactional accomplishment of information delivery in the context of prenatal genetic counselling (PGC) in Hong Kong. We argue that information delivery is structured as a joint activity between the healthcare provider and the patient, and the structure of the talk takes into account the patient’s experience and knowledge of medical issues. The healthcare provider ‘taps into’ the patient’s knowledge and experience by using what we call ‘initial inquiries’ as a means of introducing potentially new information. We define initial inquiries as a type of question-response sequence that initiates the speaker’s future action of information delivery. In this way, the information delivery is constructed as a joint activity and healthcare providers can also ‘tailor’ the information according to each individual patient. This study is part of a larger on-going interactional study of PGC based on video data recorded in a Prenatal Diagnostics and Counselling Department of one Hong Kong hospital between 2005 and 2008 and comprises more than 17 hours of recordings. We use a conversation analytic approach to examine the interactional organization of talk used in the accomplishment of information delivery. [ABSTRACT FROM AUTHOR]

Previous research in the field of politeness studies indicates that different discourse genres are characterized by different degrees of adherence to politeness rules (Lakoff 1989). In the genetic counselling setting, we propose that verbal behaviour should be analyzed within a broader framework of politic verbal behaviour (Watts 1989, 2003). We examine an L2 English context in Hong Kong to illustrate how the sociocultural context shapes the notion of politic behaviour. By sociocultural context, we are referring to the combination of language used, in this case English as a second language, the background of the interactants, and the institutional setting in which the interactions take place. In genetic counselling, politic behaviour is influenced by two well-established concepts: informed choice and nondirective counselling. Informed choice concerns the decision that a pregnant woman makes regarding genetic screening and testing. Nondirectiveness reflects the autonomous nature of the choice and the fact that the health care provider should act as a facilitator of the woman's choice, avoiding any imposition. Given these institutional goals, we discuss how health care providers negotiate politic behaviour to facilitate the decision-making process and illustrate that considerations of language and participant background take precedence over nondirectiveness in this L2 context. [ABSTRACT FROM AUTHOR]