Learning to talk and talking about talk - Medical Technologies and the Life World - page 22

the medical tasks are related to moral questions that involve the patient's life
world and most often also relatives' lives.
These new communicative needs have resulted in the emergence of new
communicative technologies and ideologies , that is, new ways and norms for
how doctors should communicate with patients. This development is not
unique to medicine; it can be seen in many other areas as well, for instance
in the educational system and above all in the commercial market sector (see
e.g. Cameron 2000; Fairclough 1992; Hochschild 1983).
Communicative technologies can be defi ned as 'transcontextual tech-
niques, which are seen as resources or tool-kits that can be used to pursue a
wide variety of strategies in many diverse contexts' (Fairclough 1992: 215).
Communicative ideologies have to do with the social and cultural norms that
guide and provide information, for instance for conversations, and also serve
as evaluative standards to show both good and bad examples of conversations.
What Norman Fairclough calls democratization of discourse , defi ned as the
removal of elements like discursive markers of inequality and power and
the informalization of language use, is an example of a new communicative
norm and ideology. The development of new communicative technologies
and ideologies results not only in new linguistic and pragmatic norms, but
also in new terminology and ways of talking about communication (cf.
Cameron 2000).
Learning to communicate professionally often means learning how to use
communicative technologies and the corresponding ideologies. Historically,
professionals learned to talk with patients and clients by learning from
senior colleagues (cf. Atkinson 1989), i.e. through a process of informal
hands-off practical skills and experience. This is of course still the case, but
communication has also become a topic of special educational programmes,
and as a consequence learning to become a professional often also means
learning specifi c communicative techniques. That is, the process of learning
to talk with patients has become formalized.
In medicine these new communicative technologies and ideologies have
been developed over recent decades, beginning in the 1970s (cf. the discussion
in Armstrong 2002: 159-73, and the historical discussion in Atkinson 1989
and Hydén and Mishler 1999). Of central importance has been the idea that
the medical doctor should not primarily talk to the patient, but rather with
him/her. That is, the doctor should not only deliver the results of examinations
and decisions about treatment but also discuss these results jointly with the
patient in a dialogue format (Sarangi 2000). It is rather the dialogue than the
one-sided delivery of information that stands out as a central, valued norm
for communication with the patient. It is also important for the doctor to
take into account and understand the patient's life world - or at least parts
of it - in order to be able to interpret not only symptoms and signs but also
to be able to suggest treatments that actually fi t into the life situation of the
patient (Kleinman 1988; Clark and Mishler 1992).