Following a discourse analysis approach this study examines triadic encounters of nine medical consultations carried out in an outpatient cancer clinic in Santiago, Chile involving an oncologist, a patient and a patient’s companion. Consultations are fully transcribed and analysed to understand the participatory roles patients’ companions play in the medical exchanges. In addition, the type of linguistic functions associated with each role and the advantages or downsides of companions’ involvement in the encounters are also investigated. The analysis reveals seven prominent roles that companions may engage in during the visits. These are studied in detail. The results show that although companions may not always provide information that is consistent with the patients’ views, they can be of great help. Relieving the patients of many daunting tasks, monitoring their well-being, establishing a partnership and bringing vital information to the clinic are instances where the controlling power that some may exercise in the medical encounter can be outweighed.
AdelmanRDGreeneMGCharonR (1987) The physician–elderly patient–companion triad in the medical encounter: The development of conceptual framework and research agenda. The Gerontologist27: 729–734.
2.
AronssonKRundströmB (1988) Child discourse and parental control in pediatric consultations. Text8: 159–184.
3.
BeiseckerAE (1989) The influence of a companion on the doctor–elderly patient interaction. Health Communication1(1): 55–70.
4.
BurgoonMBirkTHallJ (1991) Compliance and satisfaction with physician–patient communication. An expectancy theory interpretation of gender differences. Human Communication Research18: 177–208.
5.
ComeauTBEpsteinJBMigasC (2001) Taste and smell dysfunction in patients receiving chemotherapy: A review of current knowledge. Support Care Cancer9: 575–580.
6.
CordellaM (2003) En el corazón del debate: El análisis del discurso en la representación de las voces médicas. Oralia. Análisis del Discurso Oral6: 147–168.
7.
CordellaM (2004) The Dynamic Consultation: A Discourse Analytical Study of Doctor–Patient Communication. Pragmatics and Beyond Series. Amsterdam: John Benjamins.
8.
CordellaMMusgraveM (2009) Oral communication skills of international medical graduates: Assessing empathy in discourse. Communication and Medicine6(2): 129–142.
9.
CouplandNCouplandJ (2000) Relational frames and pronominal address/reference: The discourse of geriatric medical triads. In: SarangiSCoulthardM (eds) Discourse and Social Life. London: Pearson/Longman, 207–229.
10.
DrewP (2001) Spotlight on the patient. Text: An Interdisciplinary Journal for the Study of Discourse21: 261–268.
11.
FaircloughN (1989) Language and Power. London: Longman.
12.
FerraraK (1992) The interactive achievement of a sentence: Joint productions in therapeutic discourse. Discourse Processes15: 207–228.
13.
FisherSToddAD (eds) (1983) The Social Organization of Doctor–Patient Communication. Washington, DC: Center for Applied Linguistics Press.
14.
GiddensA (1987) Social Theory and Modern Sociology. Stanford, CA: Stanford University Press.
15.
GordonHSStreetRLSharfBF. (2006) Racial differences in doctors’ information-giving and patients’ participation. Cancer107(6): 1313–1320.
16.
GreeneMGMajerovitzSDAdelmanRD. (1994) The effects of the presence of a third person on the physician–older patient medical interview. Journal of the American Geriatric Society42(4): 413–419.
17.
HasselkusB (1994) Three-track care: Older patient, family member, and physician in the medical visit. Journal of Aging Studies8(3): 291–307.
18.
HelmanC (1995) Culture, Health and Illness. Oxford: Butterworth-Heinemann.
19.
IshikawaHHashimotoHRoterDL. (2005) Patient contribution to the medical dialogue and perceived patient centeredness: An observational study in Japanese geriatric consultations. Journal of General Internal Medicine20: 906–910.
20.
IshikawaHRoterDLYamazakiY. (2006) Patients’ perceptions of visit companions’ helpfulness during Japanese geriatric medical visits. Patient Education and Counseling61(1): 80–86.
21.
LabrecqueMSBlanchardCGRuckdeschelJC. (1991) The impact of family presence on the physician–cancer patient interaction. Social Science & Medicine33(11): 1253–1261.
22.
LienardAMerckaertILibertYDelvauxNMarchalSBoniverJEtienneAKlasterskyJReynaertCScallietPSlachmuylderJLRazaviD (2008) Factors that influence cancer patients’ and relatives’ anxiety following a three-person medical consultation: Impact of a communication skills training program for physicians. Psycho-Oncology17: 488–496.
23.
LinellPLuckmannT (1991) Asymmetries in dialogue: Some conceptual preliminaries. In: MarkovàIFoppaK (eds) Asymmetries in Dialogue. Hemel Hempstead: Harvester Wheatsheaf, 1–20.
24.
Mei-Hui Tsai (2007) Who gets to talk? An alternative framework evaluating companion effects in geriatric triads. Communication & Medicine4(1): 37–49.
25.
MishlerEG (1984) The Discourse of Medicine. Dialectics in Medical Interviews. Norwood, NJ: Ablex.
26.
RobertsCWassVJonesJSarangiSGillettA (2003) A discourse analysis study of ‘good’ and ‘poor’ communication in an OSCE: A proposed new framework for teaching students. Medical Education37(3): 192–201.
27.
RoterDHallJKatzN (1987) Relations between physicians’ behaviors and analogue patients’ satisfaction, recall and impressions. Medical Care25(5): 437–451.
28.
SacksHSchegloffEJeffersonG (1974) A simplest systematics for the organization of turn-taking for conversation. Language50: 696–735.
29.
SchmidtKLLinglerJHSchulzR (2009) Verbal communication among Alzheimer’s disease patients, their caregivers, and primary care physicians during primary care office visits. Patient Education and Counseling77: 197–201.
30.
StiversTHeritageJ (2001) Breaking the sequential mold: Answering ‘more than the question’ during comprehensive history taking. Text: An Interdisciplinary Journal for Discourse Research21: 151–185.
31.
StreetRLGordonHS (2008) Companion participation in cancer consultations. Psycho-Oncology17: 244–251.
32.
StreetRLMillayB (2001) Analyzing patient participation in medical encounters. Health Communication13(1): 61–73.
TannenDWallatC (1983) Doctor–mother–child communication linguistic analysis of a pediatric interaction. In: FisherSToddAD (eds) The Social Organization of Doctor–Patient Communication. Washington, DC: Center for Applied Linguistics, 203–219.
35.
TatesKMeeuwesenL (2001) Doctor–parent–child communication. A (re)view of the literature. Social Science & Medicine52: 839–851.
36.
Ten HaveP (1991) Talk and institution: A reconsideration of the ‘asymmetry’ of doctor–patient interaction. In: BodenDZimmermanD (eds) Talk and Social Structure. Berkeley: University of California Press, 138–163.
37.
van DijkTA (1996) Discourse, power and access. In: Caldas-CoulthardCRCoulthardM (eds) Texts and Practices: Readings in Critical Discourse Analysis. London: Routledge, 84–104.
38.
van DijkTA (ed.) (1997a) Discourse as Structure and Process. Discourse Studies: A Multidisciplinary Introduction. London: SAGE.
39.
van DijkTA (ed.) (1997b) Discourse as Social Interaction. Discourse Studies: A Multidisciplinary Introduction 2. London: SAGE.
40.
VegaJ (2003) Carta al editor. ¿A quién pertenece la ficha clínica? On the ownership of medical records. Revista Médica de Chile131: 1469–1470.
41.
WestC (1983) ‘Ask me no questions . . .’: An analysis of queries and replies in physician–patient dialogues. In: FisherSToddAD (eds) The Social Organization of Doctor–Patient Communication. Washington, DC: Center for Applied Linguistics, 75–106.
42.
WodakR (ed.) (1989) Language, Power and Ideology: Studies in Political Discourse. Amsterdam: John Benjamins.
43.
WolfKH (1950) The Sociology of Georg Simmel. New York: Free Press.
44.
ZimmermanDHWestC (1975) Sex roles, interruptions and silences in conversations. In: ThorneBHenleyN (eds) Language and Sex: Difference and Dominance. Rowley, MA: Newbury House, 105–129.
