Problems in Identifying Participant Structures in Medical Triadic Conversation

三人行醫病對話參與結構分析之困難

Issues related to the‘participant structure’(Rosenfeld 1996) in triadic medical encounters (i.e. doctor, patient, companion) have become the focus of much research in the study of discourse and medicine. One of the goals of researchers is to examine how the presence of a third person affects the doctor's distribution of attention. By examining some elements of discourse, such as pronouns and vocatives, they can identify the addressee of the doctor's question, and measure how the doctor's attention on the patient is affected by the presence of a third person. However, when applying Rosenfeld's framework of identifying the participant structure to our Taiwanese geriatric triads (which were collected in a teaching hospital in Southern Taiwan), we found that most of the linguistics indicators set up in her framework are unavailable in pro-drop languages such as Mandarin and Southern Min. Therefore, it is the goal of this paper to present those problems which resulted from applying pre-existing frameworks identifying the participant structure to Chinese discourse. Besides the difference in syntactical structure, arguments grounded in inter-actional and professional aspects will be presented, to show that the attempt to identify the doctor's addressee in a triadic encounter can be as difficult as identifying the type of speech act achieved in an utterance. As a result, the addressee of the doctor's question remains ambiguous. In light of these problems, other possible ways to examine the companion's participation will be suggested in the conclusion section.

近幾年來有愈來愈多的學者致力於三人行醫病對話的言談互動（例如Aronsson and Rundstrom 1988, Baker 1996, Rosenfeld 1996）。其共同的焦點為探討醫師是否因有第三者（例如陪同的家屬）在場而影響他對病人應有的注意力。藉由分析對話中的代名詞、稱呼語等言談成份，研究人員釐清互動中的參與者結構，例如當醫師對病人發問則參與者結構為”醫師病人之二人對話），對陪同家屬發問則為“醫師家屬之二人對話”，研究人員計算出此兩種參與者結構之比例，進而得出在場的家屬是否影響了醫師的問診。在本研究中，我們試圖運用西方學者所建立的研究架構檢視我們於台灣南部某教學醫院所蒐集的三人行問診對話（即醫師、老年病人、病人之隨行子女），發現文獻記載的研究架構並無法提供一套有效釐清參與者結構的方法。本文之目的即在於檢視三組研究架構（Aronsson and Rundstrom 1988, Baker 1996, Rosenfeld 1996）運用於中文言談對話之困難，尤其是當家屬與病人皆積極發言參與時，對話的參與者結構也就更難釐清。基於方法學之困難，我們認為以分析參與者結構為出發點探討隨行家屬對醫病互動影響，並非值得嘗試之角度，最後我們並提出其他可行的研究方向，提供學界參考。