The influence of the characteristics of the social-role organization of medical workers on their professional

THE INFLUENCE OF THE FEATURES OF THE SOCIAL-ROLE ORGANIZATION OF MEDICAL WORKERS ON THEIR PROFESSIONAL COMMUNICATION

 

This article analyzes the characteristics of professional communication among healthcare workers in various work situations. The author substantiates the influence of the organizational and role hierarchy of participants in collaborative activities on the choice of sublanguage (subcode) for professional communication. A study of the oral professional language of healthcare workers was conducted. As a result, a list of subcodes used by healthcare workers in various work situations was compiled. The dynamics of subcode switching are demonstrated. The influence of stress factors on the nature of professional communication is identified.

Keywords: professional communication, professional language, subcode, social organization, professional jargon, professionalisms.

Myskin S., Lychagina D

THE INFLUENCE OF SOCIAL ROLE OF MEDICAL WORKERS ON THEIR PROFESSIONAL COMMUNICATION

 

The article analyzes the features of professional communication of medical workers in different working situations. The author substantiates the influence of organizational and role hierarchy of subjects of joint activity on the choice of sublanguage (subcode) of professional communication. Research of oral professional speech of medical workers is conducted. As a result, a list of sub-codes used by medical workers in various working situations has been compiled and the evolution of subcode switching has been shown. The features of the influence of stress factors on the nature of professional communication are revealed.

Keywords: professional communication, professional language, subcode, social organization, professional jargon, professionalism.

 

Introduction 

The study of professional communication involves not only describing the phonetic, grammatical, lexical, and stylistic characteristics of the individual speech of various specialists, but also examining the extralinguistic factors that shape their speech activity in collaborative settings. Particular attention is paid to issues related to the specifics of professional communication among those in professions with a so-called increased communicative load, particularly among healthcare workers. When analyzing the professional communication of medical personnel, extralinguistic factors play a leading role in shaping the structure of language and the nature of speech, as the professional activities of these specialists are directly related to ensuring the life and health of others. This requires doctors to assume a heightened sense of responsibility for the results of their work. In psychology, such circumstances are classified as stressful work conditions, which increase the emotional strain on healthcare workers. It is undeniable that the professional speech and communication of doctors are also affected by stress.

Identifying the extralinguistic characteristics of professional communication among medical personnel (as well as representatives of other professions) is a topic within psycholinguistics. Recent advances in psycholinguistics suggest that the structure of communication reproduces the social structure of a particular group [6; 10]. The social structure of any professional group is formed based on the functional and role affiliation of the participants in the joint activity. Consequently, the essential characteristics of joint professional activity explain the specific speech manifestations that occur during professional communication. The purpose of this study is to examine the specific speech manifestations of medical workers, conditioned by the nature of their joint professional activity.

 

Professional language situation

Any small social group can be considered as a language community. The commonality of social life and the presence of communicative contacts are the main characteristics of a language community [15]. Social life is a set of diverse types and forms of joint human activity aimed at ensuring the conditions and means of existence, realizing needs, interests, and values [12]. The vital activity of an organization’s team is represented by a set of various types of joint professional activity, united by a common focus on achieving a single goal. This is where the commonality of the social (professional) life of a work collective is manifested. Furthermore, in psychology, the position is developing that any activity cannot be considered without analyzing communication [6; 7]. In work collectives, the integral role of communication, and, consequently, communication, is most clearly manifested, since joint professional activity includes «communication of cooperating communicants, served by linguistic and non-linguistic signs» [13, p. 12]. These explanations allow us to consider the team of any organization as a language community, or rather, a professional (or organizational) language community. In relation to the target group of our study, this is the language community of medical workers (medical organization).

The collective professional activity of medical personnel is organized through various specialized languages. The entire set of codes and subcodes used within a given work collective forms the socio-communicative system of the linguistic community of medical workers. It should be noted that a code is understood as a means of communication, a language. A subcode, on the other hand, is a form of language, a variety, a subsystem, a communicative tool of smaller scope, a narrower scope of use, and a smaller set of functions than a code. Communication between physicians is carried out through literary language (code) and medical language (subcode), as well as other linguistic systems and subsystems (foreign language, professional jargon, etc.). The codes and subcodes of a specific linguistic community of medical workers are in a relationship of functional complementarity, i.e., their distribution within a given linguistic community by functions, spheres of use, and situations is determined by the specifics of the social structure. For example, a medical organization may include several departments (surgical, neurological, general therapy, etc.), the staff of each of which use both a general medical language, understandable to representatives of all departments, and a specialized language, functioning only within the boundaries of a single department. The configuration of functional relationships between codes and subcodes at any given stage of the existence of a linguistic community constitutes a linguistic situation [15].

 

Research on professional communication

A pilot study of the social and communicative situation in a Moscow hospital revealed that the linguistic situation in medical organizations changes in accordance with key work situations. These include: consultations, doctor's rounds, professorial rounds, medical care, hospital-wide conferences, doctor's consultations, procedures, and conversations. (In our study, we intentionally did not consider various everyday communication situations among medical personnel in the work environment, as this is the scope of additional analysis.) Each linguistic situation that develops in the work environment is characterized by the prevalence of a particular code(s)/subcode(s) in communication:

1) During consultation The official, general medical language serves as the primary language. In this situation, specialized language supplements the primary language. Professionalisms (acceptable lexical abbreviations and acronyms) are sometimes used.

2) Doctor's rounds Mostly involves the use of professional jargon. Professionalisms are also possible. General medical and specialized vocabulary is used less frequently.

3) Professor's round The course is conducted using academic (scientific) language. General medical and specialized languages serve as additional ones.

4) When providing medical care General medical and specialized language, professional jargon and everyday medical speech are used equally.

5) During hospital-wide conference The main ones are general organizational and general medical languages.

6) Doctor's consultation is carried out through everyday medical language, and general medical vocabulary acts as an additional one.

7) Situation procedures involves the use of both everyday medical and general medical vocabulary in equal measure.

8) B conversation, as in the consultation situation, everyday medical speech is used with little use of general medical terminology.

It should be noted that in linguistics, professional language is designated as a special language, a language for special purposes, a subcode, or a professional sublanguage [1; 2; 3; 4; 11]. Considering the fact that in professional communication, communicants use the grammar of a literary language, professional language is understood as a set of specialized terms. The basic unit of analysis in the study of specialized language is the term [9].

Below are terminological examples of professional languages of medical workers that function in the work situations we have identified (Table 1).

Table 1

Lexical examples of professional languages of medical workers 

A type of professional language used by medical professionals	Terminology examples
General medical	patient, sick, diagnosis, treatment, symptom complex, drug, symptom, syndrome, course of the disease, newborn, mother in labor
Narrow-profile	Machine-assisted respiration, labor, cervical dilation, breech presentation, two uterine scars, anhydrous interval, eclampsia, adaptation period, physiological reflexes, ocular symptoms, Apgar score, gestosis, eclampsia, acrocyanosis, catheterization, shock, curability, outcome, thrombosis, asphyxia, hypoxia, tremor, screening
Household medical	sick, malnutrition (hypotrophy), oxygen starvation (hypoxia), muscle weakness (muscle hypotonia), infection, treatment, disease, drip, examine, care
Professionalisms	pit (intensive care unit), artificial ventilation, MRI, ICU (intensive care unit), take an ECG, take an X-ray, resident
Academic	anamnesis, etiology, pathogenesis, somatic diseases, anomaly, genesis, pathological condition, clinical manifestations, adaptation, transient conditions, primary diagnosis, complication, underlying diseases, assessment according to the scale
Professional jargon	ears (phonendoscope), golden hour (the time period during which medical assistance must be provided to save the patient), "barrel-shaped" chest, "samodyh" (the child is breathing on his own), "the child has burst" (the child has pneumothorax - a life-threatening condition manifested by the accumulation of air in the pleural cavity), "quiet guy" (the patient is in a coma), "the hip is standing" (there is a central catheter in the femoral vein), "the child is glowing" (receiving phototherapy), "packed his bag" (dying), "not eating" (not digesting food)
Organization-wide	medical organization, bed-day, patient stay in hospital, duration of treatment, treatment costs, cost-effectiveness, quarterly plan, unfinished case, screening report

 

In order to identify organizational and structural factors that determine the structure and nature of professional communication of medical personnel, it seems appropriate to conduct a definitional analysis of work situations.

A consultation is a meeting of physicians of the same or different specialties for the purpose of reaching an opinion on the patient's health, establishing a diagnosis of the disease, determining its prognosis, and assessing and treating the patient [8]. Since consultations are convened for complex cases, outside specialists (lawyers, scientific and technical workers, etc.) are invited to ensure accurate treatment decisions. A secondary benefit of participating in a consultation is the improved professional knowledge of its participants. The above definition demonstrates that a consultation is characterized by increased formality of relations, a formal style of interaction, and the updating of professional knowledge. The subject of discussion is a clear diagnosis and the development of a treatment program. This is possible through reliance on professional knowledge and experience, and through the use of professional medical language. Participants in a consultation are equal in status, as the decision is made collectively. The significance of a consultation is enhanced by increased responsibility for the decision made, as there is a risk of an incorrect diagnosis, a so-called medical error. Doctors exert a high degree of social control over speech. This command-based social organization of physicians determines the coded composition of the linguistic situation, leaving only general medical and specialized languages in use.

A doctor's round is a daily visit to a patient for the following purposes: monitoring the progress of therapy, treatment effectiveness, and appropriate patient behavior, obtaining additional clinical information, prescribing procedures, informing the patient, providing psychological support, etc. The results of various studies of doctor-patient interactions during rounds reveal its contradictory nature [16; 18]. The primary goal of doctors is the optimal organization of work, while the patient expects from the meeting with the attending physician to receive important information about the clinical picture, participate in the restoration of self-control, etc. Often, rounds are carried out by psychologically unprepared and insufficiently qualified specialists in the field of communication psychology, who establish more emotional, informal contacts with the patient. Appealing to the doctor's responsibility does not produce the expected effect, since an insufficient understanding of the nature of the disease and regulatory and organizational restrictions strengthen the protective psychological mechanisms of the healthcare worker. This excludes dialogic forms of communication with the patient and strengthens monologues. The doctor's speech is incomprehensible due to the use of medical jargon, unpredictable due to the rapid change of topics, difficult to understand due to the unfavorable proxemiological environment (the discussion of the patient's condition usually takes place in the general ward in the presence of other patients), and fleeting (the duration of the meeting is on average 3.5 minutes) [14, pp. 650-651; 16; 17]. Social control over speech is low. The social structure of this work situation is characterized by a hierarchy of "doctor-patient" relations, with the doctor occupying a dominant position. Given the emotional basis of the relationship, in the linguistic situation of doctor's rounds, medical jargon prevails as the main subcode.

The primary goal of a professor's rounds is to verify that professional knowledge and skills are consistent with the actions performed by the attending physician during patient care. As can be seen, the situation of a professor's rounds reproduces the situation of a test/exam at a university. In anticipation of this work situation, the attending physician experiences increased situational anxiety. They begin mentally reviewing the patients' conditions and diagnoses, checking the presence and completeness of the necessary documents, etc. The attending physician's primary task is to provide all medical documentation (medical histories, prescription sheets, clinical trial results, etc.) and to demonstrate full familiarity with this documentation as it applies to each patient. Furthermore, communication with a representative of science and education requires the formulation of questions and answers in academically correct medical language. The head of the rounds, in addition to their primary function, performs an additional function. This includes familiarizing doctors with new achievements in clinical and experimental medicine, diagnostics, and treatment [5]. Social relations in this work situation are represented by the "checker - checked" scheme. Social control over speech is heightened. The formal hierarchical subordination of the participants in the professorial round determines the structure of the language situation, in which the academic medical language is dominant.

Medical care is a set of therapeutic and preventive measures carried out in cases of illness, injury, poisoning, and childbirth by individuals with a medical (higher or secondary) education. Specialized medical care is the highest form of medical care, provided by specialist physicians in specially designated medical institutions or departments using specialized diagnostic and treatment equipment, instruments, and gear [8]. This work situation is characterized by increased dynamics and variability. Surgery, childbirth, trauma management, etc., can "take an unplanned course" at any moment. The medical team maintains close attention to the patient's health and well-being. The situation can also proceed in a routine, emotionally neutral manner. In this case, control over one's professional speech is the focus of the physicians' current consciousness. In this case, physicians communicate primarily using general medical and specialized terminology. During critical, crisis moments during surgery, doctors' emotional stress increases, leading to a loss of social control over speech. This control shifts to direct actions. At such moments, communication largely occurs in everyday medical language and professional jargon.

At a hospital-wide conference (weekly or monthly), the results of the organization's work for a given reporting period and the work under a given project are summarized. Current issues affecting the functioning of the medical organization are discussed. The topics of presentations are quite broad: the quality of medical services provided, improving working conditions for medical workers, increasing professional motivation and financial incentives for the institution's employees, etc. Since the conference is attended by medical workers from various professional backgrounds, as well as support personnel (lawyers, marketers, financiers, business managers, etc.), the topics of presentations must be understandable to all participants. Social control over speech is moderately high. This circumstance determines the coded composition of the linguistic situation: general organizational and general medical languages.

A doctor's consultation involves a physician providing a patient with professional advice regarding the optimal course of action in a specific medical situation. During the meeting, the physician elicits the most valuable information for solving the patient's problem and formulates sound advice. Using their professional knowledge, the physician discusses the symptoms or manifestations of a possible illness, clarifying the time and circumstances of the onset of symptoms, whether the patient has previously sought help, what the diagnosis was, how correctly and effectively the treatment was administered, and so on. Communicators in this situation differ in their level and profile of professional education. Obviously, an uninformed patient will not understand a specialized description of their illness. Therefore, the physician, when using general medical terms, is forced to reformulate them into everyday medical language. In this work situation, social control over speech is moderately high, as there are official regulations that hold the physician accountable for the accuracy of the diagnosis. In this linguistic situation, everyday medical language prevails.

A (medical) procedure is a set of organized actions aimed at achieving a result in the process of providing medical care to people with health problems. During a procedure, a healthcare professional may diagnose a patient's health, heal and treat wounds, restore temporarily lost organ functions and structures, and so on. As can be seen from the above definition, the primary focus of a procedure is the execution of specific actions, while explaining them clearly to the patient is secondary. Therefore, the linguistic context includes an equal balance of general medical and everyday medical subcodes.

The conversation with the patient's relatives is similar in nature and structure to a consultation. The doctor must explain the disease, its symptoms, and the treatment plan in a way that is accessible to ordinary people. The language of the conversation includes everyday medical language as the dominant one, and general medical language as a complementary one.

 

Conclusion

In conclusion, we note that a study of the specific speech and language manifestations of medical workers in the context of joint professional activities was conducted. The results revealed a dependence of the nature and structure of communication on the characteristics of the social organization of the participants in joint professional activities. Characteristics of social organization are manifested in the vertical or horizontal structure and distribution of social positions of participants. This determines the use of monologue or dialogic forms of communication, respectively. The study revealed that medical workers use various subsystems of professional language (subcodes) in work communication. These include general medical, specialized, academic, general organizational, and everyday medical languages, as well as professionalisms and professional jargon. A dependence of changes in the subcode composition of the linguistic situation on the structure of the social positions of the participants in the joint activity and its emotional load was revealed. Work situations with increased emotional load, in which the physician occupies a dominant social position, professional communication unfolds in conditions of reduced social control, which leads to the use of professional jargon as the primary subcode. In work situations with increased emotional stress, in which the doctor occupies a subordinate social position, professional communication unfolds under conditions of increased social control, which leads to the use of formal professional language (academic medical language, general medical language, specialized language) as the main one.

 

 

Literature

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