热点聚焦 | 在线健康话语研究

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2017年10月18日，习近平总书记在十九大报告中提出“实施健康中国战略”，将人民健康作为民族昌盛和国家富强的重要标志，要为人民群众提供全方位全周期健康服务。中国互联网络信息中心（CNNIC）发布的第48次《中国互联网络发展状况统计报告》显示：截至2021年6月，我国在线医疗用户规模达2.39亿，较2020年12月增长2453万，占网民整体的23.7%。因此，在线医疗咨询已然成为当前和未来医患话语分析中不可忽视的领域。在这一背景下，在线健康话语研究应运而生。查阅相关文献，我们发现近年来哈尔滨工程大学毛延生教授带领的团队初步取得了系列相关成果。例如，毛延生、杨昆（2017）分析了医疗咨询话语中反馈语的类型和功能。赵鑫、毛延生（2021）探讨了医生如何通过权威话语（针对患者对医生专业技术的信任）和态度话语（满足患者对医生的道德期望）来建构医生信任话语。毛延生（2021）研究了医患互动中医生的主导地位及其话语呈现形式。蒋庆胜、毛延生、袁周敏（待刊）则研究了在新冠疫情爆发的背景下，政府如何调节民众情绪。王晓将、毛延生（待刊）进一步分析了医患会话中患者应答信息过量的现状。此次“热点聚焦”栏目聚焦部分上述研究人员关于在线健康话语研究的期刊论文，以供对在线健康话语研究感兴趣的老师和同学参考学习。

本期策划人

袁周敏，南京邮电大学教授、外国语学院院长；博士（南京大学 语用学）、两站博士后研究经历（浙江大学 话语与传播；南京大学 社会学）；博士生导师；主持在研国家社科重点项目；在Pragmatics & Society、Journal of Multilingual and Multicultural Development、Applied Linguistics Review、Discourse, Context & Media、Journal of Language, Identity and Education、Studies in Second Language Acquisition、《外语教学与研究》《现代外语》《语言教学与研究》等SSCI/CSSCI来源期刊发表论文40余篇，为International Encyclopedia of Language and Social Interaction撰写英文词条Online News。专著《基于商业咨询顾问话语实践的身份建构研究》入选“语用学学人”文库；专著《“一带一路”倡议背景下中国—东盟贸易话语研究》入选“南开话语研究”系列丛书。主持完成国家社科基金一般项目、教育部项目、博士后特别资助项目各一项。江苏省社科英才、江苏省青蓝工程中青年学术带头人、南京邮电大学教学名师。中国大学慕课在线开放课程《语用学导论》《语言科学与艺术》负责人；中国逻辑学会语用学专业委员会常务理事；国际韩礼德语言学研究会常务理事。

From conditions to strategies:

Dominance implemented by Chinese doctors during online medical consultations

作者简介

毛延生，哲学博士（南京大学），博士后（黑龙江大学/华东师范大学），哈尔滨工程大学外语系教授、博士生导师。主要研究兴趣：健康与媒介话语的文化语用学研究。

In the field of medical consultation, many studies have constructed doctors as the dominant through language (Leet-Pellegrini 1980). For traditional consultation scenarios, the dominant image of the doctor over the patient is inherited from the asymmetry of medical information between the two sides, by whom the use and structure of language are regarded to manifest the medical superiority of the doctor vis-à-vis the patient. However, with the advent of patient-centeredness, the traditional asymmetrical relationship in doctor-patient interaction is undergoing a gradual change in which patient autonomy is becoming more prominent (Pun et al. 2018). Interestingly, as for online medical contexts, some studies (Mao & Zhao 2018) still find persistent dominance of doctors over e-patients during OMCs. One finding that is of special interest to the present study is Mao and Zhao’s (2018) discovery of the high frequency of dominance during OMCs albeit in mitigated ways. Whereas, Mao and Zhao’s (2018) appears to be the only study that has touched on this issue during OMC scenarios, which means that the issue still remains downplayed. Accordingly, ensuing research focusing on this issue of dominance employed by doctors is expected to provide a more thorough and nuanced view of the issue. This may help not only test Mao and Zhao’s (2018) findings but also map out how and why doctors still insist on dominating the e-patients during OMCs which are in great demand of patient-centeredness.

Referring to the basic premise of a smooth conversation, doctor’s dominance over e-patients can be triggered in two ways in terms of cooperation (Grice 1975) in our data: firstly, e-patients refused to cooperate with the doctor due to resistance for various reasons; secondly, although e-patients were very cooperative, the quantity or relevance of the information (Grice 1975) provided by the e-patient did not meet the doctor’s expected requirements. In terms of dominance-constructing strategies, it is found that doctors will adopt more straightforward directive speech acts like upgraded request when dealing with persistent resistance of e-patients; the doctors will be inclined to take a more mitigated elicitation to guide the e-patient to provide the expected answer for the consultation when the e-patients’ information is insufficient or not directly related under the premise of CP (Grice 1975).

Moreover, we discussed the connection between the dominance of doctors and patient-centeredness while underpinning doctor dominance as a goal-centered activity with a common goal between the two sides. Specifically, doctor-patient interaction is a purposefully joint activity directed towards a common goal: the e-patient’s question gets answered or the e-patient’s problem gets solved. To some extent, this paper contributes to our understanding of dominance during OMCs in two main ways: firstly, dominance can be seen as doctors’ optimal option to set and advance consultation agenda when confronted with patient resistance or insufficient information from e-patients; secondly, our research findings call into question the widely held assumption that medical consultation is characterized by the dichotomy that doctor-patient interaction is either doctor-centered or patient-centered. Instead, our findings suggest an alternative view that doctor-patient interaction during OMCs is a joint goal-centered activity (Gu 1996), which highlights the key to medical consultation is to solving problems in a cooperative way.

摘自：Wang, Xiaojiang, Yansheng Mao & Qian Yu. 2021. From conditions to strategies: Dominance implemented by Chinese doctors during online medical consultations. Journal of Pragmatics 182: 76-85.

医疗咨询话语中的反馈语与礼貌实现

作者简介

杨昆，哲学博士（南京大学），南京师范大学外国语学院副教授。主要研究兴趣：语用学、语用教学与测试。

反馈语（backchannel）是医疗咨询话语中的一种常见现象，起着接续话轮、维护交际秩序的作用。所谓反馈语，是指听话人在倾听的过程中不时地对说话人的话语做出简短的、言语或非言语的反应，从而表明自己对会话的积极参与（Ishida 2006）。典型的反馈语包括“是”“不是”“对的”和“当然”等词汇和短语（Yule 1996）。反馈语作为一种听话人参与对话的形式在交流中起到不可忽视的作用（Shelley & Gonzalez 2013）。因为对话并非个人单方面的行为，而是交际双方共同努力的产物。虽然反馈语是普遍现象，但其形式与功能却存在或多或少的语言上和文化上的差异（Sharifi & Azadmanesh 2011）。反馈语的差异可能会导致分属于不同文化群体的交际者在交流过程产生误解，导致沟通障碍。有些学者（如Berry 1992；Ishida 2006）已经意识到这一现象，并且对中介语和跨文化语用中的反馈语现象展开研究。此外，不少学者尝试对反馈语及涉及的话轮转换现象展开研究，探讨其社会互动性（Duncan & Fiske 1985；Sacks et al. 1974；Yngve 1970）。不过，很少有研究注意到听话人在话语互动过程中所使用的反馈语与礼貌之间的联系。事实上，从礼貌的视角对反馈语的类型与功能展开分析具有重要意义，可以防止在沟通过程中潜在的失败或误解，有利于维系人际关系。

在这样的研究背景下，研究基于医疗咨询话语展开反馈语的分析。研究主要尝试回答两个问题：（1）医疗咨询话语中的反馈语类型有哪些？（2）医疗咨询话语中的反馈语实现什么功能？为了回答这两个问题，研究通过广播节目中的电话医疗咨询来收集相关语料并对语料进行编码。

研究发现，电话医疗咨询中医疗专家对来电者使用的反馈语共计333条，这些反馈语可以分为词汇型反馈语和非词汇型反馈语。其中，词汇型反馈语（如“当然”）数量为126例，占比37.8%；非词汇型反馈语（如“嗯”）数量为207例，占比62.2%。这些反馈语可以实现跟随、反馈、重复、同意、评价、解读、重述七种不同的功能。这其中，有257例反馈语用于实现跟随功能，占有最大比例（77.18%）。这种现象的出现实际上是由电话医疗咨询的本质所决定的。电话医疗咨询的过程实际上是医疗专家和来电者之间协作解决问题的过程，目的是减少来电者的不确定性，缓解焦虑和压力，帮来电者做出明智的决定。因此，如何以礼貌且有效的方式管理咨询过程就显得十分必要，如果医疗专家没有管理咨询过程的能力，他们的医术也将变得无关紧要（Jannie & Ian 2005）。因此，医疗专家必须首先表明他们正在跟随来电者，表明他们的参与态度，减少情感对立，这也符合礼貌原则（Leech 2005）中的情感准则。此外，反馈语的其他六项功能也与“礼貌”之间存在密切联系，反映出电话医疗咨询过程中医疗专家对来电者的关注、同情与联盟。

总体而言，电话医疗咨询过程中医疗专家通过使用词汇型和非词汇型反馈语来礼貌且有效地管理电话医疗咨询过程。研究的相关发现不仅可以帮助了解反馈语的特征，推动反馈语研究的深入，而且可以循证医疗咨询管理和医患和谐的有效手段，体现很强的现实意义。

摘自：Yansheng Mao & Kun Yang. 2017. Backchanneling and politeness in the interaction of medical consultation: An empirical study. In Xinren Chen (Ed.). Politeness Phenomenon Across Chinese Genres. Sheffield: Equinoxpub Pyblishing Ltd.

Trust me, I am a doctor:

Discourse of trustworthiness by Chinese doctors in online medical consultation

作者简介

赵鑫，南京大学2019级外国语言学及应用语言学专业博士生。主要研究兴趣：健康语用学、文化语用学、变异语用学研究。

新时代背景下中国的医患关系出现了“患者赋权”现象，患方不仅期待医方提供专业的医疗技术服务，同时还希望得到医方的人文关怀。在医患交际的机构语境中，信任已经成为影响医患交际效果、维持和谐医患关系不可忽视的因素。一项调查显示，中国医患交际语境下的公共信任出现了一定程度的下降，主要表现为医方无法满足患方对医方专业技术和道德水准的预期（Li 2019）。话语互动中的关系研究是近年来语用学，尤其是人际语用学领域的热议话题。与日常交往中的人际关系不同，医患之间的信任关系是一种机构语境下，就诊前缔结的信托关系和就诊过程中建构的临时信任关系，包括一般的人际信任（general interpersonal trust）和特定信任（particular trust）。医患信任既属于一种一般的人际信任，也是特殊语境下的一种特定信任，所以医患之间的信任关系兼具一般信任的特征和特定信任的特征。一般的人际信任是指两个交际参与者根据以往互动历史而形成的一种人际信任（Kramer et al. 1996）。医患信任也是基于这样一种二元交际结构，源于医患身份赋予的信托关系而形成的一般人际信任，即患者在就医前就已经对医生产生了一般性的人际信任，相信医生会始终把患者的利益放在优先地位。在后现代主义思潮的影响下，建构主义视角下的信任话语研究开始出现，信任不再是一种交际前固有的人际关系，而是一种在话语交际过程中交际参与者通过话语动态建构的一种临时性的信任关系。

CNNIC发布的第41次《中国互联网络发展状况统计报告》显示：在线医疗咨询占所有医疗咨询类型的10.8%。因此，在线医疗咨询已是当前和未来医患话语分析中不可忽视的领域。然而，随着在线医疗咨询的如日方升，信任话语在“互联网+医疗”的在线医疗咨询话语研究中还未受到应有的关注。实际上，后疫情时代的到来加速了全球对“互联网+医疗”的普及。2021年2月国家卫健委印发的《在疫情防控中做好互联网诊疗咨询服务工作的通知》推进了互联网医疗的规范化和成熟化，也对互联网诊疗咨询服务工作提出了更高的要求，因而有必要探讨医生在线上医疗咨询中的信任话语研究。有鉴于此，本研究基于2000条在线医疗咨询实录，针对中国在线医疗咨询中医患信任缺失的现状，探讨了医生如何通过权威话语（针对患者对医生专业技术的信任）和态度话语（满足患者对医生的道德期望）来构建医生信任话语。

研究发现，医生采用权威话语和态度话语两种方式来建构信任。具体而言，医生的权威性话语主要包括医学术语和经验话语（个体经验和集体经验）。医生的态度话语主要包括情感导向话语、行为导向话语和认知导向话语。其中，情感导向话语是指医生对患者的尊重，行为导向话语是指医生对患者的避免强加，认知导向话语是指医生的异议表达。本研究顺应了“以患者为中心”的医患交际模式，为在线医疗咨询的医患信任建构提供了交际指南，有助于构筑“病者得其医，医者得其敬”的和谐医患关系。

摘自：Xin Zhao & Yansheng Mao. 2021. Trust me, I am a doctor: Discourse of trustworthiness by Chinese doctors in online medical consultation. Health Communication 36 (3): 372-380.

The more, the better: Overinformativeness by patients in Chinese online medical consultation

作者简介

王晓将，哈尔滨工程大学外国语学院2019级硕士生。主要研究兴趣：健康与媒介话语研究、网络语用学。

Since the increasing popularity of the Internet in people’s daily life (Zhao 2019), the medical model has undergone a fundamental change (Mao & Zhao 2019), especially as online medical consultations (OMC) have started to flourish in China and the world (Al-Mahdi et al. 2015). Through delineating the conditions in e-healthcare websites just in a click away, e-patients can have access to communicate with doctors online, acquiring requisite test diagnoses and results immediately (Maynard & Marlaire 1992). Whereas, due to the confinement of the virtual or online context (Locher 2006) and chat tools, it cannot be guaranteed that doctors can grasp patients’ symptoms or points to full advantage at the other side of the screen. To overcome the barriers above, e-patients often resort to some linguistic strategies to explicate their conditions. In view that e-patients asking for help online prefer efficiency and effectiveness (Gill & Roberts 2012), they are driven to employ overinformative strategies to complete medical consultation as quickly as possible.

Being rich in approaches, previous studies (Alonso-Almeida 2015) has predominantly investigated the language strategies doctors and patients employ in OMCs and how these strategies mold and impact the doctor-patient interactive patterns and results (Mao & Zhao 2019). However, while the language strategies employed by doctors in OMCs have been thrust into relatively sufficient attention in prior studies, research on e-patients’ language usage is still underexplored with scant attention. Against this backdrop, this study serves as an attempt to delve into how overinformative responses are exploited by Chinese e-patients as a pragmatic strategy during online medical consultations.

This study drew the following conclusions: Firstly, it is found that e-patients’ overinformative responses can be formally categorized into mono-propositional and multi-propositional categories. As for mono-propositional overinformative responses, they refer to the overinformative cases where only one unit or one genre of supportive extra information is introduced. Specifically, mono-propositional overinformative responses are widely used by e-patients with the purposes of providing information relevant to their symptoms or therapies of the same type for doctors. While, unlike mono-propositional overinformative responses, additional information of multi-propositional overinformative responses are coordinated. Regarding OMC scenarios, chances are that e-patients employ multi-propositional overinformative responses to extend their additional information from diverse perspectives, such as causes, conditions, and self-diagnosis (Wu et al. 2013). Secondly, on the functional level, overinformative responses can be primarily employed by the patients for the purposes of grounding, expanding, and disarming in the context of OMCs. In details, grounding accounts for the intention, motivation, cause or reason of the head act; expanding is employed to anticipate the potential appeal to excess messages or details before the examination from the doctor; disarming is to shuffle or eliminate potential discomfort or hostility of the doctor.

Theoretically, this study verifies the applicability and validity of Edmonson’s (1981) supportive moves on the study of e-patients’ overinformative responses in online medial context and proliferates the theoretical and empirical study of overinformative responses on Chinese discourse. Practically, the current study will not only contribute to doctors’ further understanding of e-patient discourse in OMCs, but also sheds new light on the identification and interpretation of e-patients’ pressing request for diagnosis.

摘自：Wang, Xiaojiang & Yansheng Mao. The more, the better: Overinformativeness by patients in Chinese online medical consultation. Onomázein, forthcoming.

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