The Handbook of Discourse Analysis

494 Suzanne Fleischman
context in interpreting language
behavior, while speech act theory
stresses the importance of illocutionary
acts. Moreover, in drawing the
comparison Ratzan seems to
underestimate the extent to which all
discourse is formulaic (i.e. displays
genre- or frame-specific conventions).
6 Gomers (an acronym for “get out of
my emergency room”), like the earlier
term crocks (of uncertain origin),
refers to the decrepit patients who
do not get better but do not die
(Donnelly 1986: 82). A brainstem
preparation, as used in neurological
research, is an animal whose higher
brain functions have been destroyed
so that only the most primitive
reflexes remain (Klass 1984).
7 Mishler (1984) distinguishes two
“voices” in medical discourse: the
(dominant) voice of medicine and the
voice of the “lifeworld” that serves
to communicate the beliefs and
attitudes of people in everyday life.
He sees these voices as discrete
(nonoverlapping) and asymmetrical
in terms of the power and authority
they carry.
8 Holland et al. (1987) conducted
a cross-cultural study on the
communication of cancer diagnoses.
They found that use of the word
“cancer” – unparalleled among
disease names for its metaphoric
power (cf. Sontag 1978) – was often
avoided in discussions with patients
in favor of substitutes implying a
swelling (“tumor,” “growth,” “lump”),
inflammation, or pathophysiologic
change (“blood disease,”
“precancerous” or “unclean” tissue),
or, alternatively, of technical terms
unlikely to be understood by the
patient (“neoplasm,” “mitotic figure”).
9 Studies coming out of biomedicine
(which are based largely on survey
data) seem inclined to accept without
question physicians’ assessments of
their own language behavior;
linguists, from experience, prefer to
listen for themselves.
10 Donnelly (1986: 84) states that
“decades of absent-minded
substitution of ‘case’ for ‘patient’ have
resulted in dictionary recognition of
usage that blurs this distinction
between the patient and his disease.”
Undiagnosed metonymies proliferate
in the discourse of medicine.
11 A scattering of writers from within
biomedicine (Warner 1976; Fein 1982;
Dixon 1983; Donnelly 1986) invoke
the Sapir–Whorf hypothesis (explicitly
or unknowingly) in acknowledging
that the vocabulary and grammatical/
discourse structures of the medical
dialect play a role in shaping
physicians’ attitudes about, and
behavior toward, patients. Citing
Sapir (1949), Donnelly observes that
“the world . . . of trainees in teaching
hospitals, like all ‘real worlds’, is to a
great extent unconsciously built upon
the language habits of the group”
(1986: 93).
12 Alternatively, the physician assumes
the agent role, the disease the object
or “patient” role, with the real-world
patient assuming third place in the
line-up.
13 Her “top six” include (the
conventional author of each is given
in parentheses): the case write-up
(medical student), discharge summary
(house officer), consultation letter
and case report (private practitioner),
research article and grant proposal
(academic physician). This roster –
like most of the literature on medical
genres – shows a bias toward
academic medicine as well as an
EST agenda (teaching medical
writing).
14 Cf. Van Naerssen (1985); Anspach
(1988); Poirier and Brauner (1988);
Poirier et al. (1992); Donnelly (1988,
1997); Hunter (1991: ch. 5, 1992);