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Those Words
Author(s): Karen Lutfey and Douglas W. Maynard
Source: Social Psychology Quarterly, Vol. 61, No. 4 (Dec., 1998), pp. 321-341
Published by: American Sociological Association
Stable URL: http://www.jstor.org/stable/2787033 .
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Social PsychologyQuarterly
1998,Vol. 61,No. 4,321-341
Wefocuson thesocializationofpatientstotheprocessofdeathanddyingbyexamin-
ingactualinteractionsamongmedicalpractitioners, and theirfamilymem-
patients,
bers.Ourdataconsistofthreemedicalinterviews. In eachone,theoncologistdelivers
thenewsthatthepatient'scanceris no longertreatable. Althoughnotstated,the
impliedmessageis thatthepatientwillsoon die.Because,in theseepisodes,
thesame
doctoris attemptingto conveya similarmessageto threedifferent we can
patients,
comparethewaysin whichthepatientsrespondto themessageand thusaffect the
deliveryof thenews.In variouspracticalways,bothphysicianand patientexhibit
cautionindiscussing
interactional deathanddying.
Excerpt Ja
75 Dr: Ouho=
76 K: =yes.Mis [sus] Parker
77 P: [she]
78 (0.4)
79 Dr: Abou:t.((Dr looksbacktoR))
80 (0.3)
81 K: [yeah]
82 R: [Sh-s]herelatesto what-whatwenton:
83 (0.2)
84 Dr: Oh
85 (0.5)
86 R: Whowasthatlady[ Is-]
87 K: [Miss]us Parker.
88 (0.5)
89 Dr: Did shetalkto youabou:t=
90 R: =Ya.
91 Dr: theprogram calledHo:spic:e?
ExcerptId
6Also see also Kinnelland Maynard(1995) fora discussionof the use of "you" in HIV testcounseling.
BAD NEWS IN ONCOLOGY 329
By reminding themofthelengthofRobert's bluntlyinforming Robert of his condition
hospitalstay (lines 208-209), Dr. T impli- and moregently"forecasting" thenewsand
cates Robert's and Katherine's common- helping him to "calculate the news in
sense knowledge,suggestingthatsuch long advance of its finalpresentation" (Maynard
stays generallyindicate serious problems 1996:109).
(lines 211-12).7Robertmeanwhileremains When Robert and Katherine remain
silent. silent(line213),Dr.T proposesan upshotor
The doctor'stalk in thisinstancefunc- completionof the syllogismby once more
tionsas something similarto an incomplete usinglitotesand tellingthecouplehe is con-
syllogism(Gill and Maynard1995); such a cernedthat"there'sa possibility thatthings
turnorganizationoccurs frequentlyin the mightnot go so well" for Robert (lines
deliveryof diagnoses,to parents,about their 214-15). Again,the doctorcautiouslyshifts
developmentally disabledchildren. Clinicians fromallusiveto moreexplicittalkabout the
providethefirsttwocomponents ofthesyllo- futureas Robert and Katherine'ssilences
gism,suggesting, forexample,that(1) people disaffiliatewiththe delicatetopic of death
withmentalretardation exhibitsymptoms x, and dying.
y,and z and (2) the parents'child exhibits Afterthisseries of turnsand silences,
symptoms x,y,andz. Clinicianstherebyinvite the doctorshiftsthe focusof his talk from
parentsto completethe syllogismby infer- thepossibility of nonrecovery to theimpor-
ringthattheirchildhas mentalretardation. tanceof palliativetreatment, allusivelyindi-
In the presentcase, the doctorsets up the catingthathe wantsto be surehe can "antic-
firsttwopartsof thesyllogism bynotingthat ipate any needs" (line 217) Robert might
(1) Roberthas been hospitalizedforthree have after he leaves the hospital (lines
weeks(lines208-209),and that(2) suchlong 218-19).Also,in contrastto thelongsilences
hospitalizationsgenerallyindicate serious following thedoctor'stalkin thefourprevi-
problems(lines 211-12). Formally,Robert ous utterances,Robert now takes several
may be invitedto completethe syllogism, turnsof talk, respondingto the doctor's
withoutits beingstated,by concludingthat
statementof concernby fashioning a series
he has serioushealthproblems.
ofgratuities (lines220,222,224,226).
An ambiguitymay be present here,
Our analysisofthisdoctor-patient inter-
however.The extentto whichthe seriesof
view is consistentwith Dr. T's own later
"you"s in lines211-12 refersto the general
reflections.Recall fromourdiscussionofthe
population ("lets one know one is having
data and methodsthatDr. T had feltawk-
problems ... ") as opposed to Robert specif-
ward duringthe interview.In addition,he
ically ("lets us know you're havingprob-
remarkedthathe was "trying"to findout
lems . . . ") is unexplicated. Insofar as Dr. T
uses "you" in a generalizedfashion,he may what Robertknewabouthisillness:
be employinga syllogistic construction. On But Robert,he sortof had his ownagenda
the otherhand,insofaras Dr. T is referring insteadand almostat timeswe weretalking
to Robert in particular,he accomplishes about different things.Whichin partmay
something that is more direct than an have been because he wantedto avoidtalk-
incompletesyllogism.Withthis utterance, ingaboutwhatI wantedto talkabout.So it's
Dr. T appears to walk a fineline between not thatunusualthatthingsare awkward.
BecauseI don'tthinkit'sveryeasyto talkto
7An ironic parallel exists between Robert's and people aboutdyinganyhow, and neverwill
Dr. T's rhetorical arguments in this conversation be. But in thatcase it was probablya little
(lines 189-99 and 206-10, respectively).Whereas Dr. MORE awkward thanusualbecauseI really
T cites commonsenseevidence consistentwithnon- didn'tsee thatI wasgetting anywhere.
recovery,Robert (lines 189-99) provides common-
sense evidence for recovery.Althoughhe admitsto Our analysisdemonstrates how Dr. T could
havinghad transitory thoughtsabout not recovering, have sensed that the patient "wanted to
he casts these ideas as typical for someone in his
position. Each participant uses "you" as a way of
avoid" talkingabout his illness trajectory
invokingwhat any competentactor could know or and thattheywere "talkingabout different
believe. The doctorattributes
things." the avoidance
330 SOCIAL PSYCHOLOGY QUARTERLY
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