The Representation of Pain and Illness II

The proposed project application is directly based on the FWF-Project "The Representation of Pain and Illness Narratives", which was completed in February, 2007. Its goal is the use of its results to more deeply examine and complete the following three sets of research questions which are suggested by investigative gaps in discourse research, and, moreover, have proven to be particularly relevant both in discussions with physicians, as well as in doctors` consultations. Firstly, a series of epidemiological and clinical studies show a pronounced connection between primary headache pain and psychologically determined complaints, particularly anxiety and depression, while it becomes increasingly clear that the subjective experience of anxiety brings with it decisive information for a better understanding of the illness. Since this is only accessible through interaction, the question this project investigates is how the patients themselves interactively construct the connection between anxiety and pain. Secondly, in the previous project, there were considerable suitability problems between the consultation plans of the doctors and the desires of the patients who visited the treatment centres. A continuing linguistic analysis of the data should allow a systematic explanation of the various forms of communication in participatory offers and activities of doctors and patients (Keywords: patient-centred medicine, empowerment, decision making) and describe both successful and unsuccessful forms of their interactive negotiation. Thirdly, the specific problem of patients from different cultural backgrounds describing their pain was underscored by the medical cooperative partners. Since the communicative representation of pain is decisive, the question must be asked whether conclusions can be drawn from pain representation as depicted by patients of culturally different backgrounds. In this field, however, it will be vital to be aware of a series of caveats that we have put together. The project draws mostly on material from the previous project that should be completed according to the existing criteria. Herewith, one of the largest German-language collections of video material on pain representation will also be made available. The theoretical and methodical basis is built on over 30 years` of research tradition known as the Wiener Ansatz, which holistically combines critical discourse analysis with conversation analysis and establishes a link with findings of medical semiotics and, in part, systemic-functional linguistics. Following the Viennese approach, the results should be applicable when re-incorporated in medical practice, possibly even in the form of recommendations.

Many doctors rank medical interviews with patients with limited or no knowledge of German among their greatest communication challenges. For dealing with headaches, and hence the question of their successful medical treatment, depends substantially on communicative factors. The better the communication between doctors and patients regarding the history, the physical examination, the diagnosis, the proposed therapy, and the checking of therapeutic success, the better disease-related symptoms are alleviated. The FWF project "The representation of pain and illness II" conducted at the Department of Linguistics of the University of Vienna examined the special challenges and problems of such settings. Overall, 56 primary and control meetings between doctors and patients with limited German language skills were videotaped at the headache clinic of the Vienna General Hospital (AKH). Twenty of these conversations were mediated either by family members or by a professional interpreter. It could be shown that it adds significantly to the success of the communication between doctors, patients and family interpreters, if varying and frequent procedures that promote and secure understanding are used (e.g. simple questions, no double issues or split questions, body language, repetition, reformulation, drawings and images). These procedures are particularly important in the conversations at issue, as the linguistic, cultural and subject- related knowledge background of the interlocutors diverges strongly. However, it has also become clear that all parties involved in the conversation are overstrained by the current circumstances: - The patients, who, despite limited knowledge of German, try to get their problems across and who instead become the object of conversation which is decided on; - The family members, who are entrusted with the task of interpretation, although their neutrality and interpreting competence is missing; - And the doctors, who despite visible efforts, under the current conditions in the health care system are overburdened with the additional requirement of ensuring that family members interpret adequately. The difficulties in medical interviews with patients with limited or no knowledge of German have therefore to be seen as a structural problem. It should be met with explicit measures: expansion and systematic use of professional interpreting services (the only form that guarantees equal opportunities for patients), exploitation of existing societal multilingualism (training courses to enhance the interpreting competence of multilingual staff) as well as a solid training for doctors to raise awareness of the specific requirements of medical interviews when family interpreters are involved.