Abstract Objective: To compare the use of some of the characteristics of male and female language by male and female primary care practitioners during consultations. Design: Doctors' use of the language of dominance and support was explored by using concordancing software. Three areas were examined: mean number of words per consultation; relative frequency of question tags; and use of mitigated directives. The analysis of language associated with cooperative talk examines relevant words or phrases and their immediate context. Subjects: 26 male and 14female doctors in general practice, in a total of 373consecutive consultations. Setting: West Midlands. Results: Doctors spoke significantly more words than patients, but the number of words spoken by male and female doctors did not differ significantly. Question tags were used far more frequently by doctors (P<0.001) than by patients or companions. Frequency of use was similar in male and female doctors, and the speech styles in consultation were similar. Conclusions: These data show that male and female doctors use a speech style which is not gender specific, contrary to findings elsewhere; doctors consulted in an overtly non-directive, negotiated style, which is realised through suggestions and affective comments. This mode of communication is the core teaching of communication skills courses. These results suggest that men have more to learn to achieve competence as professional communicators.

Background. It is widely accepted that ‘partnership’ with patients is desirable, and that patients should be enabled to participate in decisions, but it is not clear to what extent doctor–patient interactions represent partnership in action. Objective. Our aim was to measure aspects of doctor–patient interaction through the deployment of the first person pronouns ‘I’, ‘me’, ‘we’ and ‘us’ in general practice consultations. Methods. The study design was a concordance-based language analysis of spoken data. Concordancing software was used to interrogate a database of 373 consultations with 40 doctors in UK general practice. The frequency and function of first person pronouns used in these consultations were scrutinized. Concordancing enables identification of strings of text with similar lexical properties and uses specialized statistics to assess relationships between words and phrases (‘collocates’ being words commonly found together) as well as their patterns of use (MI, mutual information, describes the likelihood of two words or phrases being associated). Analysis is therefore quantitative and qualitative. Results. Doctors use the word ‘we’ far more often than patients or companions do (doctors 23.5% and patients 2.9% of all personal pronoun occurrences). Doctors are far less likely to use ‘I’, after which a verb of thinking is usually selected (38 collocates with MI >3). However, after ‘we’, doctors select verbs of physical activity or auxiliary verbs. Three types of doctor use of ‘we’ were distinguished: to include patients (“you and I”), exclude them (“we doctors” or “we as a practice”) or to mean “all of us as human beings”. Conclusions. The findings suggest a prototypical pattern of interaction in primary care: Patient: I suffer. Doctor: I think. We will act. This, within the current paradigm which values partnership between doctor and patient, might seem encouraging; but there is evidence to suggest that power relationships in the consultation may still be unequal.

Uncertainty is believed to be a central feature in illness experiences. Conversations between a consultant haematologist and 61 seriously ill patients were transcribed, entered on a database and scrutinized for patterns of language uncertainty by linguistic concordancing analysis. Transcripts were then discussed in detail with the haematologist, and techniques of protocol analysis were used to gain insight into his thought processes during consultations. The main findings were that the doctor used many more expressions of uncertainty than did patients: that evaluative terms were widely used to reassure rather than to worry patients; and that patients and doctor together used certain key terms ambiguously, in a manner which allowed the doctor to feel that facts were not misrepresented while perhaps permitting the patient to feel reassured.