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Meaning in Doctor-Patient Communication

For anybody to work and develop her/his environment, s/he must be well i.e. healthy. Unfortunately, the human body can fall sick and die. To avoid sufferance and sometimes death, people go to hospital to seek for recovery. This recovery depends on good medical treatment. A good health care is mostly based on a good communication between doctor and patient. This type of communication is called Doctor-Patient Communication. A good communication is the one in which both doctor and patient understand each other. Understanding requires a clear transfer of meaning. This article investigates into meaning in doctor-patient communication. It attempts to point out how much meaningful the interaction between doctor and patient is. How much do doctors and patients understand each other? How is meaning grasped? How is meaning processed? Are there any meaning barriers? If “yes” what are the suggestions? These are questions which this paper tries to answer.


Introduction
A good quality of health care relies on meaningful communication between doctor and patient. When meaning is obscured in doctor-patient communication, there is less hope for recovery. Therefore, doctors and patients should communicate meaningfully to reach the objective which is patient"s recovery. If patients are not satisfied, they complain. Patients in Bonzola Hospital complain over time that they do not understand their Doctor"s instructions. Furthermore, they do not communicate easily with their doctors. On the other hand, doctors complain that patients do not follow instructions. Therefore, one may ask a question to know why both patients and doctors are complaining. It has been revealed that there is misunderstanding between Doctors and their patients. The aim of this article is to analyse meaning in Doctor-Patient Communication in Bonzola Hospital so as to point out the causes of misunderstanding and suggest better ways for making meaningful communication between Doctors and Patients.
The misunderstanding between doctors and patients has led to the choice of this topic. As a researcher in the field of semantics and pragmatics, I felt called to investigate meaning in doctor-patient communication. The research has been conducted in Bonzola Hospital through observation, interviews and library research. The observation helped listen to conversation between doctors and their patients. As far as the interview is concerned, I asked questions to both Doctors and Patients. My interview with doctors intervened after doctors have finished talking to patients. Patients have been interviewed outside of doctors" offices. The library research allowed me to collect some information from books, articles and web. This paper is based on qualitative research, and it is elaborated on the basis of conversation analysis. As far as theories are concerned, I use semantic theories. This paper has four sections. The first section supplies a survey on meaning. The second part deals with Doctor-Patient communication. The third section presents meaning barriers in doctor-patient communication. The last section suggests some ways to improve meaning transfer between doctors and patients.

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International Journal of Linguistics and Communication, Vol. 6, No. 1, June 2018 Meaning Meaning is not easy to define by the simple fact that it is meaning. It is the source of any understanding. Linguists, psychologists and Philosophers have tried to define « meaning » but their definitions could not satisfy. As Miller (1973: 36-37) states that: We find, historically, a variety of direct answers, including Plato"s answer that meanings are eternal archetypes, John Locke"s answer that meanings are the mental ideas for which words stand as external signs, the answer that meanings are the things in the world to which words refer, Wittgenstein"s answer that meaning is use, the behaviorist"s answer that meanings are stimuli that elicit verbal responses, the introspectionist"s answer that meanings are mental images associated with verbal behavior, and so on. But every attempt to give a direct answer has failed.
On the other hand, Osgood at al. (1957 : 2) say that « there are at least as many "meanings" as there are disciplines which deal with language, and of course, many more than this because exponents within disciplines do not always agree with one another ».
For Berlo (1960: 173) « meaning is related to the codes we choose in communicating ».
I can attempt to define meaning as a whole set of intention, idea and concept that a speaker or writer conveys in a specific context through utterances, words/sentences, symbols, body movement, eye contact, facial expressions or any other means. I think, it is for this reason that meaning is discussed through many aspects that lead to different types of meaning. Leech (1981:9) enumerates seven types of meaning: conceptual meaning, connotative meaning, Social meaning, affective meaning, reflected meaning and collocative meaning, thematic meaning.
Conceptual meaning Leech (1981:10) states that "the conceptual meaning of a language can be studied in terms of contrastive features".
As far as doctor-patient communication is concerned, this type of meaning occurs when either the doctor or the patient tries to get meaning of an utterance by referring to the characteristics of the concept for which a word is used. This kind of getting meaning is not always assuring. For instance, the interaction below between doctor and patient shows that the features of the concept for which a word is used do not convey any precised meaning.
Doctor: What is the matter? Patient: My belly hurts. What does it mean to have pain in the belly? At this level of interaction, the doctor actually does not understand anything. In other words, s/he does not get any meaning of what the belly is. S/he starts to speculate around the features of belly to get meaning. What the matter can be? Perhaps the problem is about intestines, stomach, kidneys, etc. In brief, features are not enough to let meaning known. Leech (1981:12) writes that "connotative meaning is the communicative value an experience has by virtue of what it refers to, over above its purely conceptual content".

Connotative meaning
Connotative meaning leads also to speculation. Both doctor and patient should interact in an explicit way to avoid misunderstanding. The word "belly" in the above interaction can have different connotations such as stomach, uterus, etc.
Social meaning Leech (1981:14) says that "social meaning is that which a piece of language conveys about the social circumstances of its use". The social meaning can be useful if both doctor and patient share the same knowledge of social realities. If they do not share the same knowledge, the communication between them can suffer of misunderstanding.
Affective meaning Leech (1981:15) explains that "affective meaning is largely a parasitic category in the sense that to express our emotions we rely upon the mediation of other categories of meaning-conceptual, connotative or stylistic".
Some patients express their emotion by using lexical or conceptual meaning. For example, a patient who has swallowed a nail asks the doctor if the case requires an operation.
Patient: I have swallowed a nail. Am I going to undergo an operation?
Doctor: probably. Patient: Is it possible to treat the case without an operation? Doctor: It depends on … It is clear that the patient does not want to undergo an operation by the fact he asks if another way of treating the case is possible. This can be understood as an affective meaning. Leech (1981:16) considers the reflected meaning as "the meaning which arises in cases of multiple conceptual meaning when one sense of a word forms part of our response to another sense".

Reflected meaning
Doctors are more likely to have such type of meaning since they have to understand patients" desire from their utterances.
Collocative meaning Leech (1981:17) assumes that "collocative meaning consists of the associations a word acquires on account of the meaning of words which tend to occur in its environment".
Doctors often have this type of meaning when they try to understand what is wrong with patients" bodies. They associate words uttered by a patient with other words to get the meaning.
Thematic meaning Leech (1981:19) states that "thematic meaning, or what is communicated by the way in which a speaker or writer organizes the message, in terms of ordering, focus, and emphasis".
Some patients prefer to tell what happened to them before they fell sick so as to allow their doctors understand their problems. This is good but it requires much time. Most of time, doctors have a schedule of their activities, and because of time pressure, they would like to rush up with the consultations. So, doctors sometimes interrupt patients and ask them to say what the matter is. As Cerny (2010:16) argues that "doctors, moreover, use these interruptions with the intention to change the phase of the consultation".

Meaning processing
Meaning is conveyed through communication process, and it is grasped through brain processing.
"The human brain is ultimately responsible for all thought and movement that the body produces. This allows humans to successfully interact with their environment, by communicating with others and interacting with inanimate objects near position". (http:..www.md-health.com/Parts-Of-The-Brain-And-Function.html.) The brain is the core of Doctor-Patient communication. What is uttered, performed or listened is processed by the brain. As it is written in https://serendip.brynmawr.edu/bb/kinser/structure1.html that "sensory nerves gather information from the environment, send that info to the spinal cord, which then speed the message to the brain. The brain then makes sense of that message and fires off a response".
Utterances, gestures, actions, words and symbols are changed into signals by the sensory nerves, and these signals are sent into the spinal cord. The spinal also sends the same signals to the brain to be processed. As the link http://www.teach-nology.com/teachers/methods/info_processing/ reveals that "information processing starts with input from the sensory organs, which transform physical stimuli such as touch, heat, sound waves, or photons of light into electrochemical signals".
Meaning is not in the brain, but it is produced by the brain. As Putnam argued in his paper Meaning and reference" that "meanings aren"t in the head". The brain processing takes into account lots of elements in order to provide utterances, gestures, actions, words, and symbols with meaning.
Here are the main elements on which the brain processing is based to produce meaning: word, symbol or sound recognition in relationship with concepts and environment perception.
Word, symbol or sound recognition in relationship with concept ] Through senses (sight, hearing, taste, touch and smelling) the brain stores information in the form of "mnesic traces" which can be considered as knowledge. Words, symbols and sound that entered the human brain are stored in form of mnesic traces, and they relate specific concepts.

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International Journal of Linguistics and Communication, Vol. 6, No. 1, June 2018 Whenever these words, symbols and sounds are used, the brain recognizes them and associates them with their concepts so as to provide them with meaning. That is to say, if these words, symbols and sounds do not meet any recognition by the brain, the brain will not produce meaning by respecting the truth condition. Therefore, if the doctor"s utterances are not recognized by the patient"s brain, the patient will not get the true meaning of those utterances, as consequence the doctor-patient communication is impaired.

Environment perception
Another element that enters the brain processing mechanism is the environment perception. It is the ability of sensory nerves to film the environment or the scenario in which the communication takes place and send that into the spinal cord which also sends that signal to the brain so that the brain associates that signal with other signals to produce meaning. The environment perception includes gestures, actions, speaker"s intention and whatever surrounds the communication act.

Meaning transfer/reception Utterances, gestures, facial expressions and actions
Meaning in doctor-patient communication is conveyed through utterances, gestures and actions. As far as utterances are concerned, both doctor and patient use voices which are grammatically or ungrammatically structured. Apart from utterances, gestures are also used to convey meaning in doctor-patient communication. The gestures are often performed by using hands and arms.
Facial expressions and action are performed to convey meaning. Head movement is mostly used to accept or confirm and deny or refuse a saying. Actions are used to explain a given instruction.

Listening, watching and thinking Listening
To catch meaning of an utterance requires a good listening. Self and Carlson-Liu (1988:20) define good listening as « the active process of carefully receiving and responding to meaning in communication encounters which include an aural component ». Tara Dixon, state that « Effective communication is heavily dependent on effective listening ».

Watching
Watching is derived from the verb "watch". Flexner andHauck (1987: 2146) explain the verb "watch" in this way: « to be alertly on the lookout, look attentively, or observe, as to see what comes, is done, or happens ».
Thinking Flexner andHauck (1987: 1971) « to employ one"s mind rationally and objectively in evaluating or dealing with a given situation » The doctor receives the signal from the patient, and he tries to decode it so as to get its meaning in order to reach the patient"s desire. One can ask an important question: How does a doctor grasp meaning from the patient"s utterances? Most of the time doctors grasp meaning of patient"s utterances by referring to her/his background knowledge, experience and symptoms.

1) Background knowledge
Doctors refer to their background knowledge to understand what can be the trouble in patients" bodies. This reference can be useful if the patients" utterances were expressed through right words. Otherwise the reference can mislead the doctor.

2) Experience
Sometimes, doctors act by analogy i.e. s/he refers to the previous cases which are similar to the case under examination.

3) Symptoms
When a doctor associates the patient"s utterance to the symptoms on the patient"s body, the doctor can come to understand what the matter is.

4) Medical tests
Medical tests, when based on right diagnostic and well done in the laboratory, help doctors know what is wrong with the patient. From the laboratory results, the doctor prescribes a prescription. Flexner andHauck (1987: 1529) define prescription as « a direction, usually written, by the physician to the pharmacist for the preparation and use of a medicine or remedy ».

g) Feedback
The doctor reacts to the signal by sending back a new signal to the patient. In this way, the communication process restarts in a reverse way.

Lack of education
Longman Dictionary (1992: 407) defines education as « the process by which a person"s mind and character are developed through teaching, or through formal instruction at a school or college ».
Lack of education is a serious meaning barrier in a way that some doctor"s instructions require patient"s background knowledge. If the background is poor, the patient does not grasp any meaning from what the doctor recommends.

Mentality
Longman Dictionary (1992: 833) « a person"s habitual way of thinking ». Some patients have habit to cure themselves with some plant or leaves of plants. When doctors make diagnosis of the disease and suggest a kind of treatment, such patients use their traditional medicine without any permission of doctors.

The cultural taboo
Longman Dictionary (1992: 1346) « strong social or religious custom forbidding a particular act or word ». In luba culture, the term "sex" is almost a taboo. When a man is consulted by a she-doctor, he does not feel comfort to say something relating to sex. It is the same case when a woman or a young girl is consulted by a he-doctor. Such a taboo hinders the meaning transfer.

Time pressure
Doctors need to listen to patients carefully in a comfortable way in order to get a good diagnostic. But it is noticed that doctors are too busy to the extent that they have not much time to listen to their patients.

Doctor Inattention
Sometimes doctors respond to the phone callings while they are consulting patients. This fact leads doctors to forget what the patient has uttered. Another case is that doctors become inattentive when they think to preoccupations they have in the mind. Longman Dictionary (1992: 407) 6. The transmission error When the language used by the patient is not known by the doctor or vice versa, they both look for an interpreter. The interpreter may fail to translate exactly what has been said and lead the doctor or patient to get a wrong statement.

Ignorance of Certain Important Terms
Each domain, society or social environment has its own terms which, to some extent, are not known by the people of another domain or social environment. Most of the time doctors use the terms which patients do not understand. In this context, meaning of utterances is impaired.

Assimilation
Assimilation is a two-way phenomenon. Patients can hide his sickness or can declare pseudo-disease. This is called assimilation.

Continuing sanitary education of general public through mass media
The society is composed with educated people and uneducated people. As far as educated people are concerned, I distinguish three sorts of educated people: highly, middle and low educated people. Highly educated people are persons who completed their studies at University or College. Middle educated people are persons completed their studies at high school. Low educated people are persons who stopped their studies at the level of elementary school. On the other hand, uneducated people are persons who did not go to school or did not complete the elementary school.
It has been proved that even highly educated people have difficulties to understand some of doctor"s instructions. So, a continuing sanitary education through mass media is very important in the sense that it helps the population to come to knowledge of how to communicate with doctors.

Sanitary education of patients in every hospital
Apart from continuing sanitary education through mass media, another way to facilitate a meaningful Doctor-Patient Communication is to inform patient how they can interact with doctors. People who are coming to hospitals should be trained each morning before any consultation.

Continuing doctor training, seminars and conference
Doctors should have an on-going training in order to share their experiences through seminars and conferences.

Reasonable number of doctor for each section
A doctor can work effectively when s/he is not tired. If a doctor has to consult more than fifty patients a day, s/he cannot produce a good work. It is reasonable to appoint a sufficient number of doctors referring to the number of patient. I suggest that a doctor consults more or less 20 patients a day.

Semantic verification
It is difficult to believe that a patient has understood exactly doctor"s instructions. Even if the doctor has been giving instructions very clearly, s/he has to verify whether the patient has grasped the meaning. To ask the patient to resay what s/he has understood is the best way to verify her/his comprehension.

Conclusion
This article has been discussing meaning in doctor-patient communication. It mainly focused on meaning, meaning processing, meaning transfer, doctor-patient communication process, meaning barriers in doctor-patient communication, and suggestions for effective conveyance of meaning in doctor-patient communication.
As far as the definition of meaning is concerned, it has been shown that it is difficult to define meaning. But there is an attempt of definition that states that meaning is a whole set of intention, idea and concept that a speaker or writer conveys in a specific context through utterances, words/utterances, symbols, body movement, eye contact, facial expression or any other means.

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International Journal of Linguistics and Communication, Vol. 6, No. 1, June 2018 The human brain processes signals from the spinal cord and produces meaning of a word, sentence, symbol, an utterance, etc. This is to say that meaning is not in the brain but it is produced by the human brain. In doctorpatient communication, meaning is conveyed and received through words, utterances, signs/symbols, facial expressions, body movement.
The doctor-patient communication process includes situation, emitting, signal or message, medium/space, interference, receiving, and feedback.
The following meaning barriers have been pointed out so that they can be avoided: lack of education, mentality, the cultural taboo, time pressure, doctor inattention, transmission error, ignorance of certain important terms and assimilation.
In order to get an effective doctor-patient communication, the following suggestions have been proposed: continuing sanitary education of general public through mass media, sanitary education of patients in every hospital, continuing doctor training/seminars/conference, and semantic verification.