ABSTRACT

The use of language in human communication is predicated on social relationships; hence when people converse, they are always aware of the social relationship which determines who controls and directs the conversation. This study focuses on doctor-patient conversations in rural areas. It investigates how language is employed as a tool of social dominance in doctor-patient conversations in selected rural hospitals in Kaduna State, Nigeria. The aim is to examine and understand the nature of doctor-patient conversations in the selected rural hospitals in order to reveal the underlying power struggle. The study employs the theoretical paradigm of Fairclough‘s (1989) Discourse as Social Practice which is used to analyse the data. A total of twenty (20) conversations between doctors and patients are recorded, translated and transcribed. Twenty (20) patients are also interviewed in order to determine the level of patient satisfaction and Five (5) different doctor-patient conversations are selected for analysis at the levels of description, interpretation and explanation as proposed by Fairclough (1989). The study reveals that doctor-patient conversation in the selected rural areas is shaped by both the institution of medicine and the customs and traditions of the people in such areas where it occurs. It also reveals that the presence of a traditional ideology of health in these rural areas has an impact on the power dynamics and results in a power struggle. Another finding is that the communication style of doctors in rural areas is disease-centred, as opposed to patient-centred which as proven by William, Weinman & Dale (1998) leads to higher patient satisfaction. Finally, this study has successfully confirmed the fact that conversations between doctors and patients in rural areas are laced with unequal power relationship which is seen in their use of language.

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CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Human communication is not an isolated linguistic phenomenon; rather, it is embodied in the

social relationships of the communicators (O‘Neill, 1989). The way people use language is

dictated by their awareness of who they are and to whom they are talking. The choice of

words in conversations is more often than not, a conscious decision. When people talk, they

are always aware of the social relationship which determines who controls and directs the

conversation. It has, therefore, become undeniable that a language is a powerful tool with

which human beings exercise control and social dominance over one another.      This

consequently motivated the present study which is an investigation of how language is

employed in the exercise of social dominance in doctor-patient conversations in rural areas.

This study centres on Critical Discourse Analysis (CDA), which is an approach in Discourse

Analysis that emphasises the study of language and discourses in social institutions. CDA

draws on poststructuralist discourse theory and critical linguistics to focus on how social

relations, identity, knowledge and power are constructed through written and spoken texts in

different linguistic contexts (Wodak, 2002). CDA is founded on the idea that there is unequal

access to linguistic and social resources. van Dijk (1998a) defines CDA as a field that is

concerned with studying and analysing written and spoken texts to reveal the discursive

sources of power, dominance, inequality and bias. CDA examines how these discursive

sources are maintained and reproduced within specific social, political and historical contexts.

In a similar vein, Fairclough (1993:135) defines CDA as:

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discourse analysis which aims to systematically explore often opaque relationships of causality and determination between discursive practices, events and texts, and wider social and cultural structures, relations and processes in order to investigate how such practices, events and texts arise out of and are ideologically shaped by relations of power and struggles over power; and to explore how the opacity of these relationships between discourse and society is itself a factor securing power and hegemony.

In other words, CDA produces insights into the way discourse reproduces (or resists) social

and political inequality, power abuse or domination. Several scholars have worked within the

CDA framework on areas such as media discourse, political discourse, gender discourse, and

various institutional discourses such as classroom discourse and medical discourse.

Fairclough and Wodak (1997: 271) summarise the main tenets of CDA as follows:

1. CDA addresses social problems.

2. Power relations are discursive.

3. Discourse constitutes society and culture.

4. Discourse does ideological work.

5. Discourse is historical.

6. The link between text and society is mediated.

7. Discourse analysis is interpretative and explanatory.

8. Discourse is a form of social action.

This study also centres on rural healthcare. The materialist conception of rural health care

anchors on the fundamental assumption that health care is part and parcel of society. Health

begins with the axiom that human beings are the basis of both the forces of production, the