Referential Portraits in Russian Medical Interviews: Toward a Model of Cohesion

This paper presents initial findings from a large-scale study of over thirty clinical interviews recorded in hospitals in St. Petersburg and Moscow. Results from the fieldwork, undertaken in summer 1997, include audio-recorded and transcribed data sets and extensive observational notes. In the current paper I focus on one doctor’s interviews with three successive patients in order to identify several patterns of cohesion which I conclude to be language- and culture-specific to the setting of contemporary Russian medical discourse.

The framework for analysis is drawn, in part, from recent theories on the social construction of text as viewed through referential knowledge sets and cohesion in Russian (Yokoyama 1986, 1999, and Zaitseva 1999) and in Hebrew (Fine 1994). I identify the contextually- and culturally-bound shared knowledge sets (the so-called referential portraits) which ultimately serve to construct the text of contemporary clinical dialogues in Russia. These discourse frames will then be compared with the new “Master Interview Rating Scale” of the US Society of Teachers of Family Medicine (1997) to provide important cross-cultural analyses of these professional discourse models.

A comprehensive review of US doctor-patient discourse (Ong et al. 1995) indicates that previous traditions of “paternalistic” interviews, with doctor-dominated behaviors, have yielded to more “patient-centered” approaches with enhanced affective linguistic strategies prescribed for the doctor. However, no empirical studies to date have been undertaken in Russia to investigate this professional discourse. Despite this absence of information on Russian discourse practices, there have been many US-funded medical initiatives in Russia to establish private clinics and provide US-based training to Russian personnel. However, the measures of success remain mixed. Attempts to transfer the US interview “models” to the Russian setting, for example, present significant challenges beyond that of accurate translation alone.

My hypotheses posit the primacy of the social relationship between Russian doctors and patients in the construction and interpretation of the text. Variables include social status of the patient, gender of the doctor (the female-dominated medical profession in Russia vis-à-vis traditional “women’s speech”) and gender of the patient, shared belief in folk medicine, shared concern about the difficulty obtaining prescription drugs, and mutual expectations for patients’ contributions, including self-diagnoses. Against the background of this “Russian experience,” the interviews comprise a series of referential portraits, i.e., each participant’s picture of the deixis {I, you} and the mutually-shared code, which shapes the participation roles and ultimately reflects the cohesion—a cohesion unique in its linguistic and non-linguistic resources and one which differs markedly from the US-prescribed model.