Power and Ideology in Doctor-Patient Discourse: A Critical Analysis of Interactions at Woldia Hospital, North Eastern Ethiopia

Power and Ideology in Doctor-Patient Discourse: A Critical Analysis of Interactions at Woldia Hospital, North Eastern Ethiopia

Muluneh Demissie Sisay

Woldia University, Sociology Department, Woldia Ethiopia

DOI: https://dx.doi.org/10.47772/IJRISS.2025.908000553

Received: 16 August 2025; Accepted: 23 August 2025; Published: 20 September 2025

ABSTRACT

This study critically analyzes the discourse of doctor-patient interaction at Woldia Hospital, Northern Ethiopian context. Using a qualitative research design and purposive sampling, data was collected from seven doctors and their patients through audio-recordings, observation, and semi-structured interviews. The analysis, guided by a theoretical framework that integrates Critical Discourse Analysis (CDA), Conversation Analysis (CA), and Speech Act Theory, follows Fairclough’s three-dimensional model to investigate the linguistic manifestations of power and ideology. The findings reveal a pronounced power asymmetry within the institutional discourse. Doctors exercise significant control over the interaction through exclusive rights to turn-taking and topic control, primarily achieved through the frequent use of interrogative sentences. This power dynamic is further manifested through their use of bald-on-record directive speech acts and technical jargon, which threatens the patient’s negative face and reinforces a knowledge gap. In contrast, patients predominantly adopt a submissive, reactive role, employing negative politeness strategies to mitigate threats to the doctor’s authority. The study concludes that language use in medical encounters is not merely a descriptive tool but a powerful social practice that both reflects and actively reproduces existing social relations and ideological assumptions, such as the doctor’s inherent expertise and authority. These findings provide critical insights into the nature of medical communication in the region and underscore the urgent need for communication skills training for healthcare professionals to foster a more egalitarian and effective doctor-patient relationship.

Keywords: Discourse Analysis, Doctor-Patient Interaction, Power, Ideology, Critical Discourse Analysis.

BACKGROUND OF THE STUDY

Effective communication is widely recognized as a cornerstone of quality healthcare. As Cardella (2004) suggests, the communication that occurs between a health practitioner and a patient is central to successfully assessing and managing a medical problem. It is, in essence, the “main ingredient in medical care” (Cardella, 2004). Ong et al. (1995) further delineate the purposes of this interaction, identifying three key functions, establishing a strong inter-personal relationship, facilitating the exchange of crucial medical information, and enabling shared decision-making regarding treatment.

Historically, the doctor-patient relationship was largely paternalistic, with the physician holding the authority to unilaterally direct care (Roter & Hall, 2006). This model, however, has undergone a significant transformation in recent decades. The growing emphasis on patient autonomy and shared decision-making has moved the relationship toward a more egalitarian partnership, prompting increased attention to the dynamics and quality of medical communication (Spiro, 2005). This shift is not merely a courtesy; research has demonstrated that improved communication leads to greater patient satisfaction, better adherence to treatment plans, and even improved health outcomes (Stewart, 1995; Zolnierek & DiMatteo, 2009). The move away from a one-way flow of information to a collaborative dialogue acknowledges that patients are active participants in their own care, possessing valuable insights and preferences that must be integrated into the treatment process.

Despite the evident importance of this communicative process, existing research in Western and other English-speaking countries continues to reveal significant problems. This is largely because doctor-patient interaction is not an ordinary, everyday conversation but a form of institutional discourse (Mishler, 1984). Institutions, such as hospitals, shape the language used within them, which, in turn, is shaped by wider social power relations. This dialectical relationship means that a common-sense assumption often exists in such settings, where participants adhere to differentiated, institutionally sanctioned roles: the doctor gathers information to diagnose and treat, while the patient provides information to receive a diagnosis and treatment (Heritage & Maynard, 2006). However, these seemingly neutral practices can embody implicit ideological assumptions that legitimize existing power structures, particularly the authority of the medical profession (Foucault, 1973).

The “medicalization of society,” a concept popularized by theorists like Ivan Illich (1976), has further increased the power and control of doctors, creating a dependency dynamic that contributes to a power imbalance in the relationship. This imbalance can manifest in various ways, from the use of complex medical jargon that excludes patients from understanding their own conditions to subtle non-verbal cues that reinforce the doctor’s authority (Ting-Toomey, 1999). Consequently, the very structure of the clinical encounter, while seemingly benign, can inadvertently create barriers to effective communication and shared understanding.

Statement of the Problem

Good health is an invaluable human asset, and the communication that underpins medical care is of paramount importance. The doctor-patient relationship forms the foundation for building trust, rapport, and understanding, which are essential for effective diagnosis and treatment (Frankel & Stein, 2001). This dynamic is a universal concern, but it takes on specific characteristics within different cultural and institutional contexts. In Ethiopia, a number of studies have been undertaken to address issues in medical interactions. For instance, Zewdnesh et al. (2009) and Zewdie et al. (2009) both concluded that deficiencies exist in doctor-patient communication, while Abrham (2012) highlighted miscommunication resulting from code-switching and the use of technical terminology.

From a medical anthropology standpoint, these communication failures are not merely linguistic errors but are often rooted in deep-seated cultural beliefs about illness, authority, and the body (Kleinman, 1980). A patient’s “explanatory model” of their illness, their personal beliefs about its cause, course, and potential treatment, may clash with the physician’s biomedical model, leading to misunderstanding and mistrust (Kleinman, Eisenberg, & Good, 1978). This is particularly relevant in settings like Ethiopia, where traditional healing practices and beliefs often coexist with Western medicine. Sociologists also highlight how socioeconomic factors, such as literacy levels, class, and social status, can influence a patient’s ability to participate equally in a medical conversation (Parsons, 1951). Therefore, a full understanding of these communicative challenges requires an approach that goes beyond language to include the cultural and social contexts in which it is embedded.

While these studies have provided valuable sociolinguistic and pragmatic insights, they have not fully explored the deeper, underlying issues of power and ideology. As van Dijk (1995) argues, institutional power holders may subtly abuse their influence to restrict the freedom of less powerful participants. The nuanced analysis required to uncover these “sometimes subtle strategies of such forms of discursive dominance” has not been conducted in the Ethiopian context. There is no published or unpublished study that investigates doctor-patient interaction from a critical discourse analysis (CDA) perspective. This research, therefore, aims to fill this significant gap by providing a detailed textual analysis of doctor-patient interactions at Woldia Hospital, focusing on how power and ideology are manifested through language use. Sociologists like Foucault (1973) have shown how medical knowledge itself is a form of power a “biopower” that disciplines and regulates bodies and populations. From this perspective, the doctor’s use of specialized terminology is not just a pragmatic choice but an exercise of control, establishing a boundary between those who “know” and those who must defer to that knowledge (Conrad & Schneider, 1992). Medical anthropologists further contribute to this understanding by examining how this power dynamic is culturally enacted. For example, the physical setup of the examination room, the sequence of questions, and the use of certain tones of voice can all reinforce the doctor’s authority (Mishler, 1984).

By employing CDA, this study moves beyond merely describing communicative deficiencies to explaining them in terms of these underlying social structures and power relations. It will reveal how language use in the clinical encounter serves not only to transmit information but also to subtly reproduce a social order where the medical professional holds a position of dominance. While existing studies in Ethiopia have empirically identified deficiencies in doctor-patient communication, they have not explored the deeper issues of power and ideology from a theoretical or methodological standpoint. Previous research, such as that by Zewdnesh et al. (2009), Zewdie et al. (2009), and Abrham (2012), has highlighted linguistic and pragmatic problems but lacks a theoretical framework, like critical discourse analysis (CDA), to explain how communication is shaped by social structures. Furthermore, there is an empirical gap, as no published studies in Ethiopia have applied a CDA approach to analyze these interactions. This research will fill these gaps by providing a detailed textual analysis of doctor-patient interactions at Woldia Hospital, focusing on how power and ideology are manifested through language to ultimately inform better communication practices and healthcare policies.

Thus, the main objective of this study is to critically analyze the discourse of doctor-patient interaction in Woldia Hospital with the following Research Questions:

• What are the dominant interactional features in doctor-patient interaction in the study area?
• What ideological assumptions are held by doctors and patients in the study area?
• How are power relations manifested through language use in the study area?

THEORETICAL FRAMEWORK AND LITERATURE REVIEW

The Notion of Discourse

The term ‘discourse’ is a broad and multifaceted concept, with various definitions depending on the field of study. Linguists often define it as anything “beyond the sentence” or simply as the study of language use. However, this study adopts a definition rooted in critical theory, viewing discourse as both a linguistic and a social phenomenon. As Fairclough (1995) argues, discourse is a form of social practice that involves a complex, dialectical relationship between micro-structures of language and macro-structures of society, such as power, ideology, and social structures. This perspective posits that language not only describes reality but also actively participates in its creation.

Theoretical Approaches to Discourse Analysis

Discourse analysis is an interdisciplinary field that encompasses a wide variety of approaches. This study employs an eclectic methodology that integrates three distinct, yet complementary, theoretical frameworks to provide a comprehensive analysis.

Critical Discourse Analysis (CDA)

CDA is the central theoretical framework of this study. As defined by Fairclough (1992), it is an approach that systematically explores the often-opaque relationships between discursive practices and wider social structures, particularly power and ideology. CDA views language as a form of social practice that is shaped by power relations and, in turn, has a constructive effect on social identities, relations, and systems of knowledge. This approach is not merely descriptive; it is an active intervention that seeks to expose oppressive discourses by making the mechanisms of power visible. The core premise of CDA is that language in use is always part of specific social practices and is inherently political, influencing the distribution of social goods and power. The study’s use of CDA reflects a deliberate intellectual stance, as it aims to “uncover injustice, inequality, taking sides with the powerless and suppressed” by explaining discourse structures in terms of social structures, rather than just describing them.

Conversation Analysis (CA)

While CDA provides the macro-level lens, Conversation Analysis (CA) serves as the micro-level tool for investigating the fine-grained structure of social interaction. CA focuses on how talk is organized in social communication, including phenomena like turn-taking, turn distribution, and exchange structure. By analyzing these organizational properties of the interaction, it becomes possible to identify the concrete linguistic manifestations of power and social relations. The concept of “interactional control features,” introduced by Fairclough (1992), is particularly relevant here, as it directly relates to how powerful participants dominate interactions through strategies such as turn-taking and topic control.

Speech Act Theory

Speech Act Theory, pioneered by Austin and Searle, is a framework for understanding how language is used to perform actions. An utterance is not just a sentence with a literal meaning but a performative act with a certain “force” that can have consequential effects on the listener. The theory distinguishes between three acts: the locutionary act (the utterance itself), the illocutionary act (the intended social function, such as requesting or advising), and the perlocutionary act (the actual effect on the audience). This framework is a crucial analytical tool for understanding the communicative intentions and effects within the doctor-patient interaction, revealing the actions that individuals perform using language and discourse.

Institutional Discourse

Institutional discourse refers to verbal exchanges where at least one participant is a representative of a work-related institution, and the interaction’s goals are partially determined by the institution itself. Unlike everyday conversation, institutional talk is goal-oriented, restricted, and often characterized by context-dependent rules and norms. Participants, who are often professionals or experts, enact and legitimize a multitude of power relations through their dialogue. The doctor-patient encounter is a prime example of institutional discourse, as it is structured around the doctor’s goal of diagnosis and treatment and is governed by rules of turn-taking, topic control, and social roles.

The Doctor-Patient Relationship: A Critical Analysis

The doctor-patient relationship is a complex social institution that has been a central point of inquiry for both medical sociology and anthropology. While sociology has primarily focused on the social structures of power, the role of medicine in society, and the dynamics of professional dominance, anthropology has concentrated on the cultural meaning of illness, the subjective experience of suffering, and the patient’s narrative. By integrating these perspectives, a richer understanding of the clinical encounter emerges, moving beyond the simple biomedical model.

The Foundational Sociological Perspective: Illness as a Social Role

One of the earliest and most influential sociological frameworks for understanding the doctor-patient relationship was introduced by Talcott Parsons in his 1951 work, The Social System (Parsons, 1951). Parsons, a functionalist, viewed illness not merely as a biological state but as a form of deviance because it prevents an individual from fulfilling their expected social roles, thereby disrupting the functional order of society. To manage this disruption, he theorized the “sick role,” a set of socially sanctioned behaviors and expectations. The sick role comes with two key rights and two responsibilities. The patient has the right to be exempted from their normal social duties (e.g., work) and is not held responsible for their condition, as illness is seen as beyond their personal control. However, these rights are conditional. The patient has a responsibility to view their condition as temporary and must seek and cooperate with a technically competent medical professional to get well. Parsons’ model places the physician in a powerful role as a social gatekeeper; legitimize the patient’s deviance and guiding them back to their functional role. This functionalist perspective sees the doctor-patient relationship as a harmonious, cooperative system that maintains social order (Parsons, 1951).

This functionalist model was later challenged by other sociologists who saw a less harmonious, and more conflict-oriented, dynamic.  Eliot Freidson, a key figure in medical sociology, critiqued Parsons’ model by arguing that medicine had achieved a level of institutional autonomy that he termed “professional dominance” (Freidson, 1970). Freidson posited that this dominance allowed the medical profession to define the division of labor within healthcare and to control its own activities, leading to a “false sense of objectivity”. He argued that the doctor-patient relationship is not cooperative but adversarial, characterized by a “clash of perspectives” where the physician’s objective, biomedical view of “disease” is privileged over the patient’s subjective, lived experience of “illness”. This power imbalance is systematically reinforced by the medical institution itself (Freidson, 1970).

From Disease to the Illness Narrative

Medical anthropology offers a profound re-framing of the doctor-patient relationship by shifting the focus from the purely biomedical to the human experience of suffering. A central figure in this transition is Arthur Kleinman, a medical anthropologist and psychiatrist, whose work is predicated on a critical distinction between “disease” and “illness” (Kleinman, 1988). Disease refers to the objective, pathological state of the body—the clinical manifestation of a “malfunctioning or maladaptation of biologic and psycho physiologic processes” (Kleinman, 1988). This is the domain of the physician. Illness, on the other hand, is the human, lived experience of sickness, the patient’s “personal, interpersonal, and cultural reactions to disease or discomfort” (Kleinman, 1988).Kleinman argued that a physician exclusively focused on treating the “disease” risks overlooking the patient’s “illness,” which encompasses the difficulties they face in living with their condition. This disconnect is a significant source of patient dissatisfaction and poor compliance. Building on this, Kleinman introduced the concept of the ” illness narrative,” which he defined as “a story the patient tells…to give coherence to the distinctive events and long-term course of suffering” (Kleinman, 1988). These narratives are not just symptom descriptions; they are powerful forms of meaning-making that provide insight into the patient’s understanding of their condition. By engaging with the patient as a “narrative subject,” physicians can gain a more holistic understanding and foster empathy.

The insights of Kleinman were expanded to a systemic level by his colleague, Paul Farmer. A physician and medical anthropologist, Farmer centered his work on the structural causes of suffering, arguing that poverty and social inequality are the most critical determinants of health outcomes (Farmer, 2005). For Farmer, the doctor-patient relationship was a vehicle for social justice. He pioneered the concept of ” accompaniment,” a deep, personal commitment that extends far beyond a single clinical encounter (Farmer, 2005). Accompaniment involves not only providing medical care but also advocating for the patient against the systemic forces that perpetuate their suffering. This approach transforms the role of the physician from a detached healer to a champion of social change.

The Critical Lens: Power, Control, and Medicalization

The doctor-patient relationship is also a site for the subtle exercise of power and control. Sociologist

Peter Conrad’s work provides a key framework for understanding how the process of medicalization operates as a form of social control (Conrad & Schneider, 1980). Medicalization is the process of changing “bad” behavior into “sick” behavior, thereby giving the medical profession the authority to intervene and manage it. Conrad identified three types of medical social control:  medical ideology, which imposes a medical model on a social problem; medical collaboration, where the profession assists other institutions; and medical technology, the use of drugs or other technologies to manage social problems (Conrad & Schneider, 1980). By gaining the “authority to define certain behaviors, persons and things,” medicine consolidates its power and legitimizes its right to intervene in an ever-widening range of human activities and experiences.

MATERIALS AND METHODS

This study employed a qualitative research design, which was the most appropriate approach for conducting an in-depth, interpretive analysis of doctor-patient interactions in their natural setting at Woldia Hospital. The qualitative paradigm is essential for examining the meanings and social practices that participants bring to the interaction, a core requirement for a critical discourse analysis. The study focused on the Ear, Nose, and Throat (ENT) clinic, which was chosen due to the frequency of detailed verbal interactions and the non-sensitive nature of the topics, which facilitated data collection through audio-recording.

Research Participants and Sampling

A purposive sampling technique was used to select participants who were best positioned to provide the rich, detailed data necessary to answer the research questions. The sample included seven doctors and their respective patients. This specific number of participants was carefully chosen because the goal of the study was not statistical generalization, but a deep, nuanced understanding of specific interactional patterns. The small sample size allowed for a detailed and rigorous analysis of each encounter. For the purpose of addressing the research questions on interactional features, power relations, and ideological assumptions, a total of 24 doctor-patient interactions were audio-recorded. From this corpus, eight interactions were strategically selected for in-depth, verbatim analysis. This selection was based on the richness of the data, ensuring the chosen interactions contained ample examples of linguistic features, such as turn-taking patterns, speech acts, and the use of technical jargon, that were relevant to the study’s theoretical framework and research questions.

Data Collection Instruments

Three distinct, yet complementary, instruments were used to gather data, each serving a specific purpose for a comprehensive analysis:

Audio Recording: This was the primary method for collecting raw, unscripted discourse. A digital audio recorder was used to capture the natural, spontaneous verbal exchanges between the doctors and patients. This method ensured a precise record of the language used, which was crucial for the micro-level analysis required by Conversation Analysis (CA) and Speech Act Theory. The audio files served as the foundation for the entire analysis, allowing for repeated listening and accurate transcription.

• Semi-Structured Interviews: These interviews were used as a supplementary instrument to gather background and contextual information from the participants. Open-ended questions were designed to encourage both doctors and patients to elaborate on their perspectives regarding their roles, expectations, and communication during the consultation. The data from these interviews was particularly vital for exploring the research question on ideological assumptions, as it provided direct insight into the participants’ beliefs that underpinned their communicative behaviors.
• Observation: Freehand observation notes were taken during the interactions to capture crucial non-verbal and paralinguistic features. This included capturing details such as body language, gestures, eye contact, and the physical arrangement of the consultation room. These observations were essential for a holistic discourse analysis, as they provided the social context necessary to interpret the linguistic data and understand how power relations were manifested beyond the spoken word.

Methods of Data Analysis

The data analysis was a systematic, multi-layered process guided by a combined theoretical and methodological framework. The analysis progressed from micro-level description to macro-level explanation.

Initial Transcription: The audio recordings were meticulously transcribed into Amharic, using standard orthography. This was followed by a precise translation into English, with careful attention paid to preserving the nuances of the original discourse.

Analytical Frameworks: The transcribed and translated data were then analyzed using three interconnected frameworks: Conversation Analysis (CA), Speech Act Theory, and Critical Discourse Analysis (CDA). CA was employed first to address the research question on dominant interactional features. It enabled the description of turn-taking patterns, the distribution of turns, and the overall exchange structure.

Speech Act Theory was used to analyze the illocutionary force of utterances, such as the doctors’ frequent use of bald-on-record directives and patients’ use of negative politeness, thereby revealing the intended actions and their effects within the interaction.

RESULTS AND ANALYSIS

This chapter presents the analysis of the data collected from the doctor-patient interactions at the ENT clinic. The findings are structured according to Fairclough’s three-dimensional model, moving from a description of the linguistic features to an explanation of the underlying social practices.

Turn Taking and Distribution of Turns

Fairclough (1992, p. 234) presents some questions as a framework for the analysis of turn taking process in an interactional setting. These set of questions are: “What turn taking rules are in operation? Are the rights and obligations of participants (with respect to overlap or silence, for example) symmetrical or asymmetrical?” I used these questions as a guideline to analyze the process of turn-taking and the distribution of turns in the doctors-patients interactions. Throughout the corpus data, it appears that the interactions are mainly organized around questions from the doctor. Questions, in this case, can be seen as a part of question-answer adjacency pairs. Adjacency pairs, according to Schifrin and Hamilton (1996. p. 65), are “pairs which consists of a first pair and a second pair and produced by different speakers within the interaction”. In addition to this, Fairclough (1995) sees questions as the principal structuring elements because they organize the above introduced three-part cycles. Such a cycle comprises a question from the doctor, a response from the patient, and an acknowledgment from the doctor. This can be seen explicitly in the following extract:

Extract 1

Amharic Version

Turn

(1)       ዶ- እሺ ሰላም ነህ? እንዴት ነህ?

(2)       ታ- ደህና ነኝ እግዚአብሄር [ይመስገን

(3)       ዶ-እሺ (.) ምን ሆንክ ንገረኝ እስኪ

(4)       ታ- ዶሮዬ በመጀመሪያ ይሄኛው ነበር (.) መዘጋት ብቻ ነበር . . .

English Version

(1)       D- Ok how are you? Are you fine?

(2)       P- I am fine thanks to God

(3)       D- Ok (.) What’s wrong with you? (.) Tell me

(4)       P- My ear um at first it was this one (.) it was only an obstruction. . .

In ‘turn 1’ the doctor initiates an exchange by asking the patient, which is presented in the extract as a form of a greeting, which shows the social function of language use. The patient in ‘turn 2’ then give a response for the doctor’s questions. Thus, in ‘turn 3’ the doctor explicitly acknowledges the patient’s response by uttering the word ‘ok’ and moving onto the next course of the consultation, which shows the completion of the first cycle of the interaction.

Additionally, ‘turn 1 and 2’ represents the first part of question-answer adjacency pair. Because, the doctor (turn 1) starts the interaction by asking a question. In addition to this, when the doctor finishes addressing his question, the patient in turn 2 starts answering the question that was raised by the doctor in turn 1. Furthermore, we can also find the same exchange structures in the following extracts:

Extract Two

Amharic Version

Turn

(18)     ዶ- ይሄ እኮ ታድያ ኖርማል ነው (.) ሌላ ምንም ችግር የለውም (.) ለምንድን ነው ምትጨነቂው

(19)     ታ- ¯ጉንፋን በሚያመኝ ጊዜ የወረደ ነበር [ሚመስለኝ

(20)     ዶ- ­ አዎ ያኔማ ሲነሳ ይችላል ጉንፋን ሲያምሽ እማ ሊነሳ ይችላል (.) አሁን ግን ምንም ስሜት የለሽም አደል?

(21)     ዶ- የሚያምሽ ስሜት አለ አሁን?

(22)     ታ- ሰሞኑን ሲያመኝ ሰንብቶ (.) ትላንት ስለውቢት አንስቸ አዘዞ [ደረስኩ

(23)      ዶ- [አዎ አሁን የህመም ስሜት አለሽ

English Version

(18)     D- This is normal (.) there is no other problem (.) why are you worried?

(19)      P- ¯While I was having a cold (.) I felt like it has come [down

(20)     D- ­ Yes it is possible when you’re having a cough (.) it’s possible (.) but you don’t have any feelings now, right?

(21)     D- Are you having any sickness now?

(22)     D- I have been sick lately (.) yesterday I started from ‘Wubit’ and reached ‘Azezo’

(23)     P- Yes are you feeling any pain right now?

(24)     D- What else is the problem other than this?

As it can be seen from the extract, the interaction is organized around questions from the doctor, which subsequently are answered by the patient. For instance, in ‘turn 18’, the doctor initiated an exchange by asking the patient ‘why are you worried’, which is answered by the patient (turn 19) by telling the doctor the reason why she is concerned. Subsequently, the doctor (turn 20) acknowledges her response explicitly when he told her ‘yes, it’s possible when you’re having cold.

Extract 3

Amharic Version

            Turn

(7)        ዶ-ይጨህብሃል

(8)        ታ- አቤት

(9)        ዶ-­ ይጮሃል

(10)      ታ- መጮህ ሳይሆን ዝም ብሎ ከስር ተነስቶ ያመኛል(.) ህክምና የሄድኩበት ጠብታና አሞክሳስሊን ቀዩ ተሰጠኝ ያንን አረኩ(-) ያንን ከጨረስኩ በኋላ አሁን መፍረጥ አመጣ

(11)      ዶ-ይፈርጣል

(12)      ታ- እ

(13)      ዶ-­ ይፈርጣል?

English Version

(7)       D– Does it make a noise?

(8)       P- Come again

(9)       D- ­ Does it make noises?

(10)     P- No, it doesn’t make noises (.) rather I feel pain starting from this bottom (.) the place I went for medication (.) um they gave me an ear drop and amoxicillin the red one… I used it (.) after I’ve finished, what brings me here now is the pus

(11)     D- Does it pus?

(12)     P- yes (.) there is this liquid thing

(13)     D- ­ Turn around

Similar with ‘extract two’, ‘extract three’ shows the doctor’s dominant role in questioning and acknowledging the patient’s response. For instance, in ‘turn 7’ the doctor initiated an exchange when he asks his patient whether or not his ear is hearing unreal noises. However, the patient on ‘turn 8’ has not heard what the doctor has said. So, in ‘turn 9’ the doctor once again initiated the exchange by asking the patient the exact same question. As a result the doctor’s question, the patient in ‘turn 10’ gave a detailed response. Afterwards, the doctor acknowledges the patient’s response by repeating what the patient has just told him.

Generally, one common feature that is present in all of the interactions is that most of the time the allocation of turns is determined by the doctor, who mostly used interrogatives. The patients only take turn when the doctors ask questions. Another major feature in the excerpts is the use of directive statements employed by the doctors. In cases when the doctor uses directives, the patient accepts and does what they have been ordered. Additionally, the extracts do show a few features typical to spoken discourse, such as, instance of brief pauses and overlaps. Generally, the overall structure of the interactions follow a question-answer sequences.

Thus, it seems that through their questions, the doctors are the ones who control the interaction in terms of exchange structure. No matter questions are understood us parts of adjacency pairs or Fairclough’s (1995) ‘three-part cycles’, it is the doctors who initiate the basic unit of the conversation, and to a large extent determines its characters. Through their questions they seem to limit the patients in terms of what they can say.

Topic Control

Another dominant feature in the corpus data is the progression of the topic, or what Fairclough (1995) calls ‘topic control’. According to Fairclough (1992, p. 234), in order to analyze topic control in interactional settings, the analyst asks: “how are topics introduced, developed, and established and by whom? Does one participant evaluate the utterance of others?” I used these sets of questions as a framework to analyze how the various topics introduced in the doctors-patients interaction.

Extract 4

Amharic Version

Turn

(3)       ዶ- እሺ ምን ልርዳህ?

(4)       ታ- ትንሽ አሞኝ ነበር (.) ከሰሞኑ [እንዳለ

(5)       ዶ- [ህመሙ የቱጋ ነው ሚሰማህ?

(6)       ታ- እ::: ከአለፈው ሳምንት አንስቶ ቀኝ ጆሮየ ዝም ብሎ ይበላኛል (.) እ አልፎ አልፎም እም [ይመግላል

(7)       ዶ- እስኪ ዙር (.) ልየው (.)­ዝቅ በል በደንብ

English Version

(3)        D- ok what can I help you?

(4)        P- I am a little bit sick (.) lately

(5)        D- Where do you feel the pain?

(6)        P- um since last week my right ear is itchy (.) besides, sometime it holds um [pus

(7)        D- Turn around (.) let me see it (.)­lower your head further

As it can be seen from the extract, the doctor is the one who decide what they should be talking about by asking questions. In this regard, the doctor mostly uses interrogative sentences about a specific topic after which the patient is expected to take his turn and reply accordingly. Hence, in ‘turn 3’ the doctor shifts from greeting the patient phase to attempting to discover the reason for the patient’s attendance using a question. Additionally, in turn 7 the doctor shifts from conducting a verbal and/or physical examination to further investigating the patient’s illness.

Extract 5

Amharic Version

            Turn

(9)        ዶ- ወደዚ ዙር (0.2) ስራህ ምንድን ነው

(10)      ታ- እ፡፡ ባጃጅ ነው ምነዳ

(11)      ዶ- መጀመሪያ ሲጀምርህ ታስታውሳለህ (.) ማሳከኩ እም መምገሉ ምናምን

(12)     ታ- እ::: እንጃ (.) እም ያለፈ ሰኞ ለታ እ ማለዳ ስነቃ ነው [መግል ይዞ የቆየኝ

(13)     ዶ- ሰኞ ማለት (.) ባለፈው ሳምንት (.) እስካሁን መቆየት አልነበረብህም (0.2)

English Version

(9)        D- Turn this way (0.2) what do you do for living?

(10)      P- I drive bajaj

(11)      D- Do you remember when it started first? The itchiness, the puss and the like

(12)      P- um, I don’t know (.) but, it has already held pus when I woke up early last Monday morning

(13)      D- Monday means? Last week? (.) You should have come sooner

(14)      D- Stand and when you turn to right um using this way (.) there is a toilet (.) wash your ear um the pus and the like (.) and come back

Another aspect which shows the doctor’s control of the interaction is the nature of questions he is asking. The doctor does not use open questions (turn 9 & 11), but more or less closed questions. In addition to this, the doctor is the one who is allocating turns in the interaction. As it can be seen from ‘turn 9 and ‘turn 11’, the nature of the doctor’s question set tight limits on the content of the patient’s answers. The questions which is asked by the doctor (turn 9 & 11) come in sequences. Thus, the answer the patient is giving in turn 12 is interrupted by the doctor.

Extract 6

Amharic Version

Turn

(4)        ዶ- ሰላም ነሽ?

(5)        ታ- ሰላም ነኝ [እግዚያብሄር

(6)        ዶ- [እንዴት ነሽ

(7)        ታ- አለን

(8)        ዶ- ምንሽን ነው ያመመሽ

(9)        ታ- ኦ ከሰሞኑ አንገቴ ውስጥ እያመመኝ ነው

(10)      ዶ- ጉሮሮዎሽንም እያመመሽ ነው

English Version

(6)        D- are you fine?

(5)       P- I am fine thanks to God

(6)       D- How are you?

(7)       P- Well

(8)       D- What seems to be the problem?

(9)       P- Um:: lately I am having pain inside my neck

(10)     D- Do you feel pain on your throat too?

In ‘turn 6’ the doctor begins his question before the patient has finished speaking, and there is an interruption. Then after completing the greeting phase, the doctor initial question in ‘turn 8’ ‘what seem to be the problem?, shows the doctor’s orientation to the forthcoming interaction as being a host of the interaction. In this regard, it can be seen that the doctor is working through a pre-set agenda, because he is shifting from one phase of the interaction to another, once he has what he believes as enough information. It is clearly seen from the above extracts that the doctors are the one who organize and control the topic of the interaction. They mainly accomplish this through questions. The doctors introduce, develop and dissolve topics using questions. Throughout the data, the doctors are the only interlocutors who are initiating every interaction. They have usually accomplished this through questioning the patients.

Discursive Practice: Interpretation

Having worked on the part labeled ‘Description’, we proceed with an interpretation of the text to expose the underlining speech acts. (Fairclough, 2001).

Speech Acts

Extract 7

Amharic Version

Turn

(8)       ዶ- ምን ነበር ችግሩ?

(9)       ታ- እ::: ከሰሞኑ ከአንገቴ  ውስጥ እያመመኝ ነው

(10)     ዶ- ጉሮሮትንም እያመሞት ነው?

(11)     ታ- ኦዎ እዚች ጉሮሮየ ውስጥ ማለት [ነው

(12)     ዶ- እ

(13)     ታ- እና አሁን [በቃ

(14)     ዶ- ምንድን ነው ሚያደርግሽ (.) ስትውጪ ያምሻል?

(15)     ታ- ስውጥ ስውጥ ሳይሆን ቡና መናምን ነገር ስጠጣ (.) በዛን ሰዐት በቃ ሆነ ስንጥቅጥቅ ነገር [ያረገኛል

(16)     ዶ- ­አ በይ እስኪ

English Version

(8)       D- What seems to be the problem?

(9)       P- Um:: lately I am having pain inside my neck

(10)     D- Do you feel pain on your throat too?

(11)     P- Yes here inside my throat I meant

(12)     D- Um

(13)     P- So now here

(14)     D- How does it feel (.) do you feel pain when you swallow?

(15)     P- Not when I swallow (.) while I am drinking coffee and stuff (.) during that time it feels like this cracking [thing

(16)     D-­Say ‘HA’

In the above extract, the doctor in ‘turn 8’ uttered the sentence “what seems to be the problem’, which is a directive speech act. By deeply looking into the utterance, we can come to understand the doctor’s intention (the illocutionary act) why he utterers the sentence. In medical consultation, complaining by the patient usually serves as an avenue for both the doctor and the patient to exchange ideas, and for the doctor establish the conditions of the patient and consequently diagnosis the patient’s problem (Berry, 2007).

Therefore, by performing the directive locutionary act (turn 8), the doctor is giving the patient the floor to tell him about her problems. As a result, the patient in ‘turn 9’ uttered the sentence “um lately I am having pain inside my neck”. By looking at the bold highlighted phrase, it can be understood that the patient is claiming that she is experiencing a pain, which makes her utterance a representative speech act. Because, representative speech act, according to Searle (1969), “commits the speaker to the truth of an expressed proposition. It represents the speaker’s belief of something that can be evaluated true or false”.

However, the patient’s utterance, at the same time, can be viewed as a directive (request) which is presented as an indirect speech act. This is because, by evaluating the illocutionary act of her utterance, one can come to understand that the patient has not came to interact with the doctor just to claim that she is experiencing pain in her neck and leave, but to request the doctor to give a proper diagnosis for her problem.

Politeness and Face Threatening Speech Acts

In very general terms, politeness is seen as a feature of interpersonal conduct whereby a person “shows regard for another person by trying to make that person feel comfortable or by making an obvious effort to avoid making that person feel uncomfortable” (Green, 1996. P, 148). Brown and Levinson (1987) constructed their theory of politeness on the premise that many speech acts are intrinsically threatening to the face. Speech acts are threatening in that they do not support the face wants of the addressee. According to Fairclough (1992, p. 234), “the objective of the analysis here is to determine which politeness strategies are most used in the sample, whether there are differences between participants, and hat these features suggest about social relations between participants”. He added, “An analyst may ask: “which politeness strategies are used, by whom, and for what purpose?” (Fairclough, 1992, p. 234). Thus, I used these questions as a guideline to analyze the strategies of politeness that are employed in the doctor-patient interaction.

Extract 8

Amharic Version

Turn

(1)       ዶ – ሞገስ፣ ሰላም ነው?

(2)       ታ- እግዚአብሄር ይመስገን [ዶክተር

(3)       ዶ- እሺ ምን ልርዳህ?

(4)       ታ- ትንሽ አሞኝ ነበር ዶክተር (.) እንደው ብታዩኝ ብዬ ነበር [እዚ

English Version

(1)       D- Moges, how are you?

(2)        P- Thanks to God Doctor

(3)        D- ok what can I help you?

(4)        P- I am bit sick, doctor (.) perhaps, I am wondering if you could look at me here

There are a number of politeness strategies and face threatening speech acts in the above extract. The doctor (turn 1) addressed his patient’s without adding any title or vocation before his name as ‘Moges’, which is followed by a greeting. However, the patient (turn 2) responds to the doctor by saying “thanks to God doctor”, which shows the patient is addressing his hearer by using a politeness strategy which is aimed to mitigate the threat towards the doctor’s negative face. Consequently, as Morand (2000. P, 238) states, “negative politeness tactics include, among others, apologies (e. g. Excuse me), verbal hedges (e. g. I wonder if I could…?), or use of honorific terms such as Mr., Professor, Doctor and etc.”

Furthermore, since, the doctor (turn 1) presents his self as member of the institution, which is Gondar University Hospital, the speaker (turn 2) addresses his him as a ‘doctor’, which gave the addressee an institutional identity. By doing so, the patient (turn 2) used a negative politeness strategy, which is, by respecting the doctor’s negative face desires of self-image and by addressing him using honorific term of ‘doctor’. Hence, as Brown & Levinson (1987) state, the speaker can also decide to appeal to the addressee’s negative face, “his basic want to maintain claims of territory and Self-determination” (p, 47) using negative politeness. Since there is a self-image that is claimed by the institution member (i.e. the doctor), addressing him as a ‘doctor’ can be measured as a politeness strategy.

Extract 9

Amharic Version

Turn

(19)     ታ- ጆሮየን አሞኝ ነው (.) እንደው ብታዩኝ ብዬ [ነበር

(20)     ዶ- [ምን አደረገህ ጆሮህን?

(21)     ታ- ይፈርጣል

(22)     ዶ- ኦኬ (.) መቸ ጀመረህ

(23)     ታ- ከህፃንነቴ [ጀምሮ

English Version

            (19)     P- My ear aches (.) I’m wondering if you could look me [up?

(20)     D- [How do you feel in your ears?

(21)     P- It exudates

(22)     D- Ok (.) when did it start?

(23)     P- ever since my childhood

From the above extract, it can be seen how the patient was cautious about not being rude towards the doctor. For instance, on turn 4, the patient has used hedging (I am wondering if you could …) to address the imposition towards the doctor’s negative face. Hedges, according to Brown and Levinson (1987), are ways of politeness strategies that minimizing the threat towards the hearer’s negative face (p, 36).

However, the doctor, on ‘turn 20’ performed a directive speech act towards the hearer by asking the patient to show him where he feels the pain without using any redressive strategies. Thus, as stated in Searle (1975), directive illocutionary acts are speech acts that are cause the hearer to take a particular action”. By doing so, the doctor (turn 20) threatens the hearer’s negative face. Negative face, according to Brown and Levinson (1987) refers to, one’s need to be independent, to have freedom of action, and not to be imposed on by others.

Extract 10

Amharic Version

Turn

(14)      ታ- አዎ (.) ፈሳሽ ነገር አለው

(13)     ዶ- እስኪ ዙር (0.2)

(14)     ዶ- መች ነው የጀመርህ

(15)     ታ- ዛሬ ሁለተኛ ወይ ሶስተኛ ቀኔ ነው (.) እንዲውም ጭራሽ የኩክ [ማድረቂያ

(16)     ዶ- ቆይ እስኪ አንዴ ልየው በደንብ (0.5)

(17)     ዶ-­ጎንበስ በል (0.2)

English Version

(12)     P- yes (.) There is this liquid thing

(13)     D- Turn around (0.2)

(14)     D- When did it start?

(15)      P- Today is my third or second day (.) matter fact an ear wax [dryer

(16)     D- [wait (.) let me take a very good look at it (0.5)

(17)     D- ­Lower your head (0.2)

From the above extract, the doctor in this case (turn 13) once again committed a face threatening act towards the patient’s negative face by not minimizing the imposition. By looking at the utterance that is made by the doctor (i.e. turn around!), one can understand that it is an imperative sentence, in which case, it is also a negative FTA. Consequently, according to Brown and Levinson’s (1987, p. 24) definition, “negative face threatening acts are acts that affirm or deny a future of the hearer creates pressure on the hearer to either perform or to not perform the act”.

Negative Face is the need to be independent, to have freedom of action, and not to be imposed on by others (Levinson and Brown, 1987). However, the doctor (turn 17) showed little or no desire to maintain the patient’s negative face needs by performing a perfomative speech act ‘lower your head’, which, once again can be seen us a directive speech act without any redressive action which makes it a bald-on strategy. Hence, the utterance is clearly a command, for according to Austin’s preliminary informal description, the idea of an ‘illocutionary act’ can be captured by emphasizing that “by saying something, we do something”, as in the above utterance in turn 13 and 17, when the doctor issues an order to ‘turn around’ and ‘lower your head’ respectively, the patient is expected to do what he is told. Thus, it is a direct threat to his negative face needs of ‘freedom to action’.

Social Practice: Explanation

From the analysis under section 4.1 and 4.2, we have seen the role of the doctor in the interaction as being the dominant interlocutor. In this regard, Freed (2014, p. 53) states, “powerful institutions and individuals use language as both a means to construct their power and as a way to maintain it. Language thus becomes necessary for the maintenance of power, and the power and effect of language in turn rely on the power of individuals and institutions themselves”. Language, thus, is “delineated as ‘a social practice’, by which power relations are established and sustained” (Fowler, p. 61). This supports Fairclough’s (1995) view that power is not only built and sustained via coercive (by force), but also via indirect ways (the use of language). Such manifestations of power are found in the above interaction between doctors and patients . Additionally, as I observed and noted down, the patients were performing and giving answers to the orders of the doctors by doing what they were told. This clearly shows power asymmetry in the interaction. Consequently, as Fairclough (1995, p. 165) states “politeness is based upon recognition of differences of power, degrees of social power, and so forth oriented to reproduce them without change”. Besides  I have witnessed during my observation, the doctors were the only ones who were speaking with a high pitch range and confidence. Patients, on the other hand, were speaking with a very low intonation, which sometimes made it hard even for me during the transcription stage of the study to easily understand what they actually were saying. In this regard, the loudness may indicates confidence and authority of the doctors, while the soft or low intonation indicates uncertainty and politeness of the patients. In addition to the observation, the data from the audio recording have also shown how power can be manifested through the use of language. As it can be observed in the following extracts taken from the interaction between doctors and patients in ENT clinic of Gondar University Hospital, the doctors exercised their power in the interaction with patients.

Extract 11

Amharic Version

Turn

(21)     ታ- {በህመም እያቃሰተ ነው}

(22)     ዶ- ጠንከር በል ጭንቅላትህን ቀና አዳርገው ቀና ቆይ አንዴ ልየው እኔ መጀመሪያ

(22)     ቁስሉ እዚጋ ሜምብሬን ፈጥሯል ይኸውልህ (.) ይሄ ነው እኮ ነገሩ (.) ይሂ ነው መሃል ላይ የተፈጠረው

(23)      ዶ- ወደ ላይ ሊልህ ነው

(24)     ታ- አረ አደለም

(25)     ዶ- ­ታዲያ አንዴ ተረጋጋና ቁጭ በል (.) እህ እንደዚህ መጨናነቅ

(26)     ዶ-ተንቀጠቀጥክ እኮ

(27)     ታ-እ

(28)     ዶ-ተንቀጠቀጥክ (.) ሂድና ታጠበኀው ና በውሃ

English Version

(21)     P- {Moaning in pain}

(22)     D- Be strong (.) keep your head up (.) up (.) wait let me look at it first

(23)     D- look the wound has created a membrane right here (.) This one is the thing (.) this is the one created in between

 (24)    D- Are you going to throw up?

(25)     P- No

(26)     D- ­Then calm down and sit still (.) ugh what’s all this stressing out is about?

(27)     D- You are shivering

(28)     P- Um

(29)     D- You are shivering (.) go wash it with water

The above extract shows the dialogue between a doctor and a patient. The doctor has inserted a medical tool inside the patient’s ear for diagnosis. Being that, as it can be seen from ‘turn 21’ the patient is experiencing a pain. As a result he is moaning. However, it can be seen from turn 26 and 29 that the doctor is being impolite and performing the FTAs without giving consideration to what the patient is going through. This is not the only case,

Extract 12

Amharic Version

Turn

(9)       ታ-ከምላሴ ላይ የሆነ ፈንገስ ነገር ወቶብኝ ነው

(10)     ዶ- እስኪ አ በል (.) ታይተኸው ነበር

(11)     ታ- አዎ (.) ግን የሆነ ሚቀባ መድሃኒት ነገር ታዘዘልኝና ተጠቀምኩ ምንም አይነት ለውጥ አላመጣም

(12)     ዶ- አዎ አያመጣም (.) ምክንያቱም ፈንገስ አይደለም ይኼ

(13)     ታ- ምንድነው?

(14)     ዶ- ፈንገስ እያሉ ያልሆነውን ነገር እንደው (.) ምን መሰለህ (.) ይሄ ጂኦግራፊካል ታንግ ነው

(15)     ታ- የምን?

(16)     ዶ- አዎ (.)ጂኦግራፊክ ታንግ  የሚባለው ነው (0.2) እንደውም ይሄ ምላስህን የሸፈነው ፓፒላ

(17)     ታ- ፓፒላ?

(18)     ዶ- ያ (.) ይሄ ነጫጩ ነገር ምላስህን የሸፈነህ ማለት ነው

 (19)    ታ-እ (.) እሺ

(20)     ዶ- ለማንኛውም እም (.) ይሄ ፈንገስ አይደለም (.) ፈንገስ እኮ ብዙ ግዜ ሚመጣው ከካንዲዳ ነው (.) ያንተ ግን ጂኦግራፊክ ታንግ ነው ሚባለው (0.2)

(21)      ታ- ምንድነው ግን እሱ？

(22)     ዶ- እንደ ካርታ አይነት ስዕል ያለው ማለት ነው (.)

English Version

(9)       P- I’ve got a fungal like thing on my tongue

(10)     D- Say ‘HA’ (.) have you checked it?

(11)     P- Yes (.) but a to be smeared drug was prescribed to me and I’ve used it (.) nothing has changed

(12)     D- Yes it hasn’t (.) because this is not fungal

(13)     P- What is it?

(14)     D- They are calling it fungal (.) the thing that’s not (.) look (.) this is a geographical tongue

(15)     P- a what?

(16)     D- Yes (.) it is called geographic tongue (0.2) for that matter the papilla covering your [tongue

(17)     P- [papilla?

(18)     D- yeah (.) it means these the whitish things covering your tongue

(19)     P- oh okay

(20)     D- anyhow um (.) this is not fungal (.) fungal usually comes from candida (.) um but yours is called geographic tongue (.2)

(21)     P- what is it though? (Geographical tongue)

(22)     D- it means something which has a map like image (.)

The above extract shows how language is used to maintain a certain power relation between the interlocutors. The doctor in this case uses a highly technical jargons as “geographical tongue/ጂኦግራፊካል ታንግ” (Turn 14), “geographic tongue/ ጂኦግራፊክ ታንግ (Turn 16), “papilla/ፓፒላ (Turn 16), and “candida/ካንዲዳ (Turn 20). The doctor choose these medical jargons or words of his field of expertise to explain to the patient about his health condition.

The doctor could have used an ordinary everyday language, as he did on ‘turn 22 (it means something which has a map like image), to explain the patient’s problem, which the patient could have understood it without any difficulties. Rather, the doctor favors words (discourses) which are not accessible to the patient.

The above extract shows the doctors repeated usage of medical jargons. The way the doctor uses language during the above interactions to promote his ideological interests, or simply to preserve his authority over the patient, would contribute to the maintaining of the social relationship or the social practice between the two (doctors and patients). In this regard, it can be said that the doctor, by way of explaining to the patient what his problem, is enforcing formation of values, social or medical, which marks ideology. This supports Fairclough’s (1995, p. 86) view, which claims “ideological state apparatuses (institutions such as medical) are both sites of and stakes in class struggle, which prompts to struggle in and over discourse as a focus for an ideologically oriented discourse”. Consequently, Candlin (2000, p. 230) states that “the usage of medical jargons by the doctors is of on-going character and can be characterized by not giving an emphasis for patients’ feelings and concerns, and is an effort to maintain the basic inequalities in medical consultations”.

Consequently, Fairclough (1995) states “the ideology within which a text is written (or spoken) constrain choices in discourse organization, grammar and lexis. Hence, the language use in the above interaction has showed the ideology which is held by the doctor. For instance, most of the words the doctor uses (words like ‘geographical tongue, papilla, and Candida) are technical jargons on the account that they are uniquely related to the field of medicine.

Additionally, as it is clearly understood from the patient’s response on ‘turn 22’ (what is it though/ምንድነው ግን እሱ？), he has not understood all the above explanations which were given by the doctor about “geographical tongue”. This shows that the patient’s knowledge of the medical field is relatively lesser than with that of the doctor’s.

In this regard, the doctor could at least consider the fact that the patient is, of course a patient, and not his collogue in medicine. Thus, the doctor’s personal use of language denotes asymmetry and an interest in maintaining a “doctor-patient” distance.

Schultz and O’barr (1984. p, 32) state, “power is developed and maintained via interaction”. In addition to this, Fairclough (1989) wrote that “language is a social practice, and that power is constructed and developed via social interactions marked by hierarchy and asymmetry”. Thus, the above seen discursive construction of power by the doctor can also lead to changing social practices and realities.

DISCUSSION

The findings of this study confirm that the doctor-patient interaction at Woldia Hospital is a site for the manifestation and reproduction of institutional power and ideology. The analysis, guided by the principles of CDA, revealed that the doctors hold significant discursive control, which is evident in every facet of the interaction, from the distribution of turns to the choice of words. This aligns with Fairclough’s (1995) view that power is not solely maintained through physical coercion but also through indirect, linguistic means. The study’s findings on turn-taking and exchange structure show that doctors consistently initiate and control the conversation using interrogatives, a pattern common in institutional discourse as noted by Heritage (1997). This places patients in a reactive role, a dynamic that Schultz and O’Barr (1984) identified as a form of “powerless language.” The doctors also control the topic progression, often interrupting patients to maintain a pre-set, biomedical agenda. This limits the patient’s ability to provide a holistic account of their illness, prioritizing symptoms over personal experience.

The analysis of politeness strategies highlights a clear imbalance. Patients use negative politeness, such as honorifics and hedges, to show deference to the doctor’s higher status, as described by Brown and Levinson (1987). In contrast, doctors use bald-on-record directives without any polite modifications. This communication style, as Culpeper (2011) explains, is often acceptable from a high-status individual to a subordinate. The patient’s immediate compliance with these commands reinforces the power dynamic.

The use of medical jargon is a key ideological tool. The doctor’s use of terms like “geographic tongue” and “papilla” asserts their professional authority and creates a knowledge gap. By using language inaccessible to the patient, the doctor reinforces their position as the sole expert, disempowering the patient and fostering dependency. This aligns with Candlin’s (2000) view that such language maintains inequalities in medical consultations. The patient’s confusion, evident in their need for clarification, shows the effectiveness of this practice in maintaining the doctor’s symbolic capital.

The findings challenge the functionalist perspective of a harmonious doctor-patient relationship, as proposed by Talcott Parsons (1951). Instead, the data from Woldia Hospital supports a conflict-based perspective, where the doctor’s authority is actively constructed through discursive practices. The study also highlights the “clash of perspectives” (Freidson, 1970) between the doctor’s focus on “disease” and the patient’s experience of “illness” (Kleinman, 1988). The lack of shared decision-making and the patients’ low-intonation speech indicate a profound power difference. While the study’s focus on a single clinic is a limitation, its application of a critical framework to the Ethiopian cont

The doctor’s consistent use of directive speech acts and bald-on-record FTAs, without any attempt at redressive action, is a powerful demonstration of their institutional authority. This behavior is normalized by the patient’s submissive role, as demonstrated by their use of negative politeness and implicit requests. The asymmetrical nature of politeness in this context is not a matter of social etiquette but a mechanism that perpetuates the power differential. This phenomenon can be understood through the lens of  Eliot Freidson’s concept of “professional dominance,” which highlights how the institutional power of the medical profession systematically overrides the patient’s perspective, leading to a “clash of perspectives” (Freidson, 1970).

Furthermore, the doctor’s reliance on specialized medical jargon is not merely an efficient way to communicate with colleagues; it is a strategic and ideological choice. By using language that is inaccessible to the patient, the doctor reinforces their position as the sole holder of expertise and knowledge, which serves as a form of symbolic capital. This disempowers the patient, who is placed in a position of dependence. These findings are consistent with the work of Mishler (1999), who noted how doctors interrupt patients to control the interaction, and Candlin (2000), who characterized the use of medical jargon as an effort to maintain basic inequalities in medical consultations. The observed power asymmetry challenges the functionalist view put forth by  Talcott Parsons, who theorized a harmonious doctor-patient relationship where the physician acts as a social gatekeeper to manage the “sick role” (Parsons, 1951). In contrast, the data from Woldia Hospital supports a more conflict-based perspective, where the doctor’s authority is actively constructed through discursive practices. The patient’s struggle for voice, as evidenced by their low intonation and limited turns, also speaks to the profound difference between the doctor’s biomedical focus on the “disease” and the patient’s lived experience of “illness,” a distinction central to the work of

Arthur Kleinman (Kleinman, 1988). The lack of shared decision-making observed in the interactions indicates that the patient’s illness narrative is largely ignored, which can contribute to patient dissatisfaction and, as Paul Farmer’s work suggests, can lead to a failure to address the social and structural factors that impact health (Farmer, 2005).

CONCLUSION

This critical analysis of doctor-patient interactions at Woldia Hospital provides a significant contribution to the understanding of medical communication in the Ethiopian context. The findings unequivocally demonstrate a pronounced power asymmetry within the institutional discourse of the clinic.  The analysis of interactional features revealed that doctors maintain exclusive control over the conversational flow. Through the use of interrogatives, they initiate exchanges, dictate the topics, and limit patient contributions, creating a rigid question-and-answer sequence. The patient, by contrast, is consistently relegated to a submissive and reactive role, primarily providing answers and adopting negative politeness strategies to avoid challenging the doctor’s authority. This power imbalance is further reinforced by linguistic choices that serve to legitimize the doctor’s professional dominance. The study found that doctors frequently employ bald-on-record directive speech acts and use technical jargon (These linguistic strategies not only threaten the patient’s negative face but also construct a significant knowledge gap, reinforcing the ideological assumption that the doctor is the sole repository of medical knowledge. The patient’s inability to fully engage or question these directives is a direct consequence of this power structure.

Ultimately, the research concludes that the language used in these medical encounters is not simply a neutral tool for exchanging information. Instead, it is a powerful social practice that actively reproduces and reinforces existing social relations. The discourse at Woldia Hospital embodies the ideological assumption of the doctor’s inherent expertise and authority, which is deeply rooted in the broader “medicalization of society.” The findings of this study, therefore, provide crucial insights into the specific nature of medical communication in this region and highlight a pressing need for communication skills training for healthcare professionals. Such training should aim to foster a more patient-centered approach, shifting the paradigm from a paternalistic model to one that promotes shared decision-making and respects the patient’s narrative and agency

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