Unequal Power Relationships in Medical Discourse: Exploring the Use of Inclusive and Exclusive Pronouns in Medical Consultations in Lahore, Pakistan

Abstract

The current rhetoric of medical consultations supports egalitarian and patient-centered interactions. However it is unclear, to what extent doctor-patient interactions practically represent partnership in Pakistan. The study identifies patient-centeredness through the deployment of inclusive and exclusive pronominals in medical consultations. The data were collected through 15 video-recorded medical consultations in healthcare sectors of Lahore in 2022. The occurrences of inclusive and exclusive pronouns were manually calculated from the transcribed data set. Four types of pronouns have been identified from doctors’ speech from the data set: 1) exclusive pronouns such as aap (you), and is (him/her); 2) exclusive pronoun ma (I) and hum; 3) inclusive pronouns such as hum (we); and 4) use of null pronoun. Patients were mostly submissive listeners. The findings suggested a prototypical pattern in doctor and patient interactions that identifies with doctors’ paternalistic approach of consultations with patients, despite the current paradigm that supports partnership between doctors and patients.