Medical Action Into Surgical Text: a Discourse Analysis of the Production and Acquisition of a Particular Genre (Medical Records, Operative Reports).

Documenting patient care is a routine integral part of hospital activities. The operative report (OR) is one of many texts created by medical professionals regarding the patient's condition and reaction to treatment. Text-building here is a complex, yet generally untaught process. This dissertation derives from recent work in functional discourse analysis and modern philology (Becker 1980) which examines ways that context shapes and is shaped by the particular text itself. ORs are examined by a series of "thick descriptions" (Geertz 1973) attempting to unravel the complex matrix within which these texts are created. This dissertation examines surgical residents' roles in producing ORs. Various methodological tools are used: ethnomethodological, discourse, and contrastive text analyses. Relationships between ORs and other texts on the medical record are examined. ORs are examined from three perspectives: (1) Relationship between operation and OR, i.e., between operating room talk and the report's oral dictation; (2) Text's internal structure, i.e., relationship between episodic structure and the report's prosodic and grammatical features; and (3) Change in reporting styles over time, i.e., contrast between reports dictated in first and last years of residency. Examining any one of these relationships without taking into account the others results in a skewed view of ORs. This study concludes that ORs' communicative role in further patient care and their potential audience depend upon the operation's role in the patient's illness. The OR's "synoptic distanced" point of view does not fully reflect the operation's on-going discovery processes nor sociolinguistic manifestations of teamwork. The narrative script employed to describe the operation influences how it is reported, but this script does not fully capture the operation's actual unfolding of events. Episodes aid in examining the contrast between residents' first-year and fifth-year ORs. In first-year ORs, influence of narrative procedural genre is observed; in fifth-year reports, descriptive elements increase, although this increase is not as great as the decrease in procedural narrative elements. Features of reporting and text acquisition processes may result in "information gaps" between operations and ORs. Potential relationships between malpractice and information gaps and residency training implications are briefly discussed.Ph.D.LinguisticsUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/160856/1/8600528.pd