Complexity theory and conversational humour: Tracing the birth and decline of a running joke in an online cancer support community

This paper argues that a fuller understanding of conversational humour, in all its multifunctional, multifaceted, and heterogeneous nature, could be achieved by conducting at least some conversational humour research from the perspective of complexity theory (an umbrella term covering ‘complex adaptive systems theory’, ‘dynamic systems theory’, ‘chaos theory’, etc.). Complexity theory encourages questions that are not usually asked about conversational humour and provides ways of answering them. It ‘aims to account for how the interacting parts of a complex system give rise to the system's collective behaviour and how such a system simultaneously interacts with its environment’ making 'change central to theory and method’ (Larsen-Freeman & Cameron 2008: 1). The ‘objects of concern’ are no longer entities or things (e.g. the joke, a pun, etc.), but processes, changes and continuities: how do particular jokes, puns or humorous lexemes come into being in a given discourse community, how do their uses and meanings develop? The paper demonstrates the potential of a complexity approach to conversational humour by applying it to one particular manifestation of conversational humour: 235 instances of a running joke centred around the lemma rolo*, in approximately 680,000 words of online peer-support data (2544 forum posts, 47 blogs and blog comments), produced by 97 contributors over a period of 13 months in 2011–2012

'I feel like I am being stabbed by a thousand tiny men’: The challenges of communicating endometriosis pain

Endometriosis, as a widespread gynecological condition, affects an estimated 1 in 10 women and yet has a worldwide average diagnosis length of 7.5 years. Causing incapacitating pain, among other associated manifestations, the condition severely impacts on women’s lives. This article uses online survey data to investigate how pre-diagnosis endometriosis pain is conceptualized and articulated in order to explore communication challenges reported in early consultations that can potentially be seen to play a role in diagnosis delay. The findings of this study indicate that women feel that they do not have the appropriate tools to describe their pain and, in many instances, feel dismissed therefore prolonging diagnosis. The article finds that the majority of the pain descriptors identified use elaborate metaphorical scenarios to convey the intensity of the pain and concludes with some reflections on the issue of metaphorical language in endometriosis pain communication practices while calling for interdisciplinary work in order to devise appropriate tools for endometriosis pain communication

Examining the language demands of informed consent documents in patient recruitment to cancer trials using tools from corpus and computational linguistics

Obtaining informed consent (IC) is an ethical imperative, signifying participants’ understanding of the conditions and implications of research participation. One setting where the stakes for understanding are high is randomized controlled trials (RCTs), which test the effectiveness and safety of medical interventions. However, the use of legalese and medicalese in ethical forms coupled with the need to explain RCT-related concepts (e.g. randomization) can increase patients’ cognitive load when reading text. There is a need to systematically examine the language demands of IC documents, including whether the processes intended to safeguard patients by providing clear information might do the opposite through complex, inaccessible language. Therefore, the goal of this study is to build an open-access corpus of patient information sheets (PIS) and consent forms (CF) and analyze each genre using an interdisciplinary approach to capture multidimensional measures of language quality beyond traditional readability measures. A search of publicly-available online IC documents for UK-based cancer RCTs (2000-17) yielded corpora of 27 PIS and 23 CF. Textual analysis using the computational tool, Coh-Metrix, revealed different linguistic dimensions relating to the complexity of IC documents, particularly low word concreteness for PIS and low referential and deep cohesion for CF, although both had high narrativity. Key part-of-speech analyses using Wmatrix corpus software revealed a contrast between the overrepresentation of the pronoun ‘you’ plus modal verbs in PIS and ‘I’ in CF, exposing the contradiction inherent in conveying uncertainty to patients using tentative language in PIS while making them affirm certainty in their understanding in CF

Effective triaging in general practice receptions: a conversation analytic study

When patients call to make appointments at the doctors, the relative urgency of their healthcare needs is something that ‘triaging’ systems are designed to establish. This chapter investigates how receptionist-led triage unfolds in patients’ calls to general practice surgeries. We collected 2780 audio-recorded telephone calls from three UK surgeries, transcribed them and used conversation analysis to study the real-time interaction between receptionists and patients. We focused on receptionists’ initial responses to patients’ requests to make a doctor’s appointment, and how receptionists established whether patients’ medical needs require (i) a same-day appointment with a doctor, (ii) a call-back from a doctor or nurse, or (iii), if not urgent, an appointment on a future date. We show how variation in the way receptionists initiated the triaging, i.e., how they sought to establish whether or not the request was urgent enough for a same-day appointment, was consequential for the smooth progress of the interaction. First, when receptionists initiated triaging with a polar interrogative asking patients to (dis)confirm their problem as ‘routine’ (‘is it just a routine appointment?’), or when contrasting ‘routine’ and ‘urgent’ (‘is it urgent or routine?’), patients were reluctant to confirm either way. Second, triaging progressed more smoothly when receptionists asked questions that solicited accounts. Interrogatives that were effective in soliciting an account from the patient included both polar interrogatives (‘is it something (urgent) for today?’), and wh- interrogatives (‘may I ask what the problem is?’), but the latter was more problematic for patients who wish to withhold their reason for seeing the doctor. Third, when patients, in their initial inquiries, did not describe their problem as urgent, they readily accepted a future appointment – suggesting that receptionists need not ask about urgency at all, in the first instance. Our findings have implications for GP receptionist training and wider practice policies