Sunday, June 3, 2012

Shoulda Coulda Woulda

Catherine Schryer and Philippa Spoel: “Genre Theory, Health-Care Discourse, and Professional Identity Formation”

Schryer and Spoel introduce the terms ‘regulated’ and ‘regularized’ to our lexicon. Since regulated resources are the ones that are explicitly learned, recognized and/or required, I’ve been thinking of them as the formal, traditional genres, the ones that are defined so that they fit into categories. The regularized resources seem more closely related to Rhetorical Genre Studies because they are learned in context (situated cognition) and arise from tacit understanding rather than explicit direction. What I thought was particularly interesting is that Schryer and Spoel use these terms to refer to different uses of the same resource.

Like Carol Berkenkotter, they discuss the influence certain genres have on the formation of a professional identity. Berkenkotter focuses more on the way a manual influences the diagnostic vocabulary of a profession by serving almost as a translation tool. Schryer and Spoel look at two different resources and examine the influence they have on the professional behavior of doctors and midwives.

The case presentations Schryer discusses are formal tools medical students use to relate case histories to their faculty mentors. The structure and order of a case presentation is specific, but during the course of their presentations, students are guided in their use of language and even in the emphasis given to certain aspects of the presentation. Over time, students learn a professional language and move from seeing “any form of uncertainty as a personal deficit” to using “modal auxiliaries, such as can, could, may, might, must, shall, should, will, and would and adverbs, such as perhaps, maybe, and likely [that] ‘safely introduce levels of assuredness into the case presentation’” (264).

When I worked for a whitewater rafting company, part of what I learned and later taught was how to use degrees of promise. The absolutes came with definite language and had to do with the ordering of events: first you’ll do this, then this, than that. Anything that was possible, however unlikely, had to be tempered with an allowance for risk and usually had to do with assuaging fear or discussing the possibility of injury or death.  The words “you won’t get hurt” coming from anyone’s mouth was an invitation for every senior employee within earshot to descend and perform damage control. While the use of language was explicit in some manuals and in the release forms, the comfortable use of it came with time and indoctrination.

Spoel’s research had more to do with the ways the emerging healthcare community of midwives used the regulated genre of a policy binder to establish their position within the established medical profession. The midwives’ practice of informed choice is a communicative means of placing the decision-making power in the hands of the patient. However, the policy binder “stresses the midwife’s responsibility to other health professionals (not to the woman) so that they can together ‘plan’ the woman’s care”. 

Furthermore, since informed choice “appears within the [College of Midwives of Ontario]’s regulations as a diverse and inconsistently articulated practice”, there are challenges to knowing how to interpret the policies. Because some of the regulated policy is open to interpretation, midwives have an opportunity to regularize the genre of the policy manual through discussion of “the definition of information and decision making and the place of advice and explicit influence in the caregiving relationship” (269).

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