Table 1 Critical Discourse Analysis process demonstrated with exemplar CKD monitoring text passage
Textual passage ➜ | Description ➜ | Interpretation ➜ | Explanation |
|---|---|---|---|
Noteworthy properties of the text, such as phonology, grammar, vocabulary, figures of speech, and organization, are enumerated to identify explicit and implicit meanings. | Features of discourse practice identified and interpreted in an interpersonal context. | Textual properties and discourse practice explained in relation to larger sociocultural practice, such as the VA or nephrology care. | |
I still haven’t been given any instructions, no treatment, or recommendations whatsoever. I am supposed to come back in 2 weeks and they are going to run some more lab tests again. You know basically I’ve been giving blood, five vials of blood, a urine sample every 3 months for the last, I don’t know, 5 or 6 years. And now they still said well no treatment. They said well we’ll know, I’ll see you in 2 weeks. I said now wait a minute, you gonna wait till I die to tell me? But anyway I’m sitting in a state now I have no medication. I haven’t been told to do anything in particular. | Statements about expected and actual patient actions in monitoring appointments are bracketed by statements about provider inaction in same | The Veteran speaker describes ongoing CKD monitoring visits to his nephrologist to fellow Veterans and the moderator/recorder. | Weighing actions of the patient against actions of the provider with the verb “give” conveys an expectation that the patient-provider encounter is an exchange governed by norms of reciprocity, with patient showing up to appointments and giving blood and urine and the providers giving meaningful information in return. Instead, here the exchange is presented as one-sided, with patient giving routinely and waiting for something but receiving nothing in return. |
Repeated use of word “still” and phrases “again” and “five or 6 years” emphasize duration of situation | Speaker’s juxtaposition of “I still haven’t been given” with “I’ve been giving” characterizes monitoring as an unequal exchange | ||
Term “whatsoever” after statement about “instructions,” “treatment,” and “recommendations” from provider emphasizes totality of the lack | Addition of provider expectations (“I am supposed to”) suggests perceived double standard (expectations for patient but not for provider) | ||
Phrase “I am supposed to” conveys perceived expectations placed on patient | Patient suggests that he is being strung along with the promise of information in the future | ||
Verb “to give” used to describe both patient action (“I’ve been giving” blood and urine) and provider inaction (“I still haven’t been given”) brings patient and provider into direct comparison | Colloquial shift dramatizes confrontation in which patient rhetorically questions if information will come too late to help him | ||
Provider talk summarized as “well, we’ll know, I’ll see you in 2 weeks” implies delayed but promised delivery of information | |||
Phrase “Now wait a minute” indicates colloquial shift to directly addressing provider: “you gonna wait til I die to tell me?” | |||
End phrase “sitting in a state now” suggests helpless passivity | |||
Affective content is frustration |