Neurologist-patient interaction, an important hospital situation that focuses on the care for people with language-related disorders or impairments, has attracted interest from various disciplinary standpoints. Global attention to neurologist-patient interaction is growing, with focus on communication models, patterns, applications, and various indices in the interactional contexts. Similar attention remains scanty within the Nigerian context. This study, therefore, investigated communication model in neurologist-patient interaction in selected university teaching hospitals (UTHs) in southwestern Nigeria, in order to identify the communication goals and patterns, discourse strategies, pragmatic acts, and contexts that shape the interaction.
Jacob Mey's Pragmatic Acts, complemented by Emanuel and Emanuel's model of doctor-patient relationship, served as the theoretical framework. Data comprising 40 audio-recorded neurologist-patient interactions were collected from the UTHs of Olabisi Onabanjo University, Sagamu (nine); Ekiti State University, Ado-Ekiti (eight) and Ladoke Akintola University of Technology, Osogbo (six) and University College Hospital, Ibadan (17). These were supplemented with patients' case notes and interviews conducted with neurologists. The data were transcribed following modified Arminen's notations of conversation analysis and subjected to pragmatic analysis.
Four models of communication, namely paternalistic, informative, interpretive, and deliberative, exhibited through varying discourse strategies were identified in the neurologist-patient interaction with the diagnostic and therapeutic communication as goals. The paternalistic model reflected slightly casual conversational conventions and registers. These were achieved through the pragmemic activities of situated speech acts, psychological and physical acts, via patients' quarrel-induced acts, controlled and managed through neurologists' shared situation knowledge. All these produced empathising, pacifying, promising and instructing practs. The patients' practs were explaining, provoking, associating and greeting in the paternalistic model. The informative model reveals the use of adjacency pairs, formal turn-taking, precise detailing, institutional talks and dialogic strategies. Through the activities of the speech, prosody and physical acts, the practs of declaring, alerting and informing were utilised by neurologists, while the patients exploited adapting, requesting and selecting practs. Monologic contribution was the norm in the interpretive model. It involves the confirmatory and routine opening-and-closing discourse strategies. The communicative activities through the speech, prosody and physical acts showed the utilisation of deducing, predicting, prioritising and interpreting practs by neurologists; while patients adopted conforming, inquiring, requesting and deciding practs. The negotiating conversational strategy of the deliberative model featured in the speech, prosody and physical acts. In this model, practs of suggesting, teaching, persuading and convincing were utilised by the neurologists. The patients deployed the practs of questioning, demanding, considering and deciding. The contextual variables revealed that the four models often coalesced in the selected UTHs within the situational and psychological contexts. However, the paternalistic model was predominantly employed by neurologists with over six years in practice, while the interpretive, informative and deliberative models were found among neurologists below six years in practice in the selected UTHs.
Neurologist-patient interaction in university teaching hospitals in southwestern Nigeria is shaped by neurologists' experience, patients' peculiarities and shared knowledge. All these reinforce the paternalistic as an invaluable model for enhanced and effective communication.