All along, I have never enjoyed analysing texts. When i realised that the topic for this week was written discourse, I was like "uh-oh". Luckily class was quite interesting, with all the activities and the discussions. It was also interesting to know that people actually analyse texts and classify them through the different styles, especially the English and Oriental styles which I could much more easily identify with. Having said that, I still don't like analysing texts.


Writing Chinese Essays in English Style
Anyway, having learnt about the Chinese and English ways of writing, it does bring to my mind about writing English and Chinese essays during my primary school, secondary school and junior college days. I have always struggled with writing Chinese essays, and my grades were always borderline passes. When I went to my teachers and asked them why I fared so badly, all they could tell me was that besides my limited Chinese vocabulary, my style of writing was just so English, and it felt like a direct translation from English. And that was it. I asked which aspect of it was so "English", and none of them could give me a satisfactory answer. The typical answer was, "Just read your friends' essays and more Chinese story books." And that obviously didn't help me much, because I still couldn't see the difference. Maybe I should write to the Ministry of Education (MOE) to request them to send all their teachers to attend GEK1036.

Patient Information Leaflets - Are They Written in the English or Oriental Style?
With regards to pharmaceuticals, it also came to my mind the way that patient information leaflets (found inside medication boxes) are phrased actually follows the "English" style of writing. It is more direct, with a main topic before elaboration or supporting points. And to me, that's really important. If it followed the "Chinese" style of writing with all the "peripheral" information before coming to the main point, I wonder how many patients will actually bother to read till the end.

Let's take for example a paragraph I extracted from the package insert of a paracetamol suppository box. Just to provide some simple background information, paracetamol is the active ingredient in the painkiller Panadol, and the dosage form that we are most familiar with is the tablet form. However, there are many other dosage forms of paracetamol, including syrups, suspensions, pessaries, injections, and suppositories. Suppositories are little bullet shaped dosage forms containing the active ingredient and it is inserted into the rectum (or anus). It has a much quicker onset of action than the regular tablet form, and that means it works faster.

This is what it looks like in the information leaflet:

FOR RECTAL USE ONLY
This medication is for rectal use only. Do not consume orally or mix with other solvents. If you are unsure on how to use this medication, please consult your healthcare professional for further advice.

It goes straight to the point, telling patients that it is not to be consumed orally, before elaborating with more information. This is extremely important, because for a patient who just purchased such a product, he might assume that it is to be consumed orally. Especially for a person who's having a splitting headache, all he wants is to take something to quickly relieve his discomfort. I don't think a "Chinese" style of patient information would suit him. Imagine if it were like this (and yes it follows Text B of Activity 2) :


"Of all the ways that paracetamol can be administered in the world, some are more popular than others. Sean Ang likes the tablet form, and Fabius Chen prefers the sweet and tasty syrup form. Ever since paracetamol came to the market, people all over the world favour the tablet form. This box however, favours the suppository form because it works much faster and is just as potent as the tablet form. It is cone shaped, yellow, and wrapped in foil. The longer it stays refrigerated, the longer it lasts. Every suppository stands upright and firm. It is best to insert it into your rectum, but not eat it."

OH MY GOODNESS. If I were the patient who was suffering and I had no idea what a suppository was, I would stop reading after the first 2 lines and just consume the suppository orally and treat it as a larger sized pill. (and yes, it has happened many times before all over the world)

Having said that, perhaps if I was educated in the Chinese form of writing, I would learn to interpret all that at a glance. Then again, when it comes to medication, I'm not so sure that I would want my patient to interpret on his own what the information on the leaflet was trying to say. For me, it has to be writer responsible. It would be disaster to have a reader-responsible patient information leaflet.

As such, it is my guess that patient information leaflets that have "Chinese" as the main language actually follow an "English" style of written discourse. This is mainly functional, with patient safety of utmost importance, rather than sticking to the traditional style of writing.

That's all for this week, happy mid sem break!




Class this week was interesting for me, especially for the part where we composed a short story. My group managed to come up with that little poem which I'm very proud of, and I was very excited to present it to the class. Well done, team!


The part about spoken discourse was a little confusing for me though. I got it mixed up with a speech event. I hope I got the concept right in some of my thoughts penned below.

Anyway, while reading about the telephone openings and trying to figure out what the topic was all about, something related to pharmacy came to my mind again. It is once again about a pharmacist's interactions with the patient.

Pharmacists' Interactions with Asian and Caucasian Patients

In my experience doing my attachment at the polyclinics and the hospital, a pharmacist speaks differently to a caucasian, as compared to an asian who typically nods at everything the pharmacist says, whether or not he really does understand the instructions. I personally feel that this is due to a stereotype that healthcare professionals (including doctors, nurses and the allied health professionals) have with regards to the attitudes of our patients.

For example, let's compare a typical scenario where a caucasian patient and an asian patient comes to collect his medications.

(Ding dong) - queue number flashes
Pharmacist: Good morning sir.
Patient: Good morning to you.
Pharmacist: May I have your name and identification number.
Patient: (states his name and identification number)
Pharmacist: Any drug allergy?
Patient: Yes/No.
Pharmacist: (If yes, probes further for allergy. If no, pharmacist thanks the patient.)
Pharmacist: Alright, here's your medication for today (pharmacist goes on to explain the medication regimen)

The difference comes here, in how the pharmacist asks the patient for confirmation on whether he understands his condition, how his medication helps him, and how he is supposed to take his medication. Both have taken their medication before and are here to collect a resupply.

Caucasian

Pharmacist: Mr Connery, can you quickly tell me which medication is for your cough and which medication is for your high blood pressure?
Patient C: (picks up the bottled dextrometorphan cough syrup) this... cough. (picks up an amber bottle containing hydrochlorothiazide tablets) this... high blood pressure. But how does this one (hydrochlorothiazide) work to lower my blood pressure?
Pharmacist: This drug is a diuretic and it works by removing excess water from your body. That helps lower your blood pressure.
Patient C: And that's why this drug will cause me to visit to loo more often!
Pharmacist: That's right, Mr Connery.

Asian

Pharmacist: Mr Ang, can you remember how to take this medication? (picks up hydrochlorothiazide bottle)
Patient A: yes.
Pharmacist: This is for your high blood pressure right?
Patient A: ya, correct.
Pharmacist: This will make you go to the toilet more often ok?
Patient A: ya, i know.

We can see a stark difference in the way the counselling is done. In our practice, it is known that caucasians are generally much more inquisitive about their medications as compared to asians. Asians are also generally more silent during counselling sessions, as compared to caucasians, and it is far more difficult to probe for an answer to a question from them. Based on that knowledge, I feel that the pharmacist unconsciously generalises these 2 groups of patients and the way they counsel the patient reflects that problem.

For the caucasian, he is more responsive and the pharmacist feels more comfortable asking very open-ended questions. This naturally gives the patient more room to answer.

For the asian, because of this stereotype, the pharmacist asks close-ended questions and doesn't seem to even bother to try asking an open ended question. These are generally yes/no answers. Also, the pharmacist makes use of "response solicitations" like "ok?" and "right?" to encourage the patient to respond in some way. Personally, this does not convince me that the patient understands his medication. This situation could also be due to the fact that asians are reluctant to "embarass" a healthcare professional by further enquiring about their medications, since it implies that the healthcare professional did not do a good job in his explanation. In contrast, the caucasian wants to take ownership and control of his own medication regimen. Empowerment is important to the caucasian.

This stereotype has been passed down for many many years based on past experiences. However, in this day, with the popularity of the internet and its seemingly limitless resources on drug information, patients have become more informed and are more concerned about their own medication. Also, with current policies, the education level is much higher among patients as compared to say, 20 years ago. In school, we are taught that the "right" way to counsel a patient is as for the caucasian.

As such, isn't it time to consider a change in the way we counsel our patients? Could this be the time to drop the stereotype and treat everyone like the more "educated" caucasians, for the benefit of all our patients?

Reference
Jennifer Watermeyer, Claire Penn, 'Tell me so I know you understand': Pharmacists' verification of patients' comprehension of antiretroviral dosage instructions in a cross-cultural context, Patient Education and Counseling, Volume 75, Issue 2, May 2009, Pages 205-213.  Retrieved 13 September 09, from Science Direct.

Class this week was a little more complicated than last week's but nonetheless just as interesting!

White Coat Syndrome
This week's topic was speech events. Once Dr Deng gave the introduction, it immediately came to my mind that I have been involved in one particular speech event during the last 3 years in Pharmacy. This speech event is a patient counselling session, and we have been rehearsing to perfect this structure since we've started the course. It goes like this:

Pharmacist: Greeting
Patient: Responds to greeting
Pharmacist: Requests for confirmation of particulars and drug allergy
Patient: Responds with requested information
Pharmacist: Explains what the medication is used for, side effects, and how to take the medication correctly.
Patient: Acknowledges
Pharmacist: Asks if there are any other questions
Patient: yes/no
Pharmacist: Answers the patient if he has any questions. If not, pharmacist thanks the patient and wishes him a good day.

In fact, it does seem that the patient is generally complying with the pharmacist’s request because the pharmacist is in “power”. Especially, since we typically wear our white coat, this could be evoked by the “white coat syndrome” where a patient gets more nervous, his blood pressure goes up and fear starts to kick in when in the presence of a healthcare professional wearing a white coat.

Nagging
I read an article about nagging and I found it quite interesting. This paper described nagging as:

1. Request
2. Reminder (repeated request)
3. Repeated reminder = nagging.
4. It typically ends with a scolding or a threat depending on the relationship of the parties involved.

Some of the factors studied include gender, power/status and social distance.

A) Gender

In this study, 64/70 of the naggers were women. It could have been due to a result of culture, where many women are inclined to do what is asked of them and many men are inclined to resist even the slightest hint that anyone, especially a woman, is telling them what to do. A woman will be inclined to repeat a request that doesn’t get a response because she is convinced that she really wants him to do it. But a man who wants to avoid feeling that he is following orders may instinctively wait before doing what she asked, in order to imagine that he is doing it of his own free will.

B) Social Distance

Nagging is a speech event that is not typically encountered at the extreme end of the social distance continuum. One rarely hears of nagging among friends and acquaintances, as compared to those in the family setting. One reason given was because nagging could harm friendships and people generally want to keep their friendships healthy. This is taken for granted in a family.

C) Status/Power

In a household, one family member ends up being the "cleaning boss". And the individual in this role has inherent rights and obligations to assign chores. Since culturally, many women are seen as managing the housekeeping, it is no surprise that many of such "bosses" are women. However, it seems to me that some children are exempted from this strata. These children can have power despite lacking status, and it could be due to a situation where unconditional parental love reigns.

In the workplace, nagging is rare despite a clear heirachy being present. Here, rights, obligations and duties are strictly assigned and the consequences of not obeying are clear cut = you'll be fired.

(Diana Boxer, Nagging: The familial conflict arena, Journal of Pragmatics, Volume 34, Issue 1, January 2002, Pages 49-61. Retrieved 5 September 09 from Science Direct.)

Jokes
Something just came to my mind. Some jokes can be a form of speech event too!

"Knock knock"
"Who's there?"
"Abby"
"Abby who?"
"Abby birthday to you!"
hahahaaha.


A Long Distance Relationship

Finally something I read on a friend's blog sort of resembles a speech event. Her boyfriend is overseas on a 6-month exchange program to France. She laments about their sms-ing routine:

But i'm tired the same thing everyday like:

Hi honey how are you how was your day i miss you i miss you too what are you doing now okay afk i go study ok afk i go work hi honey what you doing i'm doing DI damn sian why sian cuz i'm doing DI oh hugs yeah i miss you i miss you too you are fat no you are fatter no you are fattest tsk you very annoying honey what you doing now why never reply me honey can skype not no leh i going to wash clothes honey can skype not no i going for dinner honey can skype not no i have no intarwebzx honey can skype not no i have no electricity.


Oh wow wall of monotonous txt back and forth I NEED TO TALK TO YOU BEFORE I EXPLODE FROM ALL THE PENT UP EXPLETIVES ):


I’ve experienced this on a long distance relationship as well. Interestingly she does write of how talking on the phone could help to break this strata, and I can say it definitely helps, since spoken language has many more elements and helps so much more to connect emotionally as compared to a structured wall of text.


Thank you for taking time to read my entry. =) That’s all for now, cheers!



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Pharmacy Year 4 student. I love playing squash! Come have a game with me some time soon =)

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