情态视角下医患沟通话语主导权研究

A Study on Discourse Dominance in Doctor-Patient Communication from the Perspective of Modality

摘要: 为解析医患沟通话语主导权的动态分配，本研究以10组心理沟通会话语料为对象，基于韩礼德情态系统理论，按开头、病情陈述、数据搜集(含病史询问与情绪检查)、结束四阶段，结合福柯的隐性权力话语理论，分析医患双方高、中、低情态值的使用特征及与话语权的关联。研究发现，医患话语主导权并非固定分配，而是由双方情态表达动态共建而成，这一过程本质上是隐性权力话语的消解与重构。低情态值主导医患互动全过程，有效弱化了传统医患会话中医生的强势引导，保障了患者的自主表达权，将责任进行一定的分摊；中情态值灵活补充，推动患者实现从被动回应者向主动诉求者的角色转变；高情态值的完全缺失，进一步凸显了非治疗性咨询“支持性、非强制性”的核心特征，助力实现医患话语主导权的动态平衡。

Abstract: To analyze the dynamic distribution of discourse dominance in doctor-patient communication, this study takes 10 groups of real psychological communication conversation corpora as the research object. Based on Halliday’s Systemic Functional Linguistics Modal Theory, the study divides the conversation into four core stages of beginning, condition statement, data collection (including medical history inquiry and emotional examination), and end, which is combined with Foucault’s analysis of the invisible mechanisms of power to analyze the usage characteristics of high, medium, and low modal values and their correlation with discourse dominance. The results show that discourse dominance is not fixed but dynamically constructed by both parties’ modal expressions, essentially the dissolution and reconstruction of disciplinary power discourse. Low modal values dominate the interaction, weakening doctors’ strong guidance and ensuring patients’ independent expression; medium modal values promote patients’ transformation from passive respondents to active claimants; the absence of high modal values highlights the “supportiveness and non-coerciveness” of non-therapeutic consultation, contributing to realize the dynamic balance of doctor-patient discourse dominance.