Abstract/Summary

This study addresses the gap in understanding decision-making (DM) as a distinct interactional genre within multilingual and multicultural healthcare teams such as those increasingly prevalent in Saudi Arabia. While previous discourse-analytical research has focused primarily on DM in doctor-patient interactions, little is known about how decisions are made interactively in doctor-doctor communication, particularly in settings where English is the medium of professional medical communication (PMC). Effective DM is crucial in medical contexts, as miscommunication can have serious consequences for patient outcomes. This study empirically explores the language and discursive resources used by doctors in team DM, offering insights for both practicing and future medical professionals. It also provides pedagogical implications for improving English medical education in Saudi Arabia, where current research often critiques the English proficiency of medical graduates without specifying the practical needs of the workplace. A multimethod discourse approach has been adopted in this study to systematically investigate and answer the research questions. The combination includes the following qualitative methods: Genre Analysis (GA), Conversation Analysis (CA), and Interactional Sociolinguistics (IS). No existing studies in the DM literature have used this kind of multimethod discourse approach to explore decision-making as an ongoing, moment-by-moment process in doctor-doctor team meetings. The primary data in this study are weekly doctor-doctor meetings, during which critical decisions are made. The analysis of the transcribed data started with GA to identify patterns – Moves and Steps – characterizing DM as an interactional genre in a multilingual medical setting. Subsequently, CA was employed to examine the turns within the moves and provided deeper insights into how doctors managed their linguistic and other verbal resources during the DM interactions – most notably code-switching and humour – which emerged as prominent discursive features of the studied doctor-doctor communication. Drawing on IS allowed for the consideration of factors beyond the conversational data, specifically the doctors’ epistemic status and primacy, which contextualised the analysis within the medical setting and its professional hierarchy. The findings that emerged from the GA provided generic features of medical decision-making episodes, where one type was unambiguous and straightforward and less frequent, while the other was more complex and occurred more frequently. Both types of decisions share basic Moves that include Presenting the patient, Pre-decision, Decision, and Closing. However, complex decisions had more variability, as the discussions were more extended and included Moves such as Decision execution details and Re-discussing the medical status of the patients. Both unambiguous and complex decisions depended on collective agreement, and elaborated turn-taking patterns due to uncertainties were noticeable features in the complex decisions. Uncertainty was expressed using hedges and hesitation, while silences and pauses were a trigger that led to more rationale to back up decisions and show that a decision was not collectively agreed upon. The findings also show that DM as a genre is in its essence a transactional interaction that, however, much depends on relational work to execute it. Unambiguous decisions were short and straightforward and were almost exclusively conducted through English as the medium of PMC. In contrast, complex decisions relied heavily on discursive resources like code-switching (CS) and humour. The function of Arabic in CS and humour included getting specific details about patient status, defending doctors' professional image, building and maintaining solidarity and harmony, and expressing negative emotions such as stress and anger while under pressure to reach a decision. This study makes the following contributions. First, it provides an authentic representation of DM as an interactional genre in teams and reveals how hierarchical and epistemic status has influenced this genre. In the studied context, consultants had higher authority in determining the decision and action plan based on their epistemic status, while assistant consultants contributed by supplying the medical information needed to aid the DM process. This shows that while the decision must be made collaboratively, the collaboration had limits. This calls for caution in ensuring that practicing medical professionals are aware of their roles in DM while ensuring that everyone has a voice in the DM negotiations. Hierarchy, epistemic status, and primacy are part of this asymmetrical interaction and guide different team members to operate and interact within the limits and boundaries of their roles. This helps provide structure and organization and offers guidelines on how medical professional should interact with each other. Another contribution is addressing the gap in the English medical textbooks used to teach medical students in Saudi Arabia. The data revealed a mismatch between the spoken interaction in the textbooks and real-life interactions. For instance, humour and CS are not part of the textbook materials, which does not aid in preparing medical students for the real interactional demands of the workplace. The study also highlights some limitations of using English as a medium of professional communication and calls for further research that takes into account the cultural effects of the context especially regarding multilingual and multicultural membership. It is important to understand how this diversity influences how medical professionals interact and make decisions, especially when they must do so collaboratively.