Narrative perspective, person references, and evidentiality in clinical incident reports

• Published in: Journal of pragmatics Vol. 117; pp. 139 - 154
• Main Authors: Myketiak, Chrystie, Concannon, Shauna, Curzon, Paul
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.08.2017; Elsevier Science Ltd
• Subjects: Authority; Clinical incident reports; Epistemic markers; Evidentiality; Language usage; Linguistics; Medical errors; Narratives; Patient safety; Patients; Person references; Pragmatics; Report writing; Patient safety; Evidentiality; Person references; Clinical incident reports; Epistemic markers; Authority
• ISSN: 0378-2166; 1879-1387
• DOI: 10.1016/j.pragma.2017.06.018

•When agents are classed as culpable, pragmatic strategies used in reporting differ.•User error reports mask identity and agency through the third-person viewpoint.•Epistemic markers of uncertainty and precision characterise user error reports.•This reporting type statistically demonstrates a pattern we call precise ambiguity.•Level of patient harm does not affect pragmatic strategies in the corpora analysed. Clinical incident reporting provides opportunities for organisational learning, ideally leading to improved patient safety. However, this process requires healthcare professionals to record experiences where patients were harmed, or had the potential to be harmed. It also requires others to interpret the language used in order to make recommendations. We investigate the use of epistemic and evidential markers in incidents labelled as ‘user error’, in which a responsible individual is categorically implied, as opposed to other types of incidents where responsible individuals may not be tacitly assumed, such as ‘failure of sterilisation or contamination of equipment’ and ‘lack of suitably trained staff’. By analysing the frequency of various linguistic features related to authority and accountability, we provide insights into the pragmatics of clinical incident reporting. We find that user error reports differ from other categories of reports in that the identity of the narrator is obscured and the locus of agency is removed, and that this difference is irrespective to levels of patient harm. User error reports differ from other incident reports in the following statistically significant ways: they are more likely to be written using impersonal absent narration and feature significantly higher frequencies of epistemic markers of uncertainty and evidentiality.