November 10, 2021
By Neelanjana Gautam
Language is an intricate tool of expression, and Peter Torres has unraveled some of its complexities by analyzing doctor-patient conversations about opioid use and addiction.
Torres, a doctoral candidate in the UC Davis Department of Linguistics, wrote his dissertation on how the current opioid crisis is linguistically expressed in policies and medical interactions. His work just earned him this year’s Linguistic Society of America (LSA) Elizabeth Dayton Award.
Torres’ remarkable work is the result of collaboration among UC Davis researchers from different disciplines.
Key collaborations unpack opioid talk in the medical setting
It started when Stephen Henry, assistant professor of internal medicine and faculty member at the Center for Healthcare Policy and Research (CHPR), contacted Vaidehi Ramanathan, professor of linguistics and Torres’ dissertation advisor. Henry was interested in bringing a linguistic angle to the data he gathered on doctor-patient encounters.
“When we started this project, we were really interested in figuring out the language of pain versus the language of addiction. We wanted to work out a way that would help doctors communicate better with their patients,” Ramanathan explained.
The Center for Healthcare Policy and Research, a research unit under the UC Davis Office of Research and UC Davis Health, facilitated the collaboration and supported Torres’ project. Torres used video-recorded patient-doctor interactions collected by CHPR staff and audio-records he gathered with the help of the center.
“The CHPR brings together and supports faculty doing impactful research on both the Sacramento and Davis campuses,” said Anthony Jerant, chair and professor at the Department of Family and Community Medicine and the interim director of CHPR.
Patients’ vocal alterations during medical opioid discussions
Torres explored different forms of language, including verbal and nonverbal cues, in interactions happening in a medical environment. He then studied how context-specific speech was used by both patients and doctors in spoken and written medical conversation.
“In recent years, the opioid crisis has drawn attention to the language of pain, especially chronic pain treatments. Yet, little attention was given to the vocal aspects of patient talk,” said Torres.
When he first started analyzing the medical conversations, Torres noticed that patients employed both low pitch and a “creaky voice” to express concerns of chronic pain, narrate symptoms, and request opioids. His research indicated that patients used situational voice modulations to frame conversations around opioids, knowing that their requests could be turned down or symptoms questioned. According to Torres, patients have a specific way of presenting their symptoms – shifting their voice to a lower pitch different from how they normally speak.
“Being more attentive to shifts in the patient’s speech can help physicians navigate the conversation better,” he said.
Language changes in opioid-related policies
Torres found that policymakers were reframing a lot of existing policies, using more restrictive language. His research highlighted the linguistic response to the opioid crisis and uncovered how physicians interpret, negotiate, and enact these policies in interactions with patients.
He gave the example of how modal verbs in policies such as “you may” versus something “you shall” or “you cannot” impact the way physicians and patients interpret these policies. He also examined the face-saving discourse features physicians adopt while enacting those policies.
Torres hopes that his findings will enable policy makers to address the opioid issue by examining how restrictive or permissive language and actions are, with input from physicians and patients who have to negotiate the meanings of these policies. In addition, navigating interactions is often challenging for doctors, especially given the number of patients they see every day. However, recognizing sudden register shifts could alert physicians about the particular issues the patients are vocally framing as important.
“We are very happy that this work is getting the recognition that it deserves, especially now with the opioid crisis,” said Ramanathan.
The Elizabeth Dayton award will be presented to Torres at the LSA Annual Meeting in Washington, D.C., on Jan. 8, 2022.
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