Medical terms and the conceptualisation of chest pain: differences in scope for doctors and nurses
This research aims to bring a multidisciplinary approach to the usage of medical terminology by health professionals, particularly doctors and nurses, in the cardiac field. The study uses Temmerman’s (2000a) sociocognitive approach to terminology to examine the conceptualisations of the term chest pain in the writings of doctors and nurses. It takes up her invitation to consider potential differences in their respective ‘units of understanding’ (UoUs) of chest pain, by investigating its formal and semantic relations with other terms in the syndrome and their usage in corpus texts. The research focuses on two key questions: 1) how convergent the repertoires of cardiology terms used by doctors and nurses are; and 2) whether their usage of terminology reflects similar or divergent conceptualisations of chest pain.
To create a reference list of standard terms of chest pain, 14 medical dictionaries and two ontological resources were consulted to identify heteronyms of chest pain for experimental purposes. The currency of these standard terms was checked in two customised corpora, the Medicinae Doctor Corpus (MDC) and the Registered Nurse Corpus (RNC), totalling 4 million running words. The filtering process showed that only about half the terms extracted from dictionaries and ontologies were in use, and the repertoire used by doctor-writers in the MDC was considerably larger than that of the nurse-writers in the RNC. The corpus searches also returned a number of emerging terms for chest pain, not yet codified in the dictionaries or ontologies, mostly in the MDC. Subsets of the standard and non-standardised terms (bigrams and trigrams) were analysed for their relative fixity as compounds and probability of occurrence, using statistical collocational measures: Delta P (ΔP) and log likelihood (LL). They showed proportionally similar distributions for the standardised and non-standardised sets of terms in the two corpora.
Much greater differentiation between the two datasets emerged in analysing semantic relations among the chest pain terms, using Temmerman’s (2000a) intracategorial and intercategorial relations. While the intracategorial relations of hyponymy and causation proved much denser in the MDC, those for the wider intercategorial relations (Domain indications, Intention assessment, and Perspective description) were much richer in the RNC. These findings align with their respective role in diagnosing chest pain and in coordinating the long-term treatments for patients. The categorial data was further analysed using multidimensional analysis which returned contrasting results from the doctors’ and nurses’ writing, particularly on Dimension 1 (‘Orientation to healthcare professionals’) and Dimension 2 (‘Orientation to patients and supporters’), both strongly loaded from the RNC. The three-dimensional cluster analysis also showed marked differences in the key participants in chest pain medicine in MDC and RNC, with fellow clinicians noted as key colleagues for doctors, and patients’ supporters for nurses.
These contrasting findings for the two professional groups suggest major differences in their orientation to chest pain and conceptualisation. A final synthesis of the findings interprets them as distinct UoUs, which need to be taken into account in multi-disciplinary medical teams.
