How Uncertainty Is Talked About in Language Discordant and Concordant Health Consultations: Patterns of Epistemic Adverb Use and Communication Accommodation Strategies

INTRODUCTION: In this study, we explored how uncertainty was expressed through epistemic adverbs in health consultations where patients and health practitioners (HPs) spoke the same language (language-concordant) versus when they did not (language-discordant). Further, we applied Communication Accommodation Theory (CAT) to identify, in these settings, how HPs used communication strategies and their patients' communicative responses. METHOD: Fifty-three health consultations between bilingual and monolingual patients and their HPs in a metropolitan emergency department were recorded and transcribed, 39 of which contained epistemic adverbs (e.g., probably, maybe). Epistemic adverbs were identified and classified, and the surrounding interactional sequences were analysed using CAT. RESULTS: Analyses revealed overall greater use of uncertainty adverbs versus certainty adverbs. CAT-informed analysis identified approximation, discourse management, interpersonal control, emotional expression and interpretability when HPs or patients expressed uncertainty. HPs responded through clarification, reformulation, backchannelling and reassurance. However, in some cases, the interaction did not establish whether the expressed uncertainty had been fully resolved or understood. DISCUSSION: In the analysed consultations, epistemic adverbs functioned as linguistic markers of uncertainty related to clinical information such as symptoms, timing and possible course of action. Although use of accommodative strategies was evident in all analysed excerpts, in some cases the available data could not confirm whether the bilingual patients had fully understood the information. CONCLUSION: Attending to patients' uncertainty as expressed through epistemic adverbs may help HPs accommodate more effectively to their patients' communicative needs. PATIENT OR PUBLIC CONTRIBUTION: Patients and members of the public were not directly involved in the design, conduct, analysis or reporting of this study. The research was based on the analysis of recordings of real-life clinical consultations. Because the study focused on evaluating communication patterns within existing consultation recordings rather than developing or testing interventions affecting patient care, additional patient or public involvement was not considered methodologically appropriate.