Communication without dialogue? Framing patient-professional interaction in UK institutional discourse on pregnancy loss

Communication failures are repeatedly implicated in harmful experiences and outcomes in pregnancy care, especially in contexts of loss, yet little is known about how communication itself is represented in the institutional texts that shape expectations of care. This study examines the extent to which communication is discussed, and how patient-healthcare professional interaction is framed, in publicly accessible UK discourse about pregnancy loss. Two corpora comprising texts from seven medical organisations (120,383 words) and eight charities (224,481 words) were divided into healthcare professional-facing and patient-facing sub-corpora. Frequency, semantic keyness, keyword and concordance analyses were conducted using Wmatrix7. In medical discourse, language and communicative interaction were underrepresented, while speech acts associated with unidirectional professional activities such as advising, recommending and referring were overrepresented. Compared with charity texts, medical outputs foregrounded clinical evidence, policy, risk and professional knowledge. Characteristic forms including 'confirmed', 'advised', 'recommended' and 'offered' frequently occurred in passive or agentless constructions that positioned patients principally as recipients of information; patient agency was most visible in 'reporting' symptoms or concerns. Charity discourse more often foregrounded talking, listening, feelings, preferences, wording, lived experience, and patient knowledge; representing communication as active and bidirectional. We argue that UK medical discourse constructs communication primarily as the transmission of authorised knowledge rather than as relational clinical practice, reinforcing a paternalistic distribution of communicative agency. Medical institutions should embed listening, reciprocal dialogue, sensitivity to language preferences, and checks on understanding as core standards of safe pregnancy care.