Affective-Discursive Practice in Online Medical Consultations in China: Emotional and Empathic Acts, Identity Positions, and Power Relations

Contents
List of Figures
List of Tables
1 Introduction
2 Online Space for Health Communication and the China Context
	2.1 Online Space for Communicating Illness and Health
	2.2 Internet Plus Healthcare in China
	2.3 Communicative Problems in Healthcare and Research Gaps
	2.4 Features of Online Affective Communication
3 Affective Practice and a Post-structuralist Perspective
	3.1 Affect and Affective Practice
	3.2 A Post-structuralist Discourse Analysis Perspective
4 Discourse Practice in Health Communication
	4.1 Studies on Face-to-Face Medical Encounters
		4.1.1 Linguistic Attributes
		4.1.2 Knowledge Territory
		4.1.3 Power Asymmetry
		4.1.4 The “Sick Role” of Patients
	4.2 Computer-Mediated Health Communication
		4.2.1 Peer-to-Peer Interactions
		4.2.2 Ask-the-Experts Online
	4.3 Affective Communications in the Clinical Context
		4.3.1 Emotional Expression by Patients
		4.3.2 Empathic Communication by Doctors
5 Research Sites and OMC Texts
	5.1 Research Sites
	5.2 Data Collection
6 Emotional and Empathic Discursive Acts
	6.1 E-patients’ Indirect Emotional Acts (Indirect PEAs)
		6.1.1 Presenting Uncertainty
		6.1.2 Narrating
		6.1.3 Self-repetition
		6.1.4 Disagreeing
	6.2 Doctors’ Empathic Acts (DEAs)
		6.2.1 Understanding Act
		6.2.2 Reassuring Acts
		6.2.3 Agreeing Act
		6.2.4 Praising Act
		6.2.5 Self-disclosing Act
		6.2.6 Implications of DEAs
	6.3 The Distribution of Empathic Acts in Response to Emotional Acts
	6.4 Summary
7 From Affective Discursive Acts to Affective Interaction
	7.1 Sequences of Empathic Communication
		7.1.1 Emotional Act → Immediate Empathic Act
		7.1.2 Emotional Act → Non-empathic Act → Re-emotional Act → Empathic Act
		7.1.3 Emotional Act → Delayed Empathic Act
		7.1.4 Emotional Act → Empathic Act → Re-emotional Act → Empathic Act
		7.1.5 Discussion of Empathic Communication Sequences
	7.2 Features of the Ineffective Empathic Response
		7.2.1 Not Addressing All the Presented Questions
		7.2.2 Providing Premature Generalization
		7.2.3 Giving No Specific Explanation
		7.2.4 Using Self-disclosure to Delegitimize E-patients’ Concerns
		7.2.5 Discussion of Ineffective Empathic Response Features
	7.3 Sequential Positions of DEA Within Empathic Response
		7.3.1 Positioning Empathic Act After Medical Agendas
		7.3.2 Positioning Empathic Act Before Medical Agendas
	7.4 Summary
8 Discursive Positionings: Bucking the Traditional Roles
	8.1 Post-structuralist Approach to Identity
		8.1.1 A Post-structuralist View on Identity
		8.1.2 Positioning Theory
	8.2 The Co-construction of Positions—Emotional Support Seeker (ESS)/Giver (ESG)
	8.3 The Negotiation of Positions
		8.3.1 From Accuser/Defender to ESS/ESG
		8.3.2 From Dissenter/Justifier to ESS/Compromiser
	8.4 Doctor Initiated Construction of Positions
		8.4.1 Online Seller
		8.4.2 Peer
		8.4.3 Family Member
	8.5 Discussion and Summary
9 Dynamic Power Relations Informed by Discursive Positionings
	9.1 A Post-structuralist View on Power
	9.2 The Dynamic Power Relations
		9.2.1 Highlighting E-patients’ Reward/Coercive Power
		9.2.2 Softening Doctors’ Expert Power
		9.2.3 Negotiating Expert Power
		9.2.4 Giving Up Legitimate Power
	9.3 Discussion and Summary
10 Concluding Remarks
	10.1 Practical Applications
	10.2 Where Is the E-healthcare Culture Going?
	10.3 Is the Degree of Sincerity of Empathic Expressions Important?
	10.4 Limitations and Future Research
Appendix PRISMA Flowchart
References