694 Medical Discourse: Early Genres, 14th and 15th Centuries
McVaugh M R & Siraisi N (eds.) (1990). Osiris 2nd series
6: Renaissance medical learning: Evolution of a tradition.
Philadelphia: University of Pennsylvania Press.
Middle English Medical Texts (2005). CD-ROM. Compilers Irma Taavitsainen, Päivi Pahta and Martti Mäkinen.
With software by Raymond Hickey. Amsterdam and
Philadelphia: Benjamins.
Minnis A J (1979). ‘Late medieval discussions of compilatio
and the rôle of the compilator.’ Beiträge zur Geschichte
der deutschen Sprache und Literatur 101, 385–421.
Minnis A J, Scott A B & Wallace D (eds.) (1988). Medieval
literary theory and criticism c. 1100–c. 1375: The commentary tradition (rev. edn.). Oxford: Clarendon Press.
Ottosson P-G (1984). Scholastic medicine and philosophy:
A study of commentaries of Galen’s Tegni (ca.
1300–1450). Napoli: Bibliopolis.
Seymour M C et al. (eds.) (1975/1988). On the properties
of things: John Trevisa’s translation of Bartholomaeus
Anglicus De Proprietatibus Rerum, vol. 1. Oxford:
Oxford University Press.
Siraisi N (1990). Medieval and Early Renaissance medicine:
An introduction to knowledge and practice. Chicago and
London: University of Chicago Press.
Siraisi N (2001). Medicine and the Italian universities,
1250–1600. Leiden: Brill.
Taavitsainen I (2001). ‘Middle English recipes: Genre characteristics, text type features and underlying traditions of
writing.’ Journal of Historical Pragmatics 2, 85–113.
Taavitsainen I (2004). ‘Transferring classical discourse
conventions into the vernacular.’ In Taavitsainen I &
Pahta P (eds.). Medical and scientific writing in Late
Medieval English. Cambridge: Cambridge University
Press. 37–72.
Taavitsainen I & Pahta P (1998). ‘Vernacularisation of
medical writing in English: A corpus-based study of scholasticism.’ In Crossgrove W et al. (eds.). 157–185.
Tavormina M T (ed.) (forthcoming). MS Trinity College
Cambridge R.14.52: A medieval medical manuscript,
its language and scribe. Tempe: Arizona Center for
Medieval and Renaissance Studies.
Voigts L E (1984). ‘Medical prose.’ In Edwards A S G (ed.)
Middle English prose: A critical guide to major authors
and genres. New Brunswick, NJ: Rutgers University
Press. 315–335.
Voigts L E (forthcoming). Electronic Thorndike Kibre
Project (eTK): L. Thorndike and P. Kibre Catalog
of Medieval scientific writings in Latin (1963, 1965,
1968).
Voigts L E & Kurtz P D (eds.) (1998). Scientific and medical
writings in Old and Middle English: An electronic reference. Ann Arbor: University of Michigan Press [(eVK)
CD-ROM.].
Wogan-Brown J, Watson N, Taylor A & Evans R (eds.)
(1999). The idea of the vernacular: an anthology of
Middle English literary theory, 1280–1520. Exeter:
University of Exeter Press.
Medical Discourse: Hedges
K Hyland, University of London Institute of Education,
London, UK
ß 2006 Elsevier Ltd. All rights reserved.
Introduction
Hedging is the expression of tentativeness and possibility, and it is central to academic writing where
statements are rarely made without subjective assessments of their reliability and the need to present
unproven propositions with caution and precision.
In medical writing, hedges play a critical role in gaining ratification for claims from a powerful peer group
by allowing writers to present statements with appropriate accuracy, caution, and humility, expressing
possibility rather than certainty and prudence rather
than overconfidence. In a context where the accreditation of knowledge depends on the consensus of the
research community and the need to evaluate evidence, to comment on its reliability, and to avoid
potentially hostile responses, expressions such as
might, perhaps, and possible can contribute to
gaining the acceptance of research claims. Medical
papers provide interesting and useful examples of
the use of hedging in scientific discourse because
they relate to matters impinging on significant issues
of our lives.
In the past decade, a growing literature has demonstrated the clear pragmatic importance of hedging as
a resource for expressing uncertainty, skepticism, and
open-mindedness about one’s propositions. Studies
have revealed the significance of hedging in textbooks, scientific letters, science digests, and academic
research papers (Hyland, 1998a, 1998b, 2000;
Myers, 1989). Hedges have also been shown to play
an major role in medical discourses by Salager-Meyer
(1994), Skelton (1997), and Adams Smith (1984).
These studies indicate how hedges represent a
writer’s attitude within a particular context and
help negotiate the perspective from which research
conclusions can be accepted. In this article, I will
briefly discuss the importance and role of hedging
in academic medical papers and sketch a framework
for understanding the functions they perform for
academic writers.
Medical Discourse: Hedges 695
Hedging and the Construction of
Knowledge
Hedging has been a subject of interest to linguists
since Lakoff (1972) first used the term to describe
‘words whose job it is to make things more or less
fuzzy.’ Essentially, it represents an absence of certainty and is used to describe ‘any linguistic item
or strategy employed to indicate either a) a lack of
commitment to the truth value of an accompanying proposition or b) a desire not to express that
commitment categorically’ (Hyland, 1998a: 1).
The importance of hedging lies in the fact that
transforming claims into accredited knowledge
requires reader acceptance and therefore linguistic
and rhetorical means of persuasion. Academic knowledge is now generally acknowledged to be a social
accomplishment, the outcome of a cultural activity
constituted by agreement between a writer and a
potentially skeptical discourse community. As a result, the research paper is a rhetorically sophisticated
artifact, carefully crafted to display a careful balance
of factual information and social interaction, set out
using community-recognized and -accepted argument
forms. Academic writers need to make the results of
their research not only public, but also persuasive,
and this involves them carefully weighing claims for
the significance and plausibility of their work against
the convictions and expectations of their readers.
Successful academic writing, in other words, involves authors evaluating their material and acknowledging alternative views because all statements
require ratification. This, at least in part, depends on
the appropriate use of various rhetorical and interactive features, of which hedges are among the
most important.
These examples show how hedges can modify the
factual status of a proposition to suggest that it is
based on imperfect reckoning rather than certainty.
provide an idea of how this is often achieved.
The hedges (italicized) indicate interpretations and
allow writers to convey their attitude about the truth
of the statements they accompany, thereby presenting
unproven claims with prudence and softening categorical assertions. More than this, however, hedges
open a discursive space in which readers are able
to dispute the writer’s arguments and interpretations, thereby enabling writers to take a position
with respect to an audience as well as to facts.
The Functions of Hedging
Although medical research scientists gain and retain
their academic credibility by securing readers’ acceptance of the most significant claims that their
findings will support, such strong claims are risky.
Few assertions in the scientific world survive for
long before being replaced by those with greater explanatory efficacy and there is always the possibility
that claims will contradict or challenge the beliefs of
one’s peers. The fact that readers are able to reject
claims means they have an active and constitutive role
in how writers construct them, and it is the writer’s
anticipation of this potential opposition that makes
hedging central to academic writing.
This opposition can be divided into two types and
claims must address these to stand any chance of
success. First, claims must correspond with what is
believed to be true in the world. Hedges here are
‘content-oriented’ and concern the relationship between a proposition and a representation of reality.
At a further level of delicacy, we can distinguish the
obligation on writers to present their claims as accurately as possible and the equally pressing need to
anticipate the dangers of overstatement. Second, a
proposition that could be presented categorically
from an objective perspective may be explicitly
hedged because of reader considerations. Thus, ‘reader-oriented hedges’ incorporate an awareness of interpersonal factors. It is often difficult to pin down
precisely what the writer intends, as indeterminacy
is a widely recognized feature of modal semantics.
However, although there is inevitably some overlap,
it is useful to conceptually distinguish these three
broad functions to understand the roles that hedges
play in academic discourse and readers’ motivations
for employing them (Hyland, 1998a).
First, hedges allow writers to express propositions
with greater precision in areas often characterized by
rapid reinterpretation. Hedging here is an important
means of attesting to the degree of precision or reliability of a claim and accurately stating uncertain
statements with appropriate caution. In medicine,
writing is necessarily a balance of fact and evaluation
as the writer tries to present information as fully,
accurately, and objectively as possible. Thus, writers
often say ‘X may cause Y’ rather than ‘X causes Y’ to
specify the actual state of knowledge on the subject.
Hedges here distinguish the actual from the potential,
or the known from the inferential, and imply that a
proposition is based on the writer’s plausible
reasoning rather than certain knowledge. Readers
are expected to understand that the proposition is
true as far as can be determined.
The second reason for using hedges concerns the
writer’s desire to anticipate the possible negative consequences of being proved wrong and the eventual
overthrow of a claim (Hyland, 1998a; Salager-Meyer,
1994). Academic reputations are built on making
novel, interesting, and plausible contributions to
696 Medical Discourse: Hedges
knowledge, which means stating the strongest claims
possible for any particular evidence. However,
writers also need to protect themselves against the
hazardous consequences of overstatement. Hedges
here help writers avoid personal responsibility for
statements in order to protect their reputations and
limit the damage that may result from categorical
commitments. This usage follows Lakoff in associating hedges with ‘fuzziness,’ but I am using the term
fuzziness here not to describe connections between
propositions, but the ways that hedges can blur the
relationship between a writer and a proposition when
referring to speculative possibilities.
One way writers achieve this is to express claims
using to employ evaluative that structures with modal
devices and non-agentive subjects (Hyland and Tse,
2005). Most commonly, this involves the use of
dummy it (see Example 7) or ‘abstract rhetors,’
which attribute judgments to inanimate sources
(Example 8).
In the medical sciences, writers may hedge in this
way because of preliminary results, small samples,
doubtful evidence, uncertain predictions, imperfect
measuring techniques, and other uncertainties in the
experimental process or case histories.
Finally, hedges can be ‘reader-oriented’ in that they
contribute to the development of a writer–reader relationship, addressing the need for respect and cooperation in gaining readers’ ratification of claims.
Research writers must always consider both the reader’s role in accrediting knowledge and the need to
conform to the expectations of the medical research
community concerning limits of self-assurance. Most
importantly, categorical assertions leave no room for
dialogue and are inherently face-threatening as they
suggest that the arguments need no feedback, thus
relegating the reader to a passive role. By explicitly
referring to themselves as the source of the claim,
often with a cognitive or discourse verb, writers are
able to mark the statement as one possible position,
an alternative view rather than a definitive statement
of truth, and thereby indicate a personal opinion
awaiting verification. Examples 10 and 11 in provide
illustrations. Here, hedges appeal to readers as intelligent colleagues, capable of deciding about the
issues, and indicate that statements are provisional,
pending acceptance by one’s peers.
Thus, we can see that hedges help protect the writer
against possible wrong interpretations or faulty
results, but they also allow them to demonstrate an
awareness of the reader’s possible alternative viewpoint, displaying the conditional nature of statements
out of strategic respect for them and indicating the
degree of confidence that the writer judges it prudent
to attribute to statements. In sum, though there is
considerable overlap in these functions, hedging
looks three ways: toward the proposition, toward
the writer, and toward the reader.
Extent and Distribution of Hedging
This multifunctional importance means that academic medical writing is extensively hedged. The essentially rhetorical nature of these functions, however,
means that there are considerable variations in the
distribution of hedges across different genres, with
greater concentrations in more argumentative and
persuasive types of texts. In a study of different
papers in the British Medical Journal, for instance,
Adams Smith (1984) found that editorials and review
articles are more heavily hedged than research papers
and medical case reports. When qualifications are
omitted, the result is both greater certainty and less
professional deference, reflecting a different attitude
to information and readers. Thus, genres that present
information as accredited knowledge, such as undergraduate textbooks (Hyland, 2000) and popular science articles (Fahnestock, 1986), contain far fewer
hedged propositions. The authors of such genres do
not have to persuade an expert audience of a new
interpretation or anticipate the consequences of
being proved wrong because most claims already
have factual status.
Similarly, hedges are differently distributed across
different parts of each genre, with their use especially
marked in the more discursive sections. They are
particularly prevalent in the introduction and discussion sections of research articles and the comment
section of clinical case notes, for example (Adams
Smith, 1984; Salager-Meyer, 1994). It is here that
writers are seeking to establish the relevance and
significance of their research and the plausibility of
their interpretations and is therefore where they need
to be more tentative and circumspect in their assertions. There is also evidence that the type of hedges
employed differ as well, with content-oriented hedges
dominating the methods and results sections and
more reader-oriented forms being found in introductions and discussions (Hyland, 1998a; SalagerMayer, 1994). These patterns allow writers to convey
approximations when discussing symptoms and
methods and to evaluate, interpret, and comment
on the evidential status of their information in the
discursive sections.
Conclusion
In this article, I have discussed some of the contextual
factors that shape the ways writers say what they
believe and want others to accept. I have tried to
Medical Discourse, Illness Narratives 697
show that the expression of doubt and possibility is
central to the negotiation of claims and that what
counts as effective persuasion is influenced by the
fact that evidence, observations, data, and flashes of
insight must be shaped with due regard for the nature
of reality and their acceptability to an audience.
See also: Accessibility Theory; Corpora; Corpus Studies:
Second Language; Genre and Genre Analysis; Medical
Discourse and Academic Genres.
Bibliography
Adams Smith D (1984). ‘Medical discourse: Aspects of
author’s comment.’ English for Specific Purposes 3,
25–36.
Fahnestock J (1986). ‘Accommodating science: The rhetorical life of scientific facts.’ Written Communication 3(3),
275–296.
Hyland K (1998a). Hedging in scientific research articles.
Amsterdam: Benjamins.
Hyland K (1998b). ‘Boosting, hedging and the negotiation
of academic knowledge.’ TEXT 18(3), 349–382.
Hyland K (2000). Disciplinary discourses: Social interactions in academic writing. London: Longman.
Hyland K & Tse P (2005). ‘Hooking the reader: A corpus
study of evaluative that in abstracts.’ English for Specific
Purposes 24(2), 123–129.
Lakoff G (1972). ‘Hedges: A study in meaning criteria and
the logic of fuzzy concepts.’ Chicago Linguistic Society
Papers 8, 183–228.
Myers G (1989). ‘The pragmatics of politeness in scientific
articles.’ Applied Linguistics 10(1), 1–35.
Salager-Meyer F (1994). ‘Hedges and textual communicative function in medical English written discourse.’
English for Specific Purposes 13(2), 149–170.
Skelton J (1997). ‘The representation of truth in
academic medical writing.’ Applied Linguistics 18(2),
121–140.
Medical Discourse, Illness Narratives
L-C Hydén and P H Bülow, Linköping University,
Linköping, Sweden
ß 2006 Elsevier Ltd. All rights reserved.
Introduction
During the past decades, the health field has become
a battlefield where alternative concepts of illness,
health, and treatment compete with the dominant
traditions of Western scientific medicine. New health
care practices such as complementary and alternative
medicine have gained status. Etiological factors have
come to include ‘lifestyle’ factors, as in the relationship between smoking and lung cancer or the relationship between stress and certain coronary diseases.
Patients have access today via the Internet to sources
of information that were previously unavailable to
them and can approach their physicians with more
knowledge and new demands.
As part of these changes, researchers have become
interested in questions having to do with the relationship between, on the one hand, the patient and his or
her illness and, on the other hand, traditional scientific medicine and its concept of diseases. In this
context, the study of illness narratives has gained
prominent status.
Research on the forms and functions of illness narratives has expanded rapidly since the early 1980s. Its
development is marked by diversity in the theoretical
perspectives and methods that are brought to bear on
a variety of problems.
Illness narratives is a wide field encompassing interview studies of patients’ narratives of illnesses,
studies of the way that narratives are used in the
interaction between medical staff and patients, and
clinical studies of how narratives could be used by
medical professionals in encounters with patients.
Another field of study that has emerged is the study
of written and published illness narratives; Hawkins
(1993) called these pathographies.
Theoretically, researchers have been interested
in the narrative as an opportunity to study the subjective experience of illness, the way in which identity is reconstructed narratively in the face of
illness, and how the institutional context affects the
relationship between medical professionals and
patients. This is especially interesting in terms of
power and the patient’s ability to make his or her
voice heard in the medical encounter. Thus, researchers focus on narrative structure and coherence, as well
as on the functions of narratives in various social
contexts.
Two Voices
A central problem area for many studies of medicine
and illness narratives is the relationship between what
is called the voice of the lifeworld and the voice of
medicine. These concepts were introduced by Elliot
Mishler in his book Discourse of medicine (1984).
Mishler pointed out that in the discourse of ordinary
medical interviews it was possible to discern two