Title: Professor of English, Linguistics, and Rhetoric
University: University of North Carolina at Charlotte
Email: rflunsfo@uncc.edu
Twitter: N/A
Website: https://clas-pages.uncc.edu/ron-lunsford/
Description of Work:
I am a Professor of English, Linguistics, and Rhetoric at UNC Charlotte. Over a long career, I have written about Cognitive Linguistics and Functional Linguistics. I have made applications of Cognitive Linguistics to the study of literature and of both schools of linguistics to the study of writing instruction. In recent years, I have been working in a branch of Functional Linguistics and of Rhetorical Theory called Genre Theory. Our work for this conference entails an exploration of how Genre Theory might provide insights into the communication between health providers and insurance companies.
Symposium Submission:
An Analysis of Requests for Medical Equipment Through the Lens of Genre Theory
The process of identifying a need for durable medical equipment for a pediatric patient with a chronic medical condition, such as cerebral palsy, requires several steps. At the end of a process that comprises identifying a child with a need, measuring a child for a device, trialing a child with several devices, and selecting the appropriate device for a child, the clinical team must submit a document called a Letter of Medical Necessity along with several other documents summarizing the history to date of the child’s progress. After this lengthy process, if the insurance company deems the device not to be medically warranted, the frustrations that families and clinical providers experience as they appeal to insurance providers are palpable. In examining documents that comprise these communications, we have found it useful to view this process through the lens of modern rhetorical genre theory.
In layman’s terms, this theory explains that all literate individuals have developed the ability to create documents that allow them to perform many different “social actions.” For example, one has something of a template in his/her mind that allows the creation of such varied communicative products as a “thank you note,” a “letter,” a “friendly email,” a “eulogy,” a “letter to the editor,” and so forth. No two people will be able to enact the same set of genres; no two people will produce the same document as an example of any one genre. However, all literate humans are able to create texts that carry out the social acts of a great many different genres.
While the information that allows one to enact various genres seems to be intuitive and unconscious, it is by no means simple. In the last forty years or so, genre theorists have provided much insight into just how complicated such genre knowledge is. Their research also provides insight into problems in communication such as those experienced by members of the medical community in interactions with insurance providers.
To understand genre theory, we will need to introduce some of the specialized language used in that theory. One leading theorist, John Swales, offers the following definition of genre: “A genre comprises a class of communicative events, the members of which share some set of communicative purposes. These purposes are recognized by the expert members of the parent discourse community, and thereby constitute the rationale for the genre.” At first glance, it seems clear that the “request for approval of medical devices for treatment” that doctors make to insurers would be a medical genre, since all of the texts that are generated in the process share the communicative purpose of securing needed devices for patients. However, genre theorists Lloyd Bitzer and Carolyn Miller make it clear that genres always occur in what Bitzer refers to as “rhetorical situations.” According to Bitzer, such a situation requires there to be some “exigence” that can only be met by means of a rhetorical act. In addition to this “exigence,” there must also be an audience to whom this text is addressed; actually, Bitzer defines this audience further as a “rhetorical audience,” consisting of “only those persons capable of being influenced by discourse and of being mediators of change” (7).
In the case of the insurance petition, we have the exigence–the patient’s need. We also have the audience represented by persons acting as agents for the insurance company. But there is, according to Bitzer, one additional element in the rhetorical situation, what he calls the “constraints” that operate in the rhetorical situation. These include “persons, events, objects, and relations which are parts of the situation because they have power to constrain decision and action needed to modify the exigence” (8). These constraints can militate against the proposed action in the way that beliefs, traditions, and such often do. They may also militate in favor of the action as is the case when one offers constraints for change, such as “documents, facts, . . personal character, logical proofs, and style” (8).
When all parties involved in a rhetorical situation have the same understandings of the elements of that situation, texts generated for that situation have a high probability of fulfilling the social purpose for which they were designed. However, as Carolyn Miller points out, there can be situations in which certain parties believe a given genre exists, when, in fact, differing understandings of the rhetorical situation undermine the social action in question. In such situations, what is thought to be a genre turns out not to be because “there is no pragmatic component, no way to understanding the genre as a social action” (164). Miller points to a study she made of Environmental Impact Statements; on the surface there seemed to be an understanding of genre underlying these texts, but as it turned out, “in spite of a recurring rhetorical situation that was, in fact, defined by law, . . these documents had no coherent pragmatic force . . .[because] the probabilistic judgments that are the substance of environmental science conflicted with the formal requirements of objectivity and quantification . . . of the administrative bureaucracies . . . invoked by the legislation requiring impact statements. Overall, the imperfect fusion of scientific, legal, and administrative elements prevented interpretation of the documents as meaningful rhetorical action” (164).
Our early analyses of petitions to insurance companies, denials of petitions by insurance companies, and subsequent appeals of clinicians lead us to hypothesize that something of this same type of rhetorical confusion is at work in this process. We propose to examine a small sample (between 20 and 30) petitions, denials, and appeals to determine just what the various stakeholders see as the social actions these texts are designed to achieve.
In speaking of her view of genre as social action, Miller argues that the genres one finds in a society embody “an aspect of cultural rationality” (165). We would add that failure to find genres where they are thought to exist may well reveal areas of cultural irrationality.
Sources
Bitzer, Lloyd. 1992. “The rhetorical situation.” Philosophy & Rhetoric, 25:1. 1-14.
Miller, Carolyn. 1984. “Genre as social action. Quarterly Journal of Speech. 70:2, 151-167.
Swales, John M. 1990. Genre analysis: English in academic and research settings. Cambridge Applied Linguistics.