Table 4 SA of medical students and frequency in CRD.

From: Collaborative reflection and discussion using the narrative medicine approach: speech acts and physician identity

Elements of CRD

SA

Examples

Frequency of SA

Percentage

Time

1. Focus on the time and speed of illness process

Physically he was fast deteriorating.

22/24

91.67%

2. Confirm that the patient is aware of the illness status

She knew she had cancer and was dying.

11/24

45.83%

3. Examine how patients experience sick time

During his hospitalization, he began to write a diary.

15/24

62.50%

Space

4. Analyze the patient’s physical changes (human body is regarded as a space)

… finally able to get out of bed after lying in bed for six weeks.

19/24

79.17%

5. Give spatial information in a region

He sank into a dream woven by the Sahara Desert in the Italian villa.

6/24

25.00%

Voice

6. Identify the different voices

She wanted to stop the medical treatment, but the doctor ignored her.

20/24

83.33%

7. Confirm the speaker’s rights and obligations

She was not listening to him.

9/24

37.50%

8. Notice the gap between the speaker and the listener

…realized that his understanding of life and medicine was wrong.

10/24

41.67%

9. Observe the effects of the speaker’s encounter with the listener

He shook hands with the doctor and accepted what he had said.

16/24

66.67%

10. Identify the voices that influence the patient

Based on the parents who knew him best, …

5/24

20.83%

Metaphor

11. Presume the patient’s wishes

He might reject the treatment.

16/24

66.67%

12. Understand complex and metaphorical expression

The opposition between night and day suggests that one should not bow to death even in old age.

15/24

62.50%

Plot and Situation

13. Know the attitude of the patient

He expected to…

20/24

83.33%

14. Rank the wishes of the patient and others

His needs should come first.

11/24

45.83%

15. Understand the plot and situation deeply

That’s because he can’t take another severe blow.

23/24

95.83%

16. New or changed knowledge

Sometimes, patients only need someone to be with them.

16/24

66.67%

17. Awareness of the rights and interests of the patient

It was not the treatment he wanted.

13/24

54.17%

18. Perceive the patient’s experience

Consulting famous doctors increased his doubts and fears.

13/24

54.17%

Empathy

19. Increase the level of empathy

He’s really struggling because he loves the family.

21/24

87.50%

20. Increase understanding of the elderly and the seriously ill

The greatest pain of a dying man is loneliness.

10/24

41.67%

21. Attention to the patient from multiple perspectives

It’s so kind to console him with his religious belief.

4/24

16.67%

Illness and Death

22. Attention to details of illness and death, such as word choice

“Finally” indicates her husband passed away.

17/24

70.83%

23. Accept and promote the concept of palliative care

… should provide him with the care he expected.

9/24

37.50%

24. Reflect on how to help the ill

Good qualities such as … are especially valuable at the moment.

16/24

66.67%

Medical Behavior

25. Raise the issue of caring for the patients

The doctor probably was waiting for his family to take him home.

12/24

50.00%

26. Notice the patient’s difficulties.

He found it particularly painful that no one felt sorry for him as he had expected.

3/24

12.50%

27. Suggest arrangements or activities for the patient

She can read some poems.

6/24

25.00%

28. Pay attention to the patient’s hobbies or the final wishes

It may be what he wanted most.

15/24

62.50%

29. Reflect on what kind of attitude doctors should have toward the patient

The patients’ feeling is the most important.

18/24

75.00%

Organizational Behavior

30. Invite peers to pay attention and listen

What do you think?

16/24

66.67%

31. Respond to others’ invitation

I partly agree with you, but…

12/24

50.00%

32. Think about communication and connection

The protection of children should extend to the entire society.

18/24

75.00%

33. Share disease information with each other

I found some information about…

14/24

58.33%

  1. The numbers highlighted in bold represent the percentage of speech acts we deem necessary for CRD.