國立臺灣師範大學英語學系 博 士 論 文 Doctoral Dissertation Department of English National Taiwan Normal University

規避詞在台灣醫學言談與期刊論文中的比較

Hedges in Medical Discourse: A Comparison

between the Spoken and the Written Genres in

Taiwan’s Medical Setting

指導教授：張 妙 霞

Advisor: Dr. Miao-Hsia Chang

研 究 生：林 婉 華

Student: Wan-Hua Lin

中 華 民 國 一百零三 年 六 月

June, 2014 ABSTRACT

The study investigates how hedging phenomena are manifested in the medical

specialist-to-specialist communication in Taiwan. Hedging strategies utilized in two types of

genres are examined and compared. The spoken genre consists of ten peer lectures, while the

written genre comprises forty research articles. I explore the questions as to what linguistic devices are used as hedges in the medical profession, what functions those hedges serve, and what are the differences in the use of hedges in terms of genres. At last, I also compare the medical spoken discourse with Chinese daily conversation and the written discourse with

Chinese academic written texts.

The results show that the medical professionals make use of various hedging devices to modify their commitment towards the propositions being stated. These hedging devices are classified into modal auxiliaries, lexical hedges, and non-lexical hedges. Lexical hedges include lexical verbs, adverbs, adjectives, and nouns, while non-lexical hedges contain conditionality, rhetorical questions, and addressing limitations. Hedges are observed to manifest their polypragmatic functions in the medical discourse. That is, the medical specialists utilize different hedging devices to convey different functions depending on communicative circumstances. It is not uncommon to note that one single hedge may serve various functions and an individual function may be fulfilled by different hedges. In the medical discourse, lexical hedges are found to be the most commonly used hedging devices regardless of genres, which confirm the findings of many studies in the literature. Overall, the speakers employ more modal auxiliaries, conditionality, and rhetorical questions than the writers, whereas the writers utilize more adjectives, nouns, and addressing limitations than the speakers. The discrepancies in the application of those various hedging categories show statistically significant. Among those hedging strategies, adverbs are used the most frequently in both genres, and the application between these two genres does not show any statistical

ii significance. Modal auxiliaries are normally used to express the speakers/writers subjective

attitudes or feelings towards the propositions. Hui 會 ‘will/may’ is found to occur the most

in the spoken discourse, while keyi 可以 is favored in the written discourse. Sensory verbs

are overwhelmingly used by the speakers, whereas quotative verbs are favored by the writers.

Genre difference accounts for the difference as writers rely heavily on hearsay evidence and

research findings in literature to support their arguments and speakers adhere to

conversational hedges to express their attitude and feelings towards the propositions. Hedging

adjectives are predominately employed to modify their following nouns with various degrees

of uncertainty or inaccuracy. Approximative nouns are used the most frequently in the spoken

discourse, whereas question words occupy the majority of hedging nouns in the medical

writing. It is worth noting that the speakers tend to apply a greater variety of forms than the

writers. In addition, the speakers mostly use disyllabic hedges, whereas the writers favor

monosyllabic hedges.

In the medical profession, there is always existing uncertainty and there are always

layers upon layers of explanation. Therefore, uncertainty can be counted as the crucial motive

for the application of hedges. Hedges enable the medical specialists to express politeness in

order to avoid potential FTAs, to express tentativeness and cautiousness, to convey less than full commitment to their statements, to convey vagueness to the exact accuracy or quantity, to show solidarity with medical community, or to present modesty for their achievements.

In Chen’s (2008) conversational data, question words sheme 什麼 ‘what’ is employed the most frequently among all the lexical hedges, while in medical speech, the modal auxiliary hui 會 ‘will/may’ occur the most. In Chen’s study, there is no category of hedging

adjectives due to their extremely small amount; however, adjectives occupy 6.01% in medical

spoken discourse. In Lo’s (2010) academic written texts, modal auxiliaries are the most

frequently used hedges for all the three disciplines, while in the medical written discourse, the

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hedging adverb huo 或 ‘alternatively’ and jiao 較 ‘relatively’, and the auxiliary keneg 可

能 ‘may’ occur the most. The adverb of indefinite degree jiao 較 ‘relatively’ is used by

medical specialists to modify the degrees of qualification and quantification. The hedging

adverb huo 或 ‘alternatively’ is used to present potential alternatives commonly seen in

medical discourse.

Keywords: hedge, medical discourse, face-to-face encounter, commitment, proposition

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ACKNOWLEDGEMENT

I would like to thank all those who supported and encouraged me in the process of completing my dissertation. This accomplishment would not have been possible without the help of a number of people.

First, I would like to express my sincere appreciation to my advisor, Dr. Miao-Hsia

Chang who inspired me with the direction for this study. Her thorough knowledge and insightful ideas guided me throughout the process. I would like to thank the committee members, Dr. Chun-Yin Doris Chen, Dr. Jen-I Li, Dr. Mei-Hui Tsai, and Dr. Huei-ling Lai for their perceptive comments and suggestions. I am grateful to Dr. Chun-Yin Doris Chen, Dr.

Jen-I Li, and Dr. Jen Ting, whose warm support and encouragement greatly comforted me and gave me the strength to continue.

I am indebted to Kao-Shan Lin. His keen computer skills assisted me greatly in analyzing data. I would like to express my appreciation to my colleague, Jim Tso, for his kind assistance in the data translation. Also, I want to thank my students at NCUE who helped me type the data in Excel.

I am thankful of those physicians who allowed me to use their lectures as my spoken data. I especially thank Dr. Yu-Lin Li. He kindly spared time to be interviewed by me, and offered me with some professional viewpoints regarding special jargon usages by physicians.

I would like to thank my dear friend, Mei-Zi Huang, who took good care of me during my several episodes of hospitalization. Without her help, I would not have been able to recover so speedily. I also thank her for taking care of my little girl whenever I was tied up with my dissertation work.

I owe my sincere appreciation to my brother (天信法師). His words of wisdom help me answer a lot of doubts in life, enhance my confidence and calm my nerves.

My earnest and deepest gratitude goes to my mother (天定法師). Her unconditional v support and love accompany me all the way. In the summer of 2012, I underwent three major surgeries in a row. Each time my mother prayed devoutly for me outside the operation room.

The people who serve in her temple took good care of me and helped me recover. Words cannot express my infinite gratitude and love to my mother. Herein I would like to dedicate this dissertation to her.

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TABLE OF CONTENTS

TABLE OF CONTENTS ··········································································· vii LIST OF TABLES ····················································································· x LIST OF FIGURES ·················································································· xi `

CHAPTER ONE INTRODUCTION ...... 1 1.1 Background ...... 1 1.2 Terminology and definition of hedges ...... 5 1.3 Uncertainty in medicine ...... 7 1.4 Purpose of the study ...... 9 1.5 Significance of the study ...... 10 1.6 Overview of the Study ...... 11

CHAPTER TWO LITERATURE REVIEW ...... 12 2.1 Studies in hedges: from semantics to pragmatics ...... 12 2.2 Hedges in medical research ...... 22 2.2.1 Hedges in medical writing ...... 23 2.2.2 Hedges in physician-physician interaction ...... 29 2.2.3 Hedges in doctor-patient interaction ...... 30 2.3 Hedges in non-medical research ...... 36 2.3.1 Hedges in conversation ...... 36 2.3.2 Hedges in research articles ...... 40 2.4 Hedges in studies of genre difference (spoken vs. written) ...... 45 2.4.1 Approximators in leisure, business, political, and academic discourses .. 47 2.4.2 Stance expressions in TOFEL 2000 Spoken and Written Academic Language Corpus ...... 47 2.4.3 If-conditionals in academic discourses ...... 48 2.4.4 Discourse features in medical conference and journal articles ...... 53 2.5 Functions of hedges in academic discourse...... 54 2.5.1 Expressing politeness and saving faces ...... 54 2.5.2 Avoiding full commitment and convey uncertainty ...... 55 2.5.3 Presenting tentativeness and cautiousness ...... 56 2.5.4 Showing solidarity and asserting in–group membership ...... 58 2.6 Categorization of hedges ...... 59 2.6.1 Modal auxiliaries...... 63 2.6.2 Lexical hedges ...... 68 2.6.2.1 Lexical verbs ...... 69 vii

2.6.2.2 Adverbs ...... 71 2.6.2.3 Adjectives ...... 73 2.6.2.4 Nouns ...... 74 2.6.2.5 Vague expression of quality and quantity ...... 77 2.6.3 Non-lexical Hedges ...... 84 2.6.3.1 Conditionals ...... 84 2.6.3.2 Questions ...... 88 2.6.3.3 Reference to limitations of the current study...... 92 2.7 Summary of Chapter Two ...... 94

CHAPTER THREE METHODOLOGY ...... 97 3.1 The database ...... 97 3.2 Discourse analysis and corpus-based approach ...... 104 3.3 Working definition of hedges ...... 105 3.4 Data analysis ...... 106 3.4.1 Statistical methods ...... 107 3.4.2 Data transcription and word segmentation...... 107 3.4.3 Data categorization ...... 109 3.5 Summary of Chapter Three ...... 112

CHAPTER FOUR RESULTS AND DISCUSSION ...... 114 4.1. Overall distribution of hedges ...... 114 4.2 Auxiliaries ...... 117 4.2.1 Keneng 可能 ‘may’ ...... 120 4.2.2 Ke(yi) 可(以) ‘can’ ...... 127 4.2.3 Hui 會 ‘will ; may’ ...... 131 4.2.4 Ying(gai/dang) 應(該/當) ‘should’ ...... 135 4.2.5 Neng(gou) 能(夠) ‘can’ ...... 140 4.2.6 Summary ...... 143 4.3 Lexical hedges ...... 145 4.3.1 Verbs ...... 145 4.3.1.1 Judgmental verbs ...... 147 4.3.1.1.1 Speculative verbs ...... 148 4.3.1.1.2 Assertive verbs ...... 151 4.3.1.1.3 Resembling verbs ...... 154 4.3.1.2 Evidential verbs ...... 157 4.3.1.2.1 Quotative verbs ...... 158 4.3.1.2.2 Sensory verbs ...... 161 4.3.1.3 Other verbs ...... 165 viii

4.3.1.4 Summary ...... 165 4.3.2 Adverbs ...... 167 4.3.3.1 Stance adverbs ...... 168 4.3.3.2 Adverbs of indefinite degree ...... 173 4.3.3.3 Adverbs of indefinite frequency ...... 176 4.3.3.4 Adverbs of approximation ...... 179 4.3.2.5 Summary ...... 181 4.3.3 Adjectives...... 183 4.3.3.1 Stance adjectives ...... 184 4.3.3.2 Adjectives of indefinite degree ...... 186 4.3.3.3 Adjectives of indefinite frequency ...... 189 4.3.3.4 Adjectives of approximation ...... 193 4.3.3.5 Summary ...... 195 4.3.4 Nouns ...... 196 4.3.4.1 Judgmental nouns ...... 197 4.3.4.2 Nouns of approximation ...... 202 4.3.4.3 Question words ...... 205 4.3.4.4 Summary ...... 210 4.3.5 Summary ...... 211 4.4 Non-lexical Hedges ...... 215 4.4.1 Conditionality...... 216 4.4.2 Rhetorical questions ...... 234 4.4.3 Addressing limitations ...... 254 4.4.4 Summary ...... 271

CHAPTER FIVE CONCLUSION ...... 275 REFERENCES ...... 286

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LIST OF TABLES

Table 1. Information of the ten speeches ...... 98 Table 2. Information of RAs from Journal of Internal Medicine of Taiwan ...... 102 Table 3. Information of RAs from Taiwan Medical Journal ...... 103 Table 4. Categories and subcategories of hedges identified in the present study ...... 109 Table 5. Frequency of hedges in the spoken vs. written genres ...... 115 Table 6. Results of Mann-Whitney U test on the relation of hedging devices used in the spoken and written discourses ...... 115 Table 7. The stratum of auxiliaries used in the spoken vs. written genres ...... 120 Table 8. Subcategories of judgmental verbs and evidential verbs ...... 147 Table 9. Frequency of speculative verbs used in the spoken vs. written genres ...... 149 Table10. Frequency of assertive verbs used in the spoken vs. written genres ...... 151 Table 11. Frequency of resembling verbs used in the spoken vs. written genres ...... 155 Table12. Frequency of quotative verbs used in the spoken vs. written genres ...... 159 Table 13. Frequency of sensory verbs used in the spoken vs. written genres ...... 162 Table 14. Frequency of stance adverbs used in the spoken vs. written genres ...... 169 Table 15. Frequency of adverbs of indefinite degree used in the spoken vs. written genres . 173 Table 16. Frequency of adverbs of indefinite frequency used in the spoken vs. written genres ...... 176 Table 17. Frequency of adverbs of approximation used in the spoken vs. written genres .... 180 Table 18. Frequency of stance adjectives used in the spoken vs. written genres...... 184 Table 19. Frequency of adjectives of indefinite degree used in the spoken vs. written genres ...... 187 Table 20. Frequency of adjectives of indefinite frequency used in the spoken vs. written genres ...... 190 Table 21. Frequency of adjectives of approximation used in the spoken vs. written genres . 193 Table 22. Frequency of judgmental nouns used in the spoken vs. written genres ...... 198 Table 23. Frequency of nouns of approximation used in the spoken vs. written genres ...... 203 Table 24. Frequency of question words used in the spoken vs. written genres ...... 206 Table 25. Frequency of conditionals used in the spoken vs. written genres ...... 217 Table 26. Functions of conditionals observed in the spoken and written genres ...... 218 Table 27. Functions of questions observed in the spoken and written genres ...... 239 Table 28. Types of imitations identified in the spoken vs. written genres ...... 254

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LIST OF FIGURES

Figure 1. Overall distribution of hedges found in the spoken vs. written genres ...... 117 Figure 2. Distribution of modal auxiliaries used in the spoken vs. written genres ...... 119 Figure 3. Distribution of epistemic verbs used in the spoken genre vs. written genres ...... 146 Figure 4. Distribution of judgmental verbs in the spoken vs. written genres ...... 148 Figure 5. Distribution of evidential verbs in the spoken vs. written genres ...... 158 Figure 6. Distribution of subcategories of epistemic adverbs in the spoken vs. written genres ...... 168 Figure 7. Distribution of subcategories of epistemic adjectives in the spoken vs. written genres ...... 183 Figure 8. Distribution of subcategories of epistemic nouns in the spoken vs. written genres ...... 197 Figure 9. Distribution of non-lexical hedges used in the spoken vs. written genres ...... 215 Figure 10. Distribution of questions used in the spoken vs. written genres ...... 238

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CHAPTER ONE INTRODUCTION

1.1 Background

The word 'hedge' conveys the sense of imprecision, dodging, refusing to commit oneself, or avoiding giving a direct answer to a question. ‘Hedging’ is a feature that used to receive pejorative connotations and is characterized as ‘poor’ in its usage, especially in circumstances inclining to formalization (Skelton 1988). It is believed that ‘hedges’ is initially used as a linguistic term (Skelton 1988, Crompton 1997, Markkanen & Schröer

1997, Meyer 1997, Varttala 1999, 2001, Kaltenböck et al. 2010) “to make things fuzzier or less fuzzy” (Lakoff 1973:471). Since the 1970s, the research of hedging phenomena has become a popular issue for subsequent linguistic analyses, and its scope has been extended from semantics to pragmatics and applied linguistics. As the scope expands to various linguistic fields, the notion of hedging is then approached from different perspectives, such as speech act and politeness theory (House & Kasper 1981, Brown & Levison 1987, Myer 1989,

Tchizmarova 2005) and interactional pragmatics (Cheng and Warren 2003, Jucker et al. 2003,

Overstreet 2005). The hedging phenomenon is thus realized as an inevitable feature that serves a variety of functions in communication. Channell (1994: 3) argues that vagueness is neither all ‘bad’ nor all ‘good” but depends on whether the vague language is used appropriately. In academic discourse, for example, hedges are shown to be an important part of a speaker’s/writer’s argument. They only help speakers/writers avoid categorical and straightforward assertions and distance themselves from full commitment to a claim, but they also allow speakers/writers to express their tentativeness and possibility regarding the factuality of their statements or to indicate deference to their audience. Investigation of use of hedges in academic discourse has also been an important line of inquiry since the 1990s

(Salager-Meyer 1994, Hyland 1994, 1996a,b, 1998, 2000, Crompton 1997, Zhang 1998, Li

1999, Meyer 1997, Varttala 1999, 2001, Ruzaite 2004, Lewin 2005, Lo 2010, Yang 2013),

The concept of politeness is the most frequently mentioned motivation for hedging practices

1 (Brown & Levinson 1987, Meyer 1989, Channell 1994, Markkanen & Schröer 1997). The politeness strategies of hedges are used to save either the speaker/writer’s or the reader/listener’s face. Being imprecise or mitigating one’s commitment to the truth value of a proposition or a claim helps protect the speaker/writer’s face from potential disapproval, and at the same time show deference to the reader/listener for not being too forceful.

Hedges can be thought of as a typical feature of highest-level scientific peer

communication, such as in professional specialist-to-specialist medical discourse. Research in

medicine is normally explored in the fields of EAP (English for Academic Purposes) and ESP

(English for Specific Purposes), and the use of hedges in the medical realm has also gained

considerable attention (Prince et al. 1983, Adams Smith 1984, Bonanno 1994, Salager-Meyer

1994, Skelton, 1997, Varttala 1999, 2001, Webber 2005, Li & Ge 2009). In the earlier days,

doctor-patient relationship was seen as an asymmetric one (Fisher 1984, West 1993, West and

Frankel 1991, Ainsworth-Vaughn 1992, 1994, 1995, 1998), with doctors assuming a

superordinate position while patients assuming a subordinate position. The asymmetry is ascribed to doctors’ specialized medical knowledge, the technical skills, and the professional

prestige of their role. Nowadays, “patient-center” care is the newest trend in medicine

(Srivastava 2011). As indicated in a speech by Dr. Huang, a chaplain and psychiatrist, of a

Christian Hospital in middle Taiwan, conventionally doctor-patient relationship was viewed

as professional to unprofessional, but now this traditional concept is challenged due to easy

access to information. As long as one has the means to obtain the information s/he needs,

everyone can be the so-called “professional”. In one lecture, Dr. Huang asked the audience

with his own experience, “Have you ever met certain patients who come to your office with

their laptop and show you the information they found from google?” Those patients have checked the possible causes and subsequent development of their illness before entering the doctor’s office. In other words, the role of the patient is transforming from a passive seeker to

2 an active participant. With the advancement of medical technology and the promotion of human rights, the doctor is no longer the authority to decide what a patient should do or should not do because patients have the right to know and participate in their medical treatments. The higher the patients’ rights are valued, the more frequently the medical legal problems occur. To respect patients’ rights and avoid unnecessary legal problems, a better way for doctors to deal with doctor-patient interaction is to face their patients with honesty.

The doctor has the obligation to tell his/her patient the possible causes of the illness, his/her diagnoses, the options of treatments, and the potential cure rates and risks along with those treatments. As exploration of the hedging phenomenon has been very much in vogue and spread from classic logics to various disciplines, the research is particularly flourishing in literature about English hedges. Comparatively, the linguistic realizations and functions of hedges in Chinese have not been taken with admirable attention (Biq 1990, Chen 2008, Lo

2010, Chang et al. 2012). Biq (1990) examines hedging functions of question words in conversational Chinese. Chen (2008) explores the realization of hedges in natural occurring

Mandarin conversation. Her spoken corpus displays the manifestation of hedges in different linguistic categories. Lo‘s(2010) compares the use of hedges in three written academic disciplines, biology, business, and history & literature. Chang et al. (2012) extend Lo’s study by focusing on authorial stance in attribution hedges. Lo’s study is probably the first academic research which deals with hedging phenomenon in written Chinese. While some attention has been directed toward written academic discourse, to my knowledge, there is no corpus providing access to authentic Chinese academic spoken discourse, and there has been much less or no attention given to spoken discourse in the Chinese academia. This is probably due to the compilation of speech corpora is “more time-consuming, complex, and costly” (Swales 2002:150). In light of this insufficiency, the present study attempts to investigate the realization of hedges in both spoken and written genres. I compare the

3

utilization of hedging strategies in physician-to-physician discourse and research articles. The

motives for me to target medical discipline, to compare hedging realizations in both spoken

and written genres, and to select physician-physician discourse and research articles as my

research objects are explained as follows. First, medicine is tightly related to matters of

human welfare. As human beings, our lives have immediate entanglement with medical science. In the past, the medical profession was seen to be distant from ordinary people, and

it used to be regarded as mysterious and supreme. Nowadays, with the increasing demand of human rights and the current trend of “patient-centered care,” patients are able to participate more actively in their visits to the hospital. Patients then gradually realize that not only they themselves but also physicians are troubled by the increasingly visible uncertainty present in clinical practice. I believe that for many people, including me, the more the glimpses we are allowed to take into the medical profession, the more intrigued we are. Second, speech and writing are two common genres for communication, and hedges are employed in both genres.

Yet some researchers (Markkanen & Schröder 1997, Flowerdew 2002, Swales 2002, Hyland

2009) have noticed that compared with written academic discourse, hedges in speech have been neglected for quite some time in the field of academia. In fact, it has been shown by a few studies in spoken academic discourse that hedges used in academic speech differ from writing in a range of different practices. Some lexical hedges have been examined to distribute divergently between speech and writing, and certain hedging devices are exclusively used in either spoken or written discourse (Ruzaite 2004); for example, the frequency of if-conditionals appear much more frequently in speech than in writing (Carter-

Thomas & Rowley-Jolivet 2008). Third, in the medical discipline, a disproportionate amount of spoken and written discourse has also been observed. Except for Prince et al.’s study

(1983) which focuses on physician-physician discourse, a majority of research examines written medical discourse (Adams-Smith 1984, Salager-Meyer 1994, Nwogu 1997, Skelton

4

1997, Varttala 1999, 2001, Carter-Thomas 2007, Li & Ge 2009). Since research articles are

realized as one type of specialist-to-specialist discourse, the face-to-face interaction among

physicians would be the symmetrical and compatible counterpart of research articles. The

physician-to-physician discourse and medical research articles are then selected as the

representatives of the spoken and written genres. For a better understanding how hedges are

applied in medical discourse and for comparative purpose, it is worth investigating hedges in terms of genre.

1.2 Terminology and definition of hedges

In previous studies, analyses of hedges and hedging-related phenomena are treated under

various terminologies, such as vagueness (Danell 1978, Wierzbicka 1986, Wardhaugh 1985,

1993, Channell 1990, 1994, Myers 1996, He 2000, Jucker et al. 2003, Ruzaite 2004, Cutting

2007), fuzziness (Zadeh 1965, 1972, Wu 1999, Zhang 1998), imprecision (Du Bois 1987,

Tannen 1989, Skelton 1988), mitigation (Caffi 1999, 2007), and pragmatic force modifier

(Nikula 1996, Lin 2010). As fuzzy as its terminology, there is so far not an consistent

definition for hedges. According to Adolphs et al. (2007: 62), “defining VL1 is a problematic

endeavor, and VL is itself, arguably, a vague concept.” For Lakoff, a hedge is used to make things fuzzier or less fuzzy; however, after the 1980s, most studies apply the approximating and attenuating sense of this term rather than its ‘less fuzzy’ sense (Chafe 1986, Salager-

Meyer 1994, Hyland 1998, 1999, 2005, Varttala 1999, 2001, Li 1999, Lo 2010). Although

Lakoff’s definition of hedges is always quoted as a starting point by subsequent hedging

studies, some researchers propose that hedges are indeed multifunctional, genre-related and

context-sensitive (Channell 1994, Hyland 1998, Vartala 1999, 2001, Lin 2010). Thus,

straightforward definitions of hedges are not commonly found in literature. Channell (1994:

20) defines an expression or word as a hedge if “a. it can be contrasted with another word or

1 Vague Language. 5

expression which appears to render the same proposition; b. it is ‘purposely and unabashedly vague’; c. its meaning arises from the ‘intrinsic uncertainty’.” Channell points out that “there are a number of different ways that a speaker can avoid being precise or exact” (p. 17).

Different writers might focus on different aspects of the same topic and use the term “vague”

to mean different things. In Hyland’s (1998: 1) investigation of scientific research articles,

hedging refers to “any linguistic means used to indicate either a lack of complete commitment to the truth value of an accompanying proposition, or a desire not to express that commitment categorically.” Following Hyland (1996), Varttala (2001) describes hedging as a

“polypragmatic” interactional strategy. That is, one single hedge may fulfill numerous pragmatic functions in discourse, depending on the communicative situation. Thus, Varttala defines hedging in a broad terms as “a strategy by which one may indicate different degrees of less than full commitment to conceptualization of the universe” (p. 34). Fraser (2010) sees hedging as a crucial aspect of pragmatic competence. If one wants to communicate effectively in a language, mastering the art of hedging is necessary. In his words hedging is “a rhetorical strategy, by which a speaker, using a linguistic device, can signal a lack of commitment to either the full semantic membership of an expression or the full commitment to the force of the speech act being conveyed” (p.22). Hedges are viewed as one of the interpersonal features by Warchal (2010: 141), who focuses on the interpersonal potential of conditional clauses in written academic discourse, and hedges are defined as “expressions that tone down the force of a statement by limiting the commitment of the author to the expressed proposition.”

As suggested by the above studies, the notion of ‘hedging’ is essentially vague. The definition varies depending on genres, disciplines, and communicative purposes. In the present study hedges are seen as a polypragmatic interactional strategy, as proposed by

Hyland (1996) and Varttala (2001), which serves to fulfill various functions in discourse.

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Hedges in this study are not restricted to single words or phrases that modify individual

utterances or elements within them since hedging is context-dependent. In many situations,

hedging devices cannot be determined by individual lexical units or phrases. More

information is needed to make propositions comprehensible. Therefore, it is not unusual to observe that hedges are employed across utterances. I examine both the spoken and the

written medical genres in terms of the attenuating sense of hedges. Linguistic expressions

defined as hedges in the present study include: those which express the speakers/writers

uncertainty about the precise quantity; those which convey the speakers/writers less than full

commitment to the arguments or claims; those which the speakers/writers express

tentativeness and possibility.

1.3 Uncertainty in medicine

Medical professionals, especially physicians, are generally regarded as almighty

experts who know everything about patients’ problems and who own the professional

knowledge to treat patients’ health problems. However, the reality seems not to meet ordinary

people’s expectation as there always exists uncertainty in the medical discipline (Bosk 1980,

Schwartz et al. 1981, Prince et al. 1982, Kong et al. 1986, Simon 1988, Levenkron and

Johnson 1988, Tsai 2006, Carney et al. 2007, Srivastava 2011, Smith et al. 2013). Doctors

realize that in clinical practice, there are layers upon layers of explanation, and “it’s

sometimes exceedingly difficult to arrive at simple, understandable definitions of diseases

and how they afflict us” (Srivastava 2011). As clearly indicated by Bosk (1980: 72):

It is rarely the case that signs and symptoms are unambiguous markers of specific diseases. Signs and symptoms often do not appear exactly as described in textbooks, and the full constellation that describes the “class” presentation of a disease is often not seen (p. 72).

Uncertainty is commonplace clinically, and it is the most basic problem that all physicians face while making diagnoses and prescribing treatments. In the doctor-patient

7 interaction, communicating uncertainty requires the ingenuity as studies find that physicians’ disclosure of uncertainty reduces patients’ satisfaction (Levenkron and Johnson 1988, Simon

1988). Levenkron and Johnson (1988) argue that the majority of patients can still respect physicians if uncertainty is communicated in a reassuring and confident manner. Their study finds that uncertainty can take at least two forms in medicine, one is physician uncertainty and the other is medical uncertainty. The physician uncertainty refers to situations when the physician cannot readily identify a piece of established medical knowledge, while the medical uncertainty refers to the probabilistic nature of a disease outcome, therapeutic response, or differential diagnosis that is associated with some degree of uncertainty. The way a physician conveys uncertainty varies individually, depending on the circumstance. It can be a frank open discussion of uncertainty, a quick mention of it, or consciously concealing it.

Uncertainty arises not only in diagnosis in doctor-patient communication, but also in description of physical finding in physician-to-physician discourse. Prince et al. (1982) examine physicians’ talk in the rounds of a pediatric intensive-care unit, and find an uncommonly high rate of hedged assertions. The common hedges identified in the physician- to-physician discourse are classified into approximators (e.g. sort of, about, around, approximately) and shields (e.g. I think, according to her estimates). “Approximators” are employed the most frequently in the description of symptoms, which indicates that the physical situations and the terms chosen to describe the symptoms are, at best, imperfectly matched. “Shields” appear the most frequently in discussions of diagnoses and planning, which signals the speaker’s less than full confidence towards the statement being said. The high frequency and great variety of hedging devices observed in the physicians’ talk manifest that uncertainty is a ubiquitous feature in the medical realm. It is clear that “the hedging, or fuzzy communication, is as much a shared way of coping with uncertainty as it is an indicator of it” (Bosk 1980: 73).

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The above discussion shows that uncertainty is an inherent feature in the medical discourse, and the linguistic expressions of hedges serve as means for the physicians to express their uncertainty. The application of hedging devices is thus seen as a necessary and vitally important skill for physicians to manipulate their uncertainty either among physicians or between physicians and patients. Hedges are often employed by physicians to express tentativeness and caution for their arguments and claims either in face-to-face encounter or in writing. The interpersonal nature rooted in face-to-face discourse is presumably the factor which differentiates the choice of hedging devices and communicative purposes from those in written discourse.

1.4 Purpose of the study

The purpose of this study is to investigate the hedging phenomenon in the specialist-to- specialist discourse in Taiwan’s medical setting. The application of hedging strategies in the spoken and in the written genres is explored and compared. As hedges are seen as characteristic of medical discourse and are identified as a necessary and vital means in

English medical communication (Bosk 1980, Prince et al. 1982 Adams-Smith 1984, Salager-

Meyer 1994, Nwogu 1997, Skelton 1997, Varttala 1999, 2001, Carter-Thomas 2007, Li & Ge

2009), it is important to examine whether hedging strategies are also tactically employed by medical professionals in Taiwan. The hedging devices utilized by physicians in the peer communication is the focus of the present study as Bosk (1980: 72) suggests that “physicians’ talk provides one indicator of the uncertainty endemic to a medical environment.” I then compare the application of hedging strategies in two medical genres, spoken discourse (peer lectures) and written discourse (research articles), in order to reveal (i) what functions hedges display in the medical discourse, and (ii) whether and how genre difference affects the manifestation of hedges in Taiwan’s medical discourse. The research questions which will direct this study are:

9

1. What linguistic devices are used as hedges in the medical profession in terms of genres?

What are their frequencies and distributions?

2. What functions do the hedging devices serve in the spoken and written medical discourse?

3. What are the differences in the use of hedges between the spoken and written medical

discourse?

4. Are there any difference in the use of hedges between Chinese spoken medical discourse

and Chinese daily conversation? If yes, what are they?

5. Are there any differences between Chinese written medical discourse and other written

disciplines? If yes, what are they?

1.5 Significance of the study

The present study aims at exploring the hedging phenomenon in the medical setting of

Taiwan. I examine hedging strategies used by medical professionals in face-to-face discourse

and in research articles, attempting to see how hedges are manifested in the Taiwanese medical profession and whether they effect differently in the spoken discourse and in the

written discourse. Although the investigation of use of hedges in academia since the 1990s

have yielded significant results (Salager-Meyer 1994, Hyland 1994, 1996a,b, 1998, 2000,

Crompton 1997, Meyer 1997, Varttala 1999, 2001, Ruzaite 2004, Lewin 2005, Lo 2010, Yang

2013), the researches mainly aim at written data. To date, there have been few systematic

studies comparing the use of hedges in research articles of different subject fields (Salager-

Meyer 1994, Varttala 1999, 2001, Lo 2010). To my knowledge, there are no studies focusing

on hedges by means of genre comparison in Chinese. Furthermore, the use of hedges in

Chinese medical discipline has not yet received attention, especially in the specialist-to-

specialist spoken discourse as spoken discourse data is not easy to obtain in the medical

setting. Prince et al.’s work (1982) is so far the only research which explores lexical hedges

used in physician-to-physician communication. The current study, therefore, may be regarded

10 as a pioneering work in a Chinese medical context.

1.6 Overview of the Study

This study is composed of five chapters. The Introduction chapter presents the background and purpose of this study, terminology and definition of hedges, and significance of the present study. In addition, the relation between uncertainty and medicine is also explicated in this chapter. An overview of the study is provided at the end of the Introduction.

In the second chapter, I review literature of hedging from its initial semantic concept to its pragmatic and academic applications. The methodology is presented in Chapter Three, including description of the database, collecting procedure, and analytical framework. In addition, the working definition of hedges for the present study is described. In Chapter Four,

I present and discuss the results of the analysis. I compare the frequency, forms, and communicative purpose in the use of hedges by means of genres. Chen’s (2008) conversational study will be used to compare with my spoken data, whereas Lo’s (2010) study in academic texts will be applied to compare with my written discourse. Chapter Five recapitulates the findings and concludes this study.

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CHAPTER TWO LITERATURE REVIEW

In this chapter, I review previous studies concerning investigation of hedging phenomena. The application of hedges is quite ubiquitous, which can be observed from ordinary daily conversation to formal institutional interaction or to academic discourse.

Hedging devices, as well as communicative purposes of hedges, are utilized differently depending on disciplines, genres, cultures, and communication circumstances. Although the research in exploration of the hedging phenomenon has been particularly flourishing in

English literature, lately there are several studies focusing on examination of Chinese hedges, which will also be reviewed in this chapter. In Section 2.1, I review the development of hedging concept, from its semantic origin to its pragmatic perspective. In Section 2.2, hedges in medical research are discussed, including hedges in medical writing, physician-to- physician interaction, and doctor-patient interaction. Hedges employed in non-medical fields, such as conversation and scientific disciplines, are reviewed in Section 2.3. Section 2.4 presents studies which compare various hedging devices between spoken and written genres.

In Section 2.5, based on the literature, I recapitulate four functions what hedges demonstrate in academic discourse. The categorization of hedges is discussed in Section 2.6, including modal auxiliaries, lexical hedges, and non-lexical hedges observed in both English and

Chinese literature.

2.1 Studies in hedges: from semantics to pragmatics

The concept of hedges can be probably traced back to Zadeh’s (1965) work on logic of fuzzy sets. According to Zadeh, a fuzzy set is “a class of objects with a continuum of grades of membership” (p. 338), and there are not precisely defined criteria of membership in the real physical world. In other words, most classes of objects in the natural world do not have sharp boundaries. It is highly unlikely to constitute a set of ‘beautiful women’ or ‘tall men’ in the light of the usual mathematical sense. In psychology, Rosch (1973) conducts experiments

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to test whether category membership is perceived as a clear-cut issue or a matter of degree, and the results consistently show the latter. For example, Rosch finds that there is a well- defined hierarchy of ‘birdiness’ which emergers in the subjects’ minds, in that robins are typical members of birds, eagles are less typical, and penguins are further away from the central prototype. Her further experiment demonstrates that while being asked to respond with ‘true’ or ‘false’ to sentences of the form ‘A (member) is a (category)’, subjects tend to respond faster on typical members than on peripheral members. That is, subjects take shorter time to respond to the sentence like ‘A robin is a bird’ than to ‘A chicken is a bird’. Rosch’s

work shows that category membership seems to be in accordance with speakers’ uncertain

rather than clearly defined perception. Based on Zadeh’s (1965) early work on fuzzy logic

and Rosch’s (1973) work on category membership, George Lakoff (1973) relates the

observations of natural phenomena in the physical world to natural language concepts. He

suggests that:

…natural language concepts have vague boundaries and fuzzy edges and that, consequently, natural language sentences will very often be neither true, or false, nor nonsensical, but rather true to a certain extent and false to a certain extent, true in certain respects and false in other respects (p. 458).

The correlation between the idea of fuzzy concept and the practice of natural language

brings up the notion of hedges. Lakoff (1973: 471) refers to hedges as “words whose

meaning implicitly involves fuzziness -- words whose job is to make things fuzzier or less fuzzy.” An experiment is conducted to examine the effect of the hedging expression sort of in the case of birdiness:

(1) a. A robin is a bird. (true) b. A chicken is a bird. (less true than a) c. A penguin is a bird. (less true than b) d. A bat is a bird. (false, or at least very far from true) e. A cow is a bird. (absolutely false)

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(2) a. A robin is sort of a bird. (false – it is a bird, no question, about it) b. A chicken is sort of a bird (true, or very close to true) c. A penguin is sort of a bird (true, or close to true) d. A bat is sort of a bird. (still pretty close to false) e. A cow is sort of a bird. (false)

In Lakoff’s experiment, some subjects do not distinguish the sentences (a), (b), and (c)

in example (1), and tend to regard them as all being true. However, after adding the

hedge sort of, as in example (2), those subjects undoubtedly distinguish the sentence (a)

from the (b) and (c). The subjects can instantly recognize the difference due to the

ability to make an underlying distinction in degree of birdiness, and such a distinction is

what the effect of sort of depends on. In the examples, the degree of truth is

corresponding to degree of category membership. Robins are conceptualized to be the

best exemplar of birdiness since they inherit the attributes, has wings, can fly, has feathers. Dirven and Verspoor’s (1998) definition may give a better idea of what the best exemplar is. They state that “the best member, called the prototypical member or

most prominent member of a category, is the subtype that first comes to mind when we

think of that category” (p. 16). Since subjects clearly know that robins are the

prototypical members of birds, the sentence (2a), with the predicate modifier sort of,

violates the knowledge they have. They then can determinately judge it as a false

statement. Lakoff’s experiment reveals that people do make the full range of

distinctions in the birdiness hierarchy, with robins judged to be the most representative

member of the bird category, chickens less typical, penguins far less typical, and bats

hardly at all. The following examples may better demonstrate Lakoff’s assertion that

hedges serve both attenuating and reinforcing functions. That is, how hedges function to

increase fuzziness, to make things fuzzier, and to decrease fuzziness, to make things less

fuzzy. The practice of these functions is correlated to the concept of category

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membership existing in human’s cognition.

(3) a. ＊A penguin is a bird par excellence. b. A penguin is sort of a bird.

Sentence (3a) is false since the hedging expression par excellence requires the highest

degree of category membership, yet a penguin is not the prototypical exemplar of birds.

However, if we use the hedge sort of to describe a penguin’s birdiness, it becomes

acceptable, as in (3b). With its implication of vagueness and imprecision, the hedge sort

of is entrusted to describe more accurately an untypical member of a category. The

status of a penguin is then modified by the hedge sort of to be a less prototypical member in the birdiness hierarchy, and which matches human’s conceptual knowledge in that a penguin is not a typical bird but is classified as a partial member in the bird category. In this sense, the hedge sort of makes the category boundary of birdiness fuzzier. Although Lakoff (1973) initiated the notion of hedges in terms of semantics, he does point out that pragmatics plays an important part in constituting truth values of sentences. The following example extracted from Lakoff’s (1973: 474) best demonstrates his view toward the significance of pragmatics:

(4) a. John is a bachelor. b. John is a regular bachelor.

Sentence (4b) would not be said of a bachelor as we normally perceive, but rather it might be said of a married man who acts like a bachelor. It is because the word regular picks out certain ‘metaphorical’ properties and those properties make ‘bachelor’ deviate from its original literal meaning. In other words, regular asserts the connotations of ‘bachelor’. The connotations of words are usually recognized as part of pragmatics, and they are deemed to be irrelevant to truth values of sentences. However, the truth value of (4b) not only depends

15 on the literal meaning of the predicate, but also strictly on the connotation. It indicates that

“semantics cannot be taken to be independent of pragmatics, but that the two are inextricably tied together” (p. 474). Later on, Lakoff touches upon the notion on how hedges interact with performatives. He argues that if a sergeant says (5):

(5) You might want to close that window, Private Snurg.

It would be appropriate to describe such a situation by the following two conditions:

(6) a. Strictly speaking, the sergeant didn’t order the private to close the window. b. Essentially, the sergeant did order the private to close the window.

Therefore, Lakoff indicates that hedges obviously interact with felicity conditions for utterances and with rules of conversation. He then in this same article attributes to Robin

Lakoff (personal communication) the observation that certain verbs and syntactic constructions convey hedged performatives which modify the force of a speech act, as in (7):

(7) I suppose (guess/think) that Harry is coming.

The idea of hedged performatives becomes one way of widening the concept of hedges.

Fraser (1975) follows up on Robin Lakoff’s observations and introduces the term

“Hedged Performative” (p. 187). He proposes that when certain performative verbs such as apologize, admit, and request are preceded by specific modals, such as can, should, and must, or semi-modals. such as have to, intend to, would like to, the sentences result in an attenuated illocutionary force of the speech act designed by the verb:

(8) a. I should apologize for being rude on the phone yesterday. b. I have to admit that you have a point. c. I must request that you sit down

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The models and semi-models in example (8) are considered to function as hedges. After

applying the model should, example (8a) is still an apology, but one less strong. Brown and

Levison (1978, 1987: 145) elaborate on Lakoff’s definition of hedges and assert that hedges

can modify the degree of membership of a predicate or noun phrase in a set, and “it says of

that membership that it is partial, or true only in certain respects, or that it is more true and

complete than perhaps might be expected.” They further develop hedging concept in the

speech act. They argue that hedging acts not only on the propositional content, as considered

by Lakoff (1973), or on the performative clause, as proposed by Fraser (1975), but also on

the illocutionary force and speaker commitment in general. Brown and Levison incorporate

Goffman’s (1967) notion of ‘face’ into their theory of politeness. They see politeness as a

social reason to deviate from Grice’s (1975, 1978) conversational principles. Hedges are

regarded by Brown and Levison as expressions which show that the speaker does not adhere

to Grice’s (1975, 1978) maxims, and the use of hedges mainly as means of negative

politeness. In Brown and Levison’s work, both the attenuation and the reinforcement aspects

of hedges are maintained though they focus more on the former.

Since hedges are pervasive in language use, Prince et al. (1982), defining hedges as

linguistic means that make things fuzzier, makes a further distinction between different types

of hedges: “fuzziness within the propositional content proper” and “fuzziness in the

relationship between the propositional content and the speaker” (p. 85). The former type is referred to as “approximators”, as sort of in His feet were sort of blue, and it is further divided

into “adaptors” (e.g. sort of ), which modify a term to fit a non-prototypical instance, and

“rounders” (e.g. approximately), which indicate a term that is not precise. The latter type is

referred to as “shields”, as I think in I think his feel were blue, and it is further divided into

“plausibility shields” (e.g. I think, I guess, probably), which are expressions related to doubt,

and “attribution shields” (e.g. according to her estimates, as far as I could tell from the

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mother), which are expressions attributing the responsibility of a proposition to someone

other the speaker. According to Prince et al. (1982), only “approximators” affect the truth

value of propositional content, whereas “shields” affect the degree of speaker commitment

but leave the truth condition of proposition unchanged.

A similar two-way distinction of hedges is proposed by Hübler (1983), who distinguishes linguistic indetermination into “understatements” (expressions of “phrastic” indetermination) and “hedges” (expressions of “neustic” indetermination), under the cover term “understatement”. Hübler presumes that there are oppositions to all sentences, and hedging devices are utilized by the speaker to prepare for possible opposition from the hearer.

This underlying assumption manifests the interactional aspect of hedging phenomena, and shows that Hübler’s framework is pragmatic by nature. “Understatements” concern the propositional content of a sentence and its correspondence with the outside world, whereas

“hedges” concern the speaker’s attitude to the hearer regarding the proposition. Thus, the understatement a bit as in the sentence It is a bit cold in here modifies the “phrastic”, that is

the propositional content, while the hedge I suppose as in It is cold in Alaska, I suppose, modifies the “neustic”, that is the speaker’s attitude toward the utterance (p. 11). Hübler’s

(1983) division of hedges is found to be quite similar to that of in Prince et al.’s (1982).

Prince et al.’s “approximators” corresponds to Hübler’s “understatements,” and their

“plausibility shields” corresponds to Hübler’s “hedges” (Markkanen and Schröder 1997,

Varttala 2001, Fraser 2010). Caffi (1999, 2007) lately extend the bipartite distinction of

Prince et al. (1982) and Hübler (1983) to a tripartite model.

In her framework of mitigation devices, Caffi (2007: 16) ascribes the concept of

mitigation, a synonym of attenuation, “is a result of a weakening operation on one of the

interactional parameters.” Mitigation serves to smooth interactional management in that it

“reduces risks for participants at various levels, e.g. risks of self-contradiction, refusal, losing

18 face, conflict, and so forth” (Caffi 1999: 882), and it is argued to work in a “multi-layered and multi-dimensional way, simultaneously affecting a plurality of linguistic levels and interactional dimensions” (p. 883). Based on different scopes of mitigation, Caffi distinguishes mitigating mechanisms into “bushes”, “hedges”, and “shields”. The three domains where these mitigating devices operate on are the proposition (and within it, reference and predication), the illocution (e.g. illocutionary verbs, expressions modifying the strength of the illocution), and the deictic origin of the utterance (e.g. the I-here-now of the utterance). In “bushes”, the focus of the mitigating device is on the propositional content, which is typically made less precise. “Bushes” then refer to lexical expressions which reduce precision of the propositional content; therefore, it corresponds with Prince et al.’s (1982)

“approximators” and Hübler’s “understatements”. An example extracted from Caffi’s Italian corpus of doctor-patient and psychotherapeutic interaction demonstrates how bushes (e.g. diminutive suffix –ino) work to attenuate the speaker’s utterance (in the following examples, the capital D stands for the doctor):

(9) D. le do uno sciroppino da prendere.+due eucc I’ll give you ((lit. I give you)) a cough syrup+DIM to take.+two table sp (Caffi: 2007: 99)

The doctor utters example (9) as he is about to write a prescription. The diminutive suffix – ino in sciroppino (lit. ‘a cough syrup+DIM) makes the reference act in the prescription fuzzy.

With its semantic feature [-serious], the diminutive suffix –ino functions to reduce both the severity and the unpleasantness of the therapeutic prescription. It not only downgrades the imposition on the patient to comply with the prescription but also indirectly mitigates her possible worries about her pathology. In “hedges”, the scope of mitigation centers on the illocution, i.e. on illocutionary force indicating devices, and the speaker’s commitment to the propositional content. The notion of Caffi’s “hedges” covers Prince et al.’s (1982)

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“plausibility shields” and Fraser’s (1975) “hedged performatives”. “Hedges” are illustrated in the following examples:

(10) D. […] io le proporrei se vuole una medicina apposta per vedere se riescxx – se riesco a farla dormire= […] I’d propose to you if you want a special medicine to see if I caxx – if I can make you sleep= (Caffi: 2007: 102) (11) D. Probabilmente è: - dove c’è l’attacapanni – probabilmente è una:: conseguenza di un problema intestinale: che è cominciato con I’influenza eh:? probably it is – where the clothes-stand is – it is probably a consequence of an intestinal problem: that began with the flu eh:? (Caffi 2007: 103) io le proporrei (‘I’d propose to you’) in sentence (10) is a hedged performative since the verb in the conditional mood is a weaker form than the performative expression ‘I propose”. In the doctor-patient relationship, although the doctor acts a strong role as the healer, he formally downgrades his directive to a proposal which is up to the patient to accept. In (11), the mitigation, which works on the aspect of the illocution, displays the speaker’s epistemic commitment to the propositional content. Probabilmente (‘probably’) is employed to weaken the speaker’s degree of certainty about the proposition. In other words, the doctor downgrades his diagnosis to a hypothesis, “nothing more than an attempt to trace abductively the temporal and causal sequence of facts” (p. 103). “Shields” are devices to avoid self- ascription to the utterance and shift responsibility to another source, which is comparable to

Prince et al.’s (1982) “attribution shields”. In “shields”, according to Caffi (2007: 106), “the act is not mitigated by explicit linguistic devices, but rather it is dislocated by means of backgrounding and de-focalizing strategies, or even by the deletion of the utterance source.”

“Shields” appear to realize some strategies of displacement, which associate with the three components of deictic origin, the “I”, “here” and “now”. “Shields” in the “I” component are cases where the act is ascribed to someone else or cases where the author is simply deleted, as

20 in impersonal constructions or agentless passive constructions. The other two means of replacement are interconnected since the displacement involves the “here and now” component of the utterance. “Shields” in the “here and now” component are cases where a narrative replaces a sequence focusing on the present context. Caffi claims that these

“shields” can either work locally, at the level of a single utterance, as in (12), or globally, as textual strategies, as in (13). Example (12) illustrates a ‘non-I’, a non-ego strategy, whereas

(13) displays a “I, not-here, not now’ mitigating device (C stands for the client and T stands for the therapist).

(12) D. c’è un’i:perplasia estrogenica – c’è scritto qui. there’s an estrogenic hyperplasia – it is written here. (Caffi 2007: 107) (13) C. e poi: dall’85 I due anni diciamo in cui: stavo male ma non: per altri versi ma non Così male come sto adesso sono comunque riuscita a continuare a avorare mi hanno cambiato la respo*nsabilità+ T. *adesso sta male? +in questo momento? C. be’ adesso io sono qua e sono entrata per degli accertamenti: ulteriori= T. =no dico adesso ora qui. C. sì. T. sta male? C. be’ – certo. T. perché parla con me? C. no: non mi dà nessun fastidio parlare con lei.

C. and then from 85 to 87 the two years when: let’s say I felt bad but not in other respects but not so bad as I feel now anyway I managed to keep working they changed my du*ties+: T. *now are you feeling bad?+ at the moment? C. well now I’m here and I’ve come in for further tests= T. =no I mean now at this very moment here. C. yes. T. are you feeling bad? C. well – of course. T. because you are speaking to me? C. no: I don’t mind speaking to you.

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In (12), the mitigation focuses on the utterance source, the deictic origin. By shifting responsibility to some other impersonal source, the doctor is able to weaken his personal commitment to the diagnosis. Furthermore, the utterance makes no reference to either interlocutor: it is not only a ‘not-I’ but also a ‘not-you’ statement. Example (13) is a transitional case between deictic shields. This interaction demonstrates a ‘narrativization’

shield, i.e. a global strategy of de-actualization o f a topic. In this specific context (the first

session in a course of psychotherapy), the topic is the patient’s present state; however, with

the process of de-actualization2, a present feeling is shifted to the past and is told in a rather

detached way than being enacted. Caffi (1999: 905, 2007: 118) concludes that “mitigators

mitigate because they manage speech act responsibility in different ways.” “Bushes” and

“hedges” are scalar devices which work along a scale of degrees of epistemic commitment to

the proposition and degrees of endorsement of the illocution respectively, whereas shields are

yes-no devices (e.g. ‘I’/‘not I’, ‘now’/‘non-now’) which work directly on the core of the

utterance act, the deictic origin, the formal support of subjectivity.

2.2 Hedges in medical research

In the early days, the roles of doctors and patients were seen as asymmetrical, with

doctors described to be dominant and active while patients are depend and passive. Ordinary

people regarded doctors as the almighty experts who know causes of their discomfort and

have the ability to cure their diseases. Until these few decades, the mysterious veil of medical

profession is gradually uncovered, and people began to realize that medical diagnoses and

prognoses involve an inherent degree of uncertainty. Smith et al. (2013) propose that no

matter what physicians do, there will always be some uncertainty in prognosis, and the

uncertainty “have profound influence on physicians, as well as on patients and families” (p.

2 Caffi (1999, 2007) points out that the process of de-actualization signals a separation from the present communication, and this strategy is claimed to aim at self-protection, with the notion of ‘resistance’ in traditional psychoanalysis. 22

2449); therefore, physicians need to recognize their reaction to uncertainty and how these reactions may influence their communication with their colleagues and patients. The language used in medical profession inevitably and necessarily reflects this degree of scientific uncertainty, and which is instantiated through the employment of hedges.

In the literature, hedging phenomena in different medical environments have gained certain attention. While most of the studies focus the hedging investigation on written discourse (Adam Smith 1984, Salager-Meyer 1994, Webber 1994, Nwogu 1997, Skelton

1997, Varttala 1999, 2001, Li & Ge 2009), there are several researches examining the utilization of hedging devices in the medical spoken discourse (Prince et al. 1982, Bonanno

1994, Ferguson 2001, Webber 2005, Caffi 1999, 2007, Carter-Thomas & Rowley-Jolivet

2008). Among those studies, Prince et al.’s (1982) work is the only one which centers on hedging phenomena in specialist-to-specialist spontaneous talk. In the following subsections, hedging strategies employed in medical writing, physician-to-physician discourse, and doctor-patient interaction will be introduced in turn.

2.2.1 Hedges in medical writing

Varttala (2001) states that, “scholars appear to put forth, the (explicit or implicit) presumption that hedging is an important strategy in communication between experts” (p.

41). Skelton (1997: 124) makes a comprehensive description on the utilization of hedging devices in medical writing. He states that “when we use language we both say things and talk about our relationship to what we say.” This is a common phenomenon that people share with while using languages. As we speak or write, the content we utter is propositions, and we comment on our attitude to the propositions. The comments we make are concerned with one or both of two things: our attitude towards the truth of the proposition and our attitude towards its value. For example, in the sentence, It has been argued that the earth is flat, The earth is flat is the proposition, and this proposition is modulated by a comment, It has been

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argued, on its truth status. In another sentence, Thank goodness the earth is flat, the

proposition is modulated by a comment on its value. According to Skelton, “Truth

judgments” refers to comments on the truth and falsehood, certainty and uncertainty,

probability and possibility, while “value judgments” refers to comments on emotional status.

Both types of judgment may function to intensify or deintensify the proposition they

modulate, and yet the deintensified truth judgments are called hedges. In scientific writing, hedges are associated with “the removal of a personal stake in the truth value of a

proposition” (Skelton 1997: 125); however there are difficulties in distinguishing truth

judgments from value judgments, especially when it is not clear to what extent a text is

written with the consideration of its potential audience. Skelton identifies three main types of

truth which are employed commonly in medical writing, contextualized truth, evidential

truth, and interpreted truth. Contextual truth deal with the truth as the research convention

states it to be, and it serves one overt and one covert function within the structure of the

research paper. The overt function is to assert those things (e.g. shared knowledge) which are

taken to be true for the purposes of the paper. Contextualization in generally takes places in

the Introduction and Discussion sections of the research paper. The covert function of

contextual truth is to sustain the creative ambiguity of medical writing. That is, authors may use contextual truth to leave open the extent to which they personally committed to the truth of what they say. Evidential truth deals with truth as the statistical evidence states it to be, which is by definition unambiguous, and it is applied most in the Results section in medical writing. Skelton indicates that “it is the creation of evidential truth which removes responsibility from the writer, and by extension facilitates the convention of

depersonalization” (p.129). Interpreted truth is associated with truth as a matter of deriving

possible non-statistical meaning from findings. Interpretations are classified into

“interpretative labelling” which is used to label a particular finding, set of findings, or indeed

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the whole study, as being in some (non-statistical) sense ‘important’ or as having particular

value, and “speculation” is used to speculate the meaning of the main findings.

Adam Smith (1984) argues that students’ difficulties in distinguishing objective

statements of fact from author-marked observations of hypothesis, opinion, or

recommendation is due to their inability to interpret author’s comment which is actualized by

modals forms, either verbal or nonverbal, and other attitudinal markers. For helping students

to cope with this problem, Adam Smith examines the incidences of the subjective element in

three categories of articles, clinical case notes, research papers, and editorials, from the

British Medical Journal. The subjective element is the so-called “author’s comment”, and it is

better known as “speaker’s comment.” Adam Smith (1984) indicates that speaker’s comment

“plays a major part in any genre which involves evaluation or advice giving, and stands out particularly clearly in certain types of article in medical journals” (p. 27). It seems to manifest an abrupt and clear-cut breaks between the objective detached reporting found in the method/result section and the more subjective author involvement in the discussion/comment section. The results show that author’s comment is expressed by verbal modality (i.e., modal auxiliaries), nonverbal modality (i.e., related nouns, adjectives, and adverbs), and attitudinal markers (a number of words and phrases), with verbal modality makes up the most of the author’s comment. The modal auxiliaries may and should occur most frequently in the class of verbal modality; whereas modal adverbs (e.g. probably, possibly, certainly) and the related adjectives appear occur the most in the class of nonverbal modality. The nonmodal forms composing attitudinal markers includes adverbs (e.g. surprisingly, fortunately, admittedly), the choice of the reporting verb or verbal phrase (e.g. appears, suggests, is known to be, has been considered as), the qualification of the reporting verb (e.g. a long way from proving, said to predispose), the choice of the reporting noun (e.g. evidence, hypothesis, speculation), the qualification of modification of the reporting noun (e.g. strong evidence, evidence is

25

steadily accumulating, ample justification), emotive nouns (e.g. culprit, lunatic fringe), the

use of the first person in preference to the impersonal passive (e.g. I decide to re-examine, we

aimed to identify), the use of metaphor, antithesis, and analogy, and the selection of the

discourse structure. The specific purposes the author involve himself are found to be: the

assessment of probability or possibility related the truth of definiteness of the thesis,

recommending or expressing obligation or necessity, evaluation, emphasis to underline the

important items, ability, disputation, argumentation, and concession, expected or unexpected

outcomes.

Salager-Meyer (1994) conducts a genre-based contextual analysis on the use of hedges

in medical English written discourse. In sympathizing with Swales (1990), Salager-Meyer

believes that research articles cannot be considered as homogeneous discourse; each section

contains different communicative purposes from other sections. In this study, she examines

how the communicative purpose of the different rhetorical sections of research papers (RP)

and case reports (CR) influences the frequency and category distribution of hedges in each section. The RP follows the IMRAD (Introduction, Methods, Results And Discussion) structure while the CP has a short Introduction, a detailed Case Report, and a brief Comment

(sometimes called Discussion) section. The five categories of hedges adopted in her study are

Shields, Approximators, Authors’ personal doubt and direct involvement, Emotionally-

charged intensifiers, and Compound hedges. The results show that the Discussion section of

RP and the Comment sections of CR are the most heavily-hedged divisions, and the shield

category are the most frequent hedging device for both genres. The Discussion section is

where:

writers speculate, argue, contrast, and extrapolate from the described results, and at the same time avoid stating results too conclusively so that the readers can note that the authors are not claiming to have the final word on the subject (Salager-Meyer 1994: 163).

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The frequent use of shields (mostly verbal modality) in both RP and CP further confirm that

modals are frequently used in scientific literature to “tone down and enhance quantitative and

qualitative information as well as to modulate the degree of certainty on the author’s part” (p.

157). In RP, shields are followed by compound hedges and Approximators, whereas in CR,

shields are followed by Approximators and compound hedges. These three hedging

categories account for 90% of the total number of hedges.

Varttala’s (1999, 2001) findings regarding the distribution of hedges in the medical RAs

are not very far removed from Salager-Meyer’s (1994) results on hedging in her medical RA

corpus. In Varttala’s (1999, 2001) medical corpus, the research articles are also structured

according to the IMRD3 structure which is seen as characteristic of the RA genre, and the

Discussion section is the one with the highest incidence of hedges. According to Hyland

(1998), the Discussion section is where authors make their claims, speculate about what the

results might mean, and offer general interpretations. Therefore, the density of hedges is much higher in this section as “writers explore the ramifications of their results” (p. 154).

Hedges in Varttala’s medical data occur when there is uncertainty about the meaning of the experimental results. While the results obtained do not yield sufficient evidence, the authors then hedge their claims on the issue under scrutiny. Among the categories of hedges, full verbs is the primary means of hedging, followed by modal auxiliaries, while the categories of clausal elements and questions are more infrequent. Varttala (2001: 118) explains that while auxiliaries are normally viewed as a central way of producing modal meanings, it in fact seems that “particularly full verbs may often be an even more common exponent of modality than the modal auxiliaries.”

In Webber’s (1994) study, the use of questions in medical journals is examined. Webber indicates that scientists often met strong opposition against their claims and they have to fight

3 IMRD refers to the Introduction-Methods-Results-Discussion structure, which is equivalent to the IMRAD. 27

for their ideas and compete to get their work published. Therefore, the scientific writers rely on various rhetorical devices to persuade their readers, and questions serve one of the ways.

The corpus yield 112 interrogative sentences, and the most important objective of using

interrogatives is to get reader involvement. The number of interrogatives found in the data

reflects the discrepancy among different journals, where the language of the more specialist journal, such as aiming at the relatively restricted circle of diabetologists, tends to be more impersonal. In other words, the greater the professional level of the medical content is, the less the interrogative forms are used. Questions in medical texts convey various purposes. For example, questions are frequently used in the titles of articles to rouse interest and to pinpoint the main topic of the paper; questions may be posed in the paragraph to provide a framework for the following discourse; questions are used to address a highly complex subject about which little as yet is known and leave the issue open for debate; questions can be used as a kind of punch line towards the end of a text to point to the future with suggestions for debate or future research. Webber concludes that interrogatives “at times, they may be discreet. At other times, they may be very aggressive when they are used to attack opponents as part of academic debate” (p. 266). In the discreet usage, interrogatives serve as a hedging device for

“raising doubts on an issue without giving any names or taking up a strong position, and thus leaving open the possibility of alternatives” (p. 267). It is observed that the application of questions varies with genres: questions occur more frequently in editorials and letters which are more overtly personal genres, whereas they appear less in research articles.

Among various hedging devices in RA data, qualitative expressions of probability, such as probably, likely, virtually always, are under intense discussion in medical journal articles

(Greene 1976, Bryant & Norman 1980, Kenny 1981, Schwartz et al. 1981, Mosteller & Youtz

1990, Mazur & Hickam 1991, Clarke et al. 1992, Ohnishi et al. 2002). Qualitative expressions may have substantially different meanings to different people, which may result

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in misunderstanding among physicians and between physicians and patients. Although many

studies propose that it is necessary to assign unified numerical values to qualitative

expressions of probability in order to enhance communication among medical professionals, there is still not an agreed codification coming up so far. Some people may think that if the medical professionals knew the numerical probabilities, they would always use the numbers.

But according to their own medical experience, Kong et al. (1986) argue that they have occasion to use qualitative expressions even when they know the numerical value because

“sometimes we want to be vague” (p. 743). Schwartz et al. (1981) also point out that

‘consistent with,’ ‘highly suggestive of,’ ‘may represent,’ or ‘cannot exclude,’ are linguistic terms used frequently in medical setting since “clinical information, often fragmentary in character, is implicitly linked with the histologic findings, and interpretations are couched in ambiguous language” (p. 917).

2.2.2 Hedges in physician-physician interaction

Prince et al.’s (1982) study is a pioneer work in exploring hedging phenomena in medical setting. They explore hedging devices, focusing on attenuating sense of hedging, used in physician to physician communication in a pediatric intensive-care unit in

Philadelphia. Different types of hedges are found in the physician-to-physician discourse and certain types are related to speaker-uncertainty to the truth of the proposition the speaker convey. The hedges are classified into “approximators” and “shields”, with the former refers to fuzziness within the propositional content proper and the latter correlates with fuzziness in the relationship between the propositional content and the speaker. “Approximators” contribute to the semantics by indicating non-prototypical (marked) members in related to class membership, while “shields” affect the pragmatics by implicating a level of uncertainty with respect to speaker’s commitment. “Approximators” are further divided into “adaptors”

(e.g. almost, sort of, a little bit) and “rounders” (e.g. approximately, about, something

29 between…and…), with the former adapts an existing term to a new instance and the latter indicates a range rather than the precise term. “Shields” are divided into two subclasses,

“plausibility shields” (e.g. I think, probably, as far as I can tell right now) and “attribution shields” (e.g. according to her estimates, presumably, mother says that). “Plausibility shields” expresses the speaker’s degree of uncertainty, whereas “attribution shields” attributes the degree of uncertainty to someone other than the speaker. Prince et al.’s (1982) conclude that a great deal of hedges employed in the interaction among physicians is owing to the medical-technical matters rather than the emotional difficulties the physicians encounter.

2.2.3 Hedges in doctor-patient interaction

Although investigation of medical hedges is mainly centered on written discourse, there are several studies drawing their attention on spoken interaction between doctors and patients

(Bonanno 1994, Ferguson 2001, Webber 2005, Caffi 1999, 2007, Carter-Thomas & Rowley-

Jolivet 2008).

Bonanno (1994) explores the utilization of hedges in medical interview. The medical interview is a highly specific institutionalized type of speech event, which is mainly dominated by the physician. She focuses on a limited set of hedges, termed “approximators” by Prince et al. (1982), as they occur in the context of medical intake interviews between 8 physicians and 4 simulated patients. The category of approximators is subdivided into adaptors and rounders. In Bonanno’s (1994) study, hedges are defined as particles, words or phrases which are used to modify an utterance in one of the three ways: 1) A hedge can be used to modify the semantic content of an utterance; hence making the degree of membership of an element within a set. 2) A hedge can be used to modify the illocutionary force of an utterance. 3) A hedge may also be used to indicate doubt on the part of the speaker as to the truth of an utterance (p. 235-236). Unlike most social interactions, in which fact-threating acts are disfavored, the medical environment values directness at times. Bonanno suggests

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that in medical intake interviews, directness on the part of the patient might assist the physician in diagnosing illness and recommending medical treatment, whereas directness on the part of the physician might help the patient understand the physician’s diagnosis and recommendations, and then comply with them. The adaptors found in the data includes sort

of (sorta), kind of (kinda), somewhat, and slightly, and they are found to either exist alone or

co-occur with like and just. The primary grammatical function of the adapters in the data is to

modify the words they preceded, thus functioning as either adjectives, as in example (14), or

adverbs, as in example (15):

(14) We’re sorta meat and potatoes people. (15) You just kinda wake up and can’t get back to sleep.

Participants apply adaptors to describe medical procedures, symptoms, and physical states,

and they are normally found to occur in predicate complements on clause level. The

frequencies of adaptors used by doctor versus by patient are not distinct greatly. The adaptors

are found to be used by the doctors under 5 kinds of circumstances: requesting confirmation

of their understanding of the patients’ statements; requesting that the patients confirm or deny

the accuracy of conclusions (hypotheses) that they have made based on the data presented by

the patients, describing non-prototypical representations of idealized mental concepts and

degree of membership to a set, directing the discourse both overtly and indirectly, and

instructing the patients both formally and informally. And adaptors function to modify the

semantic content of an utterance to indicate a mismatch between a physical reality and an

idealized conceptual model, to attenuate the illocutionary force of an utterance when a potentially face threatening topic is raised, to single lack of speaker commitment to the truth of the propositional content of the utterance, to assist in mitigating or attenuating the illocutionary force of the physicians’ utterances when directing the discourse both directly and indirectly, to signal the reception of new information from the patients (when the doctors 31

repeated the adaptors used by the patients). In addition, adaptors serve to assist the doctors to accommodate on the lexical level when instructing the patients. Bonanno concludes that when the adaptors are applied to mitigate directives and to accommodate to the patient’s speech on the lexical level, they function as “politeness strategies to reduce the social distance between the physician and the patient and contribute to a more relaxed environment within the medical interview” (p. 119). Adaptors occur in the patients’ speech when the patients are describing physical sensations and emotional states, recounting/narrating past events during which physical and psychological trauma occurred, describing, categorizing and locating pain, introducing an embarrassing topic, and making generalizations. Among those circumstances, the majority of the adaptors are used when the focus of the interview is on symptoms, especially on the topic of pain. All of these adaptors function to signal fuzziness. In some instances, adaptors are used to indicate fuzziness on the propositional

level of an utterance to signal a mismatch between a physical reality and an idealized

conceptual model, as the utterance Just sort of phlegm type of stuff, while in other instances,

adaptors are used to reflect the vague boundaries and fuzzy edges of concepts, such as

descriptions of pain. In the medical intake interview, certain functions on the use of adaptors

are shared by doctors and patients, whereas differences on the usage are also found. The

common pragmatic functions are to modify the propositional content of an utterance by

marking nonprototypical member of sets and to modify the illocutionary force of utterances

by marking them as tentative or uncertain. As to the difference, doctors use adaptors to frame

inferences, to mitigate their directives to the patients, to simplify technical language and

descriptions while instructing the patients, and to soften their refusals to the patients’ requests

to pursue new topics. In other words, doctors use adaptors to enhance the politeness of their

interaction with their patients and to accommodate to their patients’ needs. Patients use

adaptors to describe metaphorically about their ambiguous physical or emotional states and to

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mitigate potentially face threatening statements about themselves when recounting events and

symptoms. The other subcategory of approximators which Bonanno examines is called

rounders. About, around, just over, a little, and or so/something are rounders found in the

study, which are lexical items co-occurring with measurable quantities and represent a range

or an approximation. Rounders is found to appear in two specific environments: one is in the

doctors’ requests for specific information involving quantities, and the other is in the patent’s

response to a request for numeric information. It is found that the patients use a significantly

larger number of rounders than the doctors do, which may be attributed to institutionalized

role expectations, dialogic pattern of the interviews, the topic of the discourse and the

discourse tasks at hand. The doctors use the rounder about exclusively while the patients use

about, around, just over, a little, and or so/ something. There is a significant difference in the

use of rounders in terms of the role of participants because the rounders occur in the patients’

speech are almost twice as often as those of in the doctors’. Generally, rounders occur when

the doctors requesting confirmation of their understanding of the patients’ statements,

requesting that the patients confirm or deny the accuracy of conclusions/hypotheses they have

made based on the data presented by the patients, and directing the discourse of the interview.

Rounders are found to serve several functions in doctors’ speech: they are used to mark a quantity as an approximation in responses, making the replies more general and fuzzy; while being used with questions, rounders help narrow down the topic and limit the patient’s answer, which help the doctors obtain specific information; Doctors might repeat rounders used previously by patients to signal the reception of information and to reduce the social distance between doctor and patient, and this accommodation can be viewed as positive politeness on the part of the doctors. In the patient’s speech, most rounders (95%) are used to respond to questions posed by doctors. Patients use rounders when responding to questions about past medical events and related trauma, physical symptoms, personal lifestyles, medical

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histories, and the medical histories and lifestyles of other family members. Rounds function

as hedges or ranges to make the patients’ response as approximations rather than precise

measurements, and they also function as a means of mitigating statements and of

accommodating to the doctors’ speech through lexical convergence. Both of these functions

serve as positive politeness strategies.

In addition to approximators, conditionals in Ferguson’s (2001) study are also proved to be a useful resource in doctor-patient consultations for managing the interaction with politeness and sensitivity. 34 consultations are recorded at outpatient clinics in Edinburgh and

Newcastle of UK. With regard to the forms of if-conditionals, some features characterized particularly to speech are found: conditionals with an absent apodosis, conditionals where the apodosis consists of an imperative, and conditionals where protasis and apodosis are distributed across different speaker turns. As to the functions, the most salient and distinctive used of conditions in this genre is in polite directives. The protasis serves the negative face needs of the patient by “presenting the proposed action as if it were an option for the patient to consider” (p. 77). Therefore, the directive sounds more tentative and the force is then softened. Conditionals can be used to describe or elicit symptoms, given that the main clause states the symptom and the subordinate protasis specifies the circumstances that give rise to the symptom. Conditionals are used in contexts of prediction or prognostication, with the main clause apodosis states a predicted outcome and the protasis the circumstances on which that outcome is contingent. Conditionals are also utilized by the doctor to explain the reasoning underlying a course of action, diagnosis, and treatment. Furthermore, conditionals occur in the contexts of assurance where the doctor suspects a particular problem and choose to present it as hypothetical and provisional. With this usage, the potentially unpleasant information would be less threating to the patient. If-conditionals in Carter-Thomas &

Rowley-Jolivet’s (2008) spoken discourse, conference presentations (CPs), serve as a

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politeness strategy for the speaker to guide the audience in the talks. The high frequency of if- conditionals with Discourse Management function4 marks the real specificity of the CP

genre. In the Discourse Management category, the P-clause instructs the audience on where

to direct their attention. According to Carter-Thomas & Rowley-Jolivet, two reasons are

accounted for the large number of discourse management if-conditionals. First, as compared

with highly standardized medical RAs, speakers have much more latitude to structure their presentation. If-conditionals then help speakers guide their audience by “signposting its structure, chucking it into manageable segments and marking topic boundaries” during the talks (p. 199). Second, speakers need to concurrently manage the visual space (what is projected on the screen) in addition to the verbal space; therefore, if-conditionals serve as a polite device to signal audience when to focus on the visual channel. The second person pronouns you observed in Webber’s (2005) medical conference presentations seem to coincide with this politeness strategy which draws the audience’s attention on the slides.

While directing the audience’s attention on the data that he/she considers worthy, the speaker can deliberately avoid carrying solo responsibility for the claims made since the data appear to speak for themselves. The first person pronoun ‘I’ collocates strongly with think, and this lexical phrase I think is widely used for hedging, as in (16), or to declare speaker’s stance, as in (17).

(16) In fact, I think maybe I can generalize and I can say… (17) Now this slide is a little complicated but I think it’s useful. (Webber 2005: 164)

As noted by Webber that it is not possible to give exact figures on how far an utterance is a declaration of opinion or of uncertainty, but “in any case a bare assertion of the same clause without I think would sound more categorical” (p. 164). The first person plural is even more

4 The Discourse Management category contains “occurrences which provide readers and listeners with guidance about the author’s intentions and the development of the text” (p. 194) 35

frequent than the singular in conference presentations: the inclusive we may be used to show deference or affiliation to the audience while the exclusive we are used to present the work on

behalf of a team or even an international group.

2.3 Hedges in non-medical research

In this section, I introduce studies that explore hedging phenomena in non-medical field.

Section 2.3.1 presents two studies that investigate hedges in conversational setting. Section

2.3.2 introduce two researches that focus on hedging phenomena in research articles.

2.3.1 Hedges in conversation

In daily conversation, people are not always clear or precise about what they try to

convey. For certain communicative purposes, vague and indirect expressions may carry more

relevant contextual implications than would convey precise expressions in everyday

communication. Following Channell’s (1994) categorization, Jucker et al. (2003) examine

examples of vague additives (i.e. approximators, downtoners, vague category identifiers, and

shields) and examples of lexical vagueness (i.e. vague quantifying expression, vague adverbs

of frequency, vague adverbs of likelihood, and placeholder words) in a corpus of semi-

controlled spoken interactions between Californian students. The students were asked to talk

about topics assigned by the researcher, such as movies, sports, opera, or karate. The corpus

consists of 14 sessions of conversations, which lasts for 3.5 hours. Jucker et al. argue that

“vagueness is not only an inherent feature of natural language but also – and crucially – it is

an interactional strategy” (p. 1739). Vague language is seen as conveying procedural meaning

along with representational meaning as they guide the listener to an interpretation that best

fits the speaker’s intentions for the addressee. In their study, speakers may flag the vagueness

explicitly by using a variety of expressions, such as downtoners, vague category identifiers,

or placeholder words. Downtoners (e.g. sort of, kind of, a bit), which have been called

‘adaptors’ by Prince et al. (1982) and ‘downtoners’ or ‘detensifiers’ by Hübler (1983), are

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used to introduce vagueness into a proposition or increase the degree of vagueness of an utterance. As well as observed in physicians’ talk (Prince et al. 1982), downtoners display a

loose use of language, indicating a relevant mismatch between the prototype and the item

being described. The following example demonstrates the vague use of kind of:

(18) A: I’ve been to o=ne and, I was kind of, I think .. I was kind of bored, (Jucker et al. 2003: 1746)

In this example, the speaker describes her experience in going to an opera as kind of bored.

The previous two false starts and the use of I think suggest that the word bored is not the best

term to summarize her experience. The downtoner kind of is thus used as a hedging device to

denote that although ‘bored’ may be the closest term the speaker can think of, it is not the

exact representation of her impression. Downtoners are also found to convey rhetorical

meaning, functioning to soften a criticism or a complaint, as in the examples below:

(19) R: the way you communicate is a little bit different one, (20) B .. I have to take care of my parents a little, (Jucker et al. 2003: 1747)

Vague category identifiers (e.g. or something like that, and stuff, or whatever) is another type

of hedges with flagging notion. This type of vague expressions is termed as “set marking

tags” by Dines (1980: 23), which serves to mark the preceding element as an illustrative example of a set. By applying tag expressions, the speaker is able to convey the concept that his/her thought is more complex than is being expressed. The part of the thought that is not uttered may be due to the speaker’s cognitive constraint at the moment of talk. This type of hedges seems to be highly informal, and they are more typically used in spoken conversation than in writing. Speakers sometimes use placeholder words, such as stuff, thing, and things, to refer to an entity that they are not exactly sure what will be the best word to name it. In this

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circumstance, the use of a placeholder word allows the speaker to hold the floor of the

conversation or to invite collaboration from the hearer. Yet sometimes the speaker may know

the right word for the entity but choose not to use it in order to avoid wrong pronunciation,

being offensive, derogatory, or pretentious (Channell 1994). Vague quantifying expressions

(e.g. many, some), adverbs of frequency (e.g. sometimes, usually), vague adverbs of likelihood (e.g. probably, maybe), and approximators (e.g about, around) are used to refer to amounts, frequencies, and probabilities of things or events when speakers are uncertain about the precise figures, when the exact figures are unnecessary for the current purposes, when precision would result in unwarranted processing effort on the part of the addressee, or when speakers believes a vague expression would better convey the intended implications. Jucker et al. also observe that speakers can use vague expressions to convey their propositional attitudes or stance towards what is being asserted. One way of doing so is to use ‘shields’, which can be further divided into ‘plausibility shields’ and ‘attribution shields’ (Prince et al.

1982: 89). ‘Plausibility shields’ are the main concern in Jucker et al.’s stu. Several types of hedges are included in this category, such as parenthetical verb phrases (e.g. I think, I believe,

I guess) and adverbs (e.g. presumably, probably, possibly). Parenthetical verbs enable the speaker to separate his/her viewpoint from the propositional content of the utterance, and thus reduce the speaker’s commitment towards the proposition conveyed. Adverbs are also employed to express the speaker’s uncertainty towards the proposition being stated, especially the adverb probably which can be used to indicate any type of uncertainty in an utterance. Upon their observation on the conversational corpus, Jucker et al. (2003: 1766) claim that “interlocutors generally do not have problems in understanding vagueness. They are apparently able to find an interpretation which they consider good enough for the purposes of the conversation.”

Based on naturally occurring conversational data, Chen (2008) explores hedging

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phenomena in Mandarin talk-in-interaction in accordance with different linguistic categories,

including modal auxiliaries, lexical verbs, adverbs, nouns, classifiers, and final particles.

Among all those lexical categories, adverbs are used the most frequently by the speakers to

express their less than full commitment to the statements. The question word sheme 什麼

‘what’ is the most frequent lexical hedge among all the occurrences of hedges found in the

data as sheme can refer to any indefinite entity, which lowers a speaker’s commitment to

what is being referred to. Five modal auxiliaries, keneng 可能 ‘possible’, hui 會 ‘can’, yinggai 應該 ‘should’, neng(gou) 能(夠), and yao 要 ‘want’, are used by the speakers to hedge their utterances. With modal auxiliaries, the speaker is able to demonstrate that the degree of commitment is based on personal deduction from available references. Epistemic verbs may function as hedges since they can be used to express the speaker’s judgment or attitude towards a proposition. According to Chen (2008), hedging verbs are used to indicate different modes of knowing, and the sources may come from the speaker’s belief (e.g. xiang

想 ‘think, renwi 認為 ‘think’, zhidao 知道 ‘know’, jianyi 建議 ‘suggest’, xiangxin 相信

‘believe’) or induction (juede 覺得 ‘feel’, ganjue 感覺 ‘feel’, jide 記得 ‘remember’, kan

看 ‘see’, tingqilai 聽起來 ‘sound’), or from some hearsay evidence (e.g. tingshuo 聽說

‘hear of’, jushuo 據說 ‘it is said that’). Since the judgments are derived from the speaker’s

subjective reasoning, the epistemic verbs help reduce the speaker’s responsibility to the

truthfulness of the proposition. Adverbs are found to be the most commonly used hedges in

Mandarin conversation, and it is presumably attributed to the fact that adverbial hedges are

linked to various concepts. They can be used to present a speaker’s attitude to his/her

utterance, to convey a speaker’s uncertainty to the degree of possibility of a statement, to

express indefinite degree or frequency of events, or to provide a range of numerical limits.

The epistemic adverbs which contain the notion of uncertainty and indefiniteness allow the

speaker to distance him/herself from full commitment to the utterance being said. The

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hedging adjectives observed in the corpus are all in reduplicated forms, such as xiaoxiao de

小小的 ‘small’, which are used to minimize the extent of the effect described by the proposition. Hedging nouns consist of nominal forms of verbs (5%) and interrogative pronouns (95%), with shemen 什麼 ‘what’ being the most common means of this category.

Zhong 種 ‘kind’ and lei 類 ‘type’ are two classifiers used by the speaker to make a vague classification, while ba 吧 is the only final particle found in the Mandarin conversation.

Both classifiers and particles can be used to convey a speaker’s uncertainty and thus reduce the commitment to the truthfulness of a proposition. In addition to the above lexical hedges, larger syntactic patterns, such as questions and conditionals, are also identified in Chen’s data. Questions include rhetorical questions and tag questions. The rhetorical question is used as an indirect way to mitigate the force of an utterance, while the tag question is utilized tactfully to seek agreement from the addressee. Besides mitigating the speaker’s commitment, these question forms serve as politeness strategies to minimize the potential

FTAs. Conditionals are used by the speaker as a self-protection strategy since the truthfulness of the proposition in an apodosis is dependent on the fulfillment of the condition profiled in a protasis. Therefore, the utterance in the apodosis is essentially indeterminate, which lowers

the speaker’s commitment and distances him/herself from possible opposition. Chen (2008:

135) concludes that “hedging manipulation in language in fact reflects the speaker’s attempt

to express subjectivity and intersubjectivity.” The notion of subjectivity is realized as hedging

devices which allow speakers to express their attitudes and stance to the truth of a

proposition, whereas the intersubjectivity is established since hedges can function as both

positive and negative politeness strategies to save the speaker’s both positive and negative

faces.

2.3.2 Hedges in research articles

Hedges are regarded as significant communicative resources in academic writing as

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they enable writers to express tentativeness on their statements, to present unproven claims with caution, and to enter into a dialogue with their readers. Hyland (1998: 6) contends that

“hedges are a crucial means of presenting new claims for ratification and are among the primary features which shape the research article (RA) as the principal vehicle for new knowledge.”

Given that much of the work on the modality of hedges has been theoretical (Lyons

1977), or corpus studies have tended to focus on modal verbs with nonacademic sources

(Coates 1983, Palmer 1990), Hyland (1996a) argues that a better understanding of how

hedges are used in scientific RAs can contribute to the growing literature on how science establishes its claims to knowledge and how scientists carry out their work. Based on a contextual analysis of 26 research articles selected from six leading journals in the field of cell and molecular biology, Hyland (1996a) argues that hedges are a prevalent feature of research writing in the biological science, and hedges allow scientific writers “to express

claims with precision, caution, and humility and to meet audience expectations of accuracy

and negotiation” (1996a: 258). In this study, Hyland also compares the results of his scientific

RA with other general academic data: a sample from the JDEST technology corpus,5 Butler’s

(1990) findings from 12 hard-science texts, and Holmes’ (1988) general academic corpus.6

The results show that scientific hedging is principally a lexical phenomenon, with 79% of

cases realized by modals, lexical verbs, adjectives, and adverbs, and it seems to employ a

more restricted range of items than found more generally in Holmes’ academic writing. In

addition to lexical hedges, three discourse-based strategies (reference to limiting

experimental conditions, reference to a modal, theory, or methodology, and admission to a

lack of knowledge) are also identified as significant means of scientific hedges, which make

5 The JDEST Corpus is compiled by Jiao Dong University in Shanghai in 1985. It consists of English texts from ten subjects in science and technology. See also Hyland 1998, p. 95. 6 Holmes’ study is based on the J Sections of the Brown and LOB corpora. See also Hyland 1998, p. 99. 41

up 15% of all hedges in the corpus. In the RA corpus, would, may, and could account for 77% of the total hedging cases. The highest density of modal auxiliaries is found in the Holmes’ and JDEST samples, whereas Butler’s science material and the RA corpus contain relatively lower density of modals. The frequency of will is the main difference between the general academic corpora and the scientific RAs, which may be due to its hedging function. To make predictions based on anticipated outcomes is presumably more suitable to less cautious fields than the hard sciences. Epistemic lexical verbs constitute the largest groups and greatest range of items in the RA corpus, with 38 different forms identified. Hedging verbs are employed to display the subjectivity of the epistemic source, and they are normally used to hedge assertiveness and convey the writer’s less than full commitment to the truth of a proposition. The high frequency of verbs in scientific RAs “reflects their rhetorical versatility in contexts where categorical assertions rarely represent the most effective means of expression” (pp. 264-265). The verbs, indicate, suggest, appear, and propose make up 56% of all instances. As compared with the other corpora, these four verbs, particularly indicate and suggest, appear much more often in scientific writing than in academic writing.

Epistemic adjectives occupy twenty percent of all hedging devices in the since corpus, with

(un)likely and possible (each 3.1 per 10,000 words) being used the most frequently. Possible is often used to obscure the source of epistemic judgment, as the example below:

(21) It appears possible that the mechanism causing the light activated fluorescence quenching may be triggered by either photosystem.

Epistemic adverbs are the second most frequent means of hedges in the RA corpus, with thirty-six forms being identified. Among those forms, apparently, probably, essentially, relatively, and generally are commonly used. Hyland suggests that the high frequency of hedging adverbs may be due to their distributional mobility, which allow the modality of an utterance to be either “thermalized”, as in (22) or inserted intrasententially, as in (23) (p. 42

269):

(22) Presumably, some “signal” generated in the chloroplasts initiates a… (23) No Pre-PS II has been detected, presumably because it has not yet been sought.

As to the strategic discourse-based hedges, by referring to experimental weaknesses, limited knowledge, or limitations of the model, theory, or method used, writers are able to qualify their commitment to the propositions being stated. The most common discourse-based strategy used as hedges is to comment on doubts regarding the experimental conditions, either by failing to guarantee the precision of experimental results, as in (24), or by withholding endorsement of the decisiveness of claims, as in (25) (p. 273):

(24) We have not been able to determine precisely whether GUS expression and Lotus leghemoglobin synthesis are initiated simultaneously, but… (25) So it is difficult to conclude whether the 100 kDa protein mentioned above is…

Writers may point out the deficiencies in the model, theory, or method applied in the research, which allows the researchers to anticipate potential challenges to the premises or methods by which the results were achieved. Conditionals are often employed to mitigate the writer’s commitment on the experimental outcomes since the occurrence of one circumstance is dependent on another, the hypothetic condition. Commenting on the state of existing knowledge is one of the clearest ways to distinguish conditionally truth conclusions from speculative possibilities, and questions can be used to hedge the truth of a proposition by making it relative to a writher’s state of knowledge, as in (26) below:

(26) Could such a putative interaction of an aminoacyl-tRDA synthetase with precursor tRNA have a physiological significance? Although it is premature to answer this question, it might be suggested synthetase present in…

Hyland (1996a) concludes that hedges are a prevalent feature of research writing in the

43 biological sciences, and it is largely owing to two reasons. First, hedges are crucial to procedures of argumentation and claim acceptance; Second, hedges play a significant role in

“both the social ratification of knowledge and the system of professional rewards and recognition that emanate from publication” (p. 278).

Lo (2010) examines Chinese writers’ use of hedges in three academic fields, biology, business, and history & literature. Ninety Chinese RAs are selected form outstanding journals awarded by National Science Council as the written corpus. Hedges in Lo’s study refer to

“the linguistic devices that writers exploit to indicate less than full commitment to the truth or accuracy of their argument or claims” (p. 6), and hedges are classified into lexical hedges, structural categories, and qualifying chunks. Lexical hedges are classified according to their grammatical categories which include auxiliaries, verbs, adverbs, adjectives, and nouns.

Structural categories refer to syntactic constructions, including conditionals, questions, and double negation; Qualifying chunks refer to hedges that cannot be classified as lexical or syntactic categories. The linguistic realizations of hedges observed in Lo’s corpus overlap greatly with those found in English studies. The results of Lo’s study show that academic writers greatly rely on lexical hedges, representing nearly 90% of all hedging devices, to qualify their argument. The lexical hedges consist of auxiliaries, verbs, adverbs, adjectives, and nouns, and among those various lexical hedges, adverbs are used the most frequently, followed by auxiliaries, and then verbs. Like in English, the high frequency of adverbs is presumably due to the flexible syntactic positions adverbs can occur and a variety of concepts associated with them. Although adverbs occupy the biggest portion of all the hedges, it is the auxiliaries keneng 可能 ‘may’, ying(gai/dang) 應(該/當) ‘should’, and ke(yi) 可(以) ‘can’ being the most frequent hedging expressions in the three academic fields. The high frequency probably results from their essential meaning in expressing epistemic modality. Modal auxiliary are typically used to evaluate the possibility or probability of the statements

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according to the writers’ reasonable judgment or available information. Verbs is the third

frequent hedging category in Lo’s study. According to Lo (2010), academic writers rely on a

limited set of verbs to hedge their claims. Judgmental verbs (e.g tuice 推測 ‘speculate’, renwei 認為 ‘consider’) are used the most frequently, which make up the majority (around

70%) of all hedging verbs across the three fields. As well as in English, the frequent use of verbs is probably owing to their transparency of coding writers’ commitment or judgment of information (p. 198). Although structural categories and qualifying chunks account for a much smaller portion of hedges in academic texts, they display various hedging functions.

Academic writers show preference for using conditionals, reference to limitations of the current study, and personal attribution to reduce their commitment to the truth of claims.

Disciplinary variation in the use of hedges is observed in Lo’s study; however, the variation lies in the types of hedges used instead of the frequency of hedges. Biology writers rely on a much more restricted set of hedges, whereas writers of history & literature make use of the greatest variety of hedges. Lo (2010) also compares her academic texts to Chen’s (2008) conversation data, and the results suggest that types of hedges that writers of history & literature use are closer to those found in the spoken discourse. That is, both writers in history

& literature discipline and interlocutors in conversation tend to use more sensory verbs and nouns, stance adverbs, and question words. As to the motivations for using hedges, politeness plays an influential role in the face-to-face encounter, while avoiding opposition and presenting statements with appropriate degree of certainty are the main concerns in academic writing.

2.4 Hedges in studies of genre difference (spoken vs. written)

Besides representing differently in forms, spoken and written discourses have distinct characteristics respectively. Speech is normally recognized as “more highly contextualized, far more dependent on a shared situation, more reliant on immediate feedback and involving

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more real-time monitoring and less planning”, whereas it is often the case that formal written

discourse tends to be “more lexically dense (with a higher ratio of content words to

grammatical words), to have greater nominalization (where events are presented as nouns

rather than verbs) and to be more explicit (with clear signaling of semantic relations)”

(Hyalnd 2009: 23). In scientific arena, new knowledge is transmitted mainly through RAs

(Swales 1990, Salager-Meyer 1994, Hyland 2000). For quite some time, academic discourse has been recognized by means of written texts. The significance of speech seemed to be overlooked in the academia (Dubois 1987, Hyland 2009). However, in recent years, researchers have been aware of the important role academic speech plays in education and research. As Hyland (2009:3) points out:

Following years of neglect, we are now beginning to understand something of the ways that academic speech differs from, and works together with, writing in a range of different academic practices. We are recognizing its important role in educational and research settings and how it varied across disciplines and genres.

In other words, it is also highly important to know how academic speech is structurally and strategically organized. After all, “no single dimension of comparison can separate speech and writing and differences should be seen on a continuum rather than as polar opposites of mode” (p. 24). In academic writing, the RA has its conventional structure and particular linguistic features. Rowley-Jolivet (2002) points out that the written article, especially the research report, has been seen as a textual artifact. Without direct contact with audience, scientific writing is removed further from spontaneous language. The linguistic expressions used in writing are essentially more restricted than in speech due to the formality and rhetoric convention in writing, while “linguistic choices in talks are governed more by considerations such as time constraints, audience expectations and affiliation conventions than in written articles” (Webber 2005: 171-172). There are several studies discussing discrepancies of hedging phenomena between spoken and written discourses in literature (Ford and Thompson

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1986, Ferguson 2001, Ruzaite 2004, Webber 2005, Biber 2006, Cater-Thomas & Rowley-

Jolivet 2008).

2.4.1 Approximators in leisure, business, political, and academic discourses

Ruzaite (2004) investigates the use of approximators in various types of discourse

(leisure, business, political, and academic discourse), in both their spoken and their written modes. The results show that in spoken discourse, approximators occur the most frequently in leisure discourse (39% of the total number of approximators) and the least frequently in academic spoken discourse, with about being the predominate approximator in all the discourse types. In written discourse, they appear the most frequently in academic discourse

(37% of the total number of approximators) and the least frequently in business discourse, with also about being the preferred approximator. The similar high frequency of approximators employed in both formal academic writing and informal leisure discourse suggests that “imprecision can be an equally dominant feature in very different discourse types” (p. 230). Ruzaite’s analysis further shows that approximators display multiple functions in both spoken and written academic discourse. Some functions are shared by both modes, while certain functions are found in one mode exclusively. For both spoken and written discourse, approximators are used when precision is unnecessary or unattainable.

They are typically utilized to generalize certain tendencies, to refer to proportions, percentages, and exceptionally large or small numbers, and to refer to hypothetical, future or past situations. The three functions that are exclusively found in spoken discourse are making impromptu calculations, encouraging listeners to participate, and self-correction.

2.4.2 Stance expressions in TOFEL 2000 Spoken and Written Academic Language

Corpus

Based on a sub-component of the TOFEL 2000 Spoken and Written Academic

Language (T2K-SWAL) Corpus, Biber (2006) shows that ‘stance expression’ is important in

47 all university registers. Four registers from the corpus are examined: classroom teaching, class management talk, textbooks, and written course management language (e.g. syllabi).

Modal verbs (and semi-modals), stance adverbs, and stance complement clauses are the three major structural categories analyzed in the study, and the results display that stance is overtly marked to a greater extent in spoken than in written registers, and stance features tend to be associated with different communicative purposes, cutting across the spoken/written difference. Modal verbs are the most common grammatical device used to mark stance in university registers: prediction/volition modals (e.g. will and would) are the most commonly used; possibility modals (e.g. can, could, may) are more common in speech than writing; necessity modals (e.g. must, should) are more common in written course management than in others registers. Stance adverbs (e.g. actually, in fact, possibly) are much more common in the spoken than in the written registers, with essentially no differences associated with communicative purpose. The overall grammatical stance devices are used more frequently in university speech than in writing. In the spoken registers (classroom teaching and classroom management), stance devices serve both epistemic and directive functions; in written course management, stance devices are highly directive; stance devices are less commonly used in textbooks. A surprising finding is the rarity of stance expressions in university textbooks.

People normally expect textbook authors would feel obligate to signal the episteme status of statement since “written language is generally regarded as more precise and accountable than speech” (p. 114). However, in Biber’s corpus, epistemic stance expressions are much more common in speech than in writing. It is concluded that stance expressions in the written registers is rare and restricted in meaning in comparison with spoken university registers.

2.4.3 If-conditionals in academic discourses

If-conditionals are one of the common hedging devices in academic discourse, whether spoken or written, as they can be used to hypothesize, set up an alternative argumentative

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space, and shape the writer-reader/speaker-hearer relationship. Ford and Thompson (1986)

examine the discourse function of conditionals on both spoken and written discourses. The

spoken English data comprise a university engineering lecture, a university management

lecture, a presentation by a graduate student, and transcripts from meetings which include

anywhere from two to 18 persons, usually with a task at hand, not free conversation. The written data consist of three books7 regarding professional skills and knowledge. It is

observed that conditionals are used more in spoken discourse (7.2 conditionals per 1000

words) than in written text (4.6 conditionals per 1000 words), and initial conditional clauses

outnumber final conditional clauses by a ratio of around three to one. Ford and Thompson

claim that the preponderance of initial conditional clauses is a language universal phenomenon. In the spoken data, there is a strong tendency for speakers to initiate if-clause before associated utterances (82%), which is not surprising as “rather than take the risk that a listener might misinterpret one’s meaning, a speaker would provide the crucial background or qualification prior to delivering the propositions that are to be qualified” (p. 362). In written discourse, initial conditionals occupy 77% of the total conditionals while 23% of them are final conditional clauses. A conditional clause tends to occur in final position when it appears within a nominalization, an infinitive, or a relative clause. There are four basic relations, assuming, contrasting, expressing particular cases, exploring options, between initial conditionals and their preceding discourse regardless of genres. Initial conditionals serve as a framework for the following clause, “either in the direct reactions to something in the preceding context or by exploring options relevant to the situation expressed in the preceding context” (p. 359). Ford and Thompson observe that there is one type of relationship occur exclusively in their spoken data: the interpersonal function of if-clauses expressing polite

7 The three books are Bertrand Russell’s Unpopular essays, a series of twelve essays exemplifying highly skilled uses of argumentation, Randall K. Richard’s Auto engine tune-up, a book for professional auto mechanics, containing both description and procedures, and Herbert Terrace’s Nim, a personal narrative account of a project to train the chimpanzee Num Chimpsky to use American Sign Language. (Ford and Thompson 1986: 355) 49

directives, which is presumably due to a combination of the softening effect of

hypotheticality and the implication of alternatives (p. 365). All of these conditionals occur in

the conversational data. In both genres, conditionals do occur in final position, that is, after

the consequent, with 18% in speaking and 23% in writing. Ford and Thompson suggest that

in speaking sometimes if-clauses are produced as afterthoughts or reminders by speakers,

which may due to less planned nature of spoken discourse and the need to remind the listener

of background assumptions. Like initial if-clauses can be polite forms for directives, a large

portion of the final if-clauses serve to show deference, another function of politeness, in face

to face communication. In addition, a great deal of final if-clauses in spoken data is

associated with main clauses which either make evaluations or form questions although these

patterns are only suggestive. There are also two factors for writers to postpose an if-clause in

final position: one is the tendency for an ‘interesting’ subject to be introduced in the main

clause and the other is the length of the if-clause. In written English, new, heavy, or compared

NPs are normally introduced in the main clause, whereas shared, unchallengeable,

background for the following proposition are provided in the conditional clause. When a

writer intends to present the interesting subject, the if-clause will be purposely postposed in

final position. In addition, writers try to avoid initial if-clauses which are disproportionately longer than their associated main clauses since it may cause difficulty in possessing of sentences in discourse contexts. The comparison of if-conditionals in spoken versus written discourse is also conducted in medical profession (Ferguson 2001, Cater-Thomas & Rowley-

Jolivet 2008). Ferguson (2001) examines if-conditionals in three medical genres (research articles, journal editorials, and doctor-patient consultations), attempting to see how conditionals function distinctly between naturally occurring discourse and intuition-derived data. The results show that there is significant variation across genres. Conditionals occur with higher frequency in spoken than in written discourse, which is consistent with Ford &

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Thompson’s (1986) findings. Conditionals proved to be a useful resource for managing the interaction with politeness and reassurances of consultations, which are not found in RAs and editorials; conditional clauses without apodoses and clauses distributed across speaker turns occur exclusively in the spoken genre. Similar to Ferguson’s (2001) research, Cater-Thomas

& Rowley-Jolivet (2008) explore how if-conditionals are employed in three medical genres, namely research articles (RA), conference presentations (CP), and editorials (ED). They point out that If-conditionals are a potentially highly valuable resource in academic discourse since the inherent non-assertiveness characteristic can be used for hypothesizing and hedging and setting up an alternative argumentative space within which the author can manipulate and situate the research claim. Cater-Thomas & Rowley-Jolivet claim that the rhetorical functions proposed are based on the regularities observed in their data, and the three macro-functions are Factual, Refocusing, and Discourse Management functions. The Factuals category covers many of the features that have been called course of event, generic, or habitual conditionals in other approaches (Athanasiadou & Dirven 1997, Ferguson 2001); The Refocusing category comprises occurrences which have a marked argumentative function; the Discourse

Management category involves occurrences which guide readers and listeners to the author’s intentions and the development of the text. The results demonstrate that many features emerging as characteristics of the spoken data different from those of in the written genre, such as commutative purposes and the clause ordering. In the RA, all the medical research articles follow the standardized Introduction-Methods-Results-Discussion (IMRD) format.

Factual conditionals (68% of occurrences) are the preferred function while Discourse

Management functions are absent in this genre. The distribution of occurrences across the sections is found to correspond to the communicative functions. The Methods and Results sections contain more Factual if-conditionals since these two sections are essentially informative and descriptive; the Introductions and Discussion sections have more Refocusing

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argumentative conditionals because these two sections are generally polemical and

argumentative (Salager-Meyer 1994, Nwogu 1997) In the CP, the three functions distributed

evenly, with Factuals 41%, Refocusing 28%, and Discourse management 31%. The function

which marks the real specificity of the CP genre is Discourse Management which is absent in

the highly standardized medical RAs. The Discourse Management functions enable speakers

to lead their audience through the talk by “signposting its structure, chunking it into

manageable segments and marking topic boundaries” (p. 199). In the ED, the Refocusing

function of if-clauses is preferred, which accounts to 87.7%. The relative scarcity of Factuals

(10.5%) is due to the fact that there is little or no need for editorials to describe methodology

and research results. The almost absence of Discourse Management functions (1.8%) is owing to the editorials are usually short and rarely contain tables and figures. Thus, the authors do not need Discourse Management functions to explicate their findings or argue for ratifications from the readers. Another feature which displays differently between spoken and written genres is the clause ordering of if-conditional construction. In this study, the occurrences of if-clauses are classified into three positions: initial, medial, and final. From the information structuring perspective, the initial part of the sentence tends to be interpreted as

given or topical information. The initially occurring if “acts as a signal to the receiver to

provisionally accept a set of circumstances denoted by the P-clause as backcloth to a new

state of affairs expressed in the Q-clause” (p. 194). In the RA, the final positioning P-clauses

are preferred (42.9%), which is probably caused by genre since most Factual conditionals

involve post-posted P-clauses. In the CP, the initial positioning of if-clauses is considered as

the default position (75.5%) because in an on-line processing it is important for speakers to

provide the background for the assertion in Q to avoid misinterpretation and back-processing

by listeners. The relative high frequency of medial positioning (11.2%) in the CP is

presumably affected by the same factor. In the ED, although the initial if-clauses occupy

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relatively more than half (55.6%) of occurrences, the features of ED are closer to those of the

RAs (42.9%) than those of the CPs (75.7%).

2.4.4 Discourse features in medical conference and journal articles

Webber (2005) compares the discourse features, personal deictics, markers (e.g. now,

well, so), and imprecise quantifiers, used in medical conference and journal articles. The

analysis shows that on the same topic these features occur more frequently in talks than in written articles, and the spoken and written genres differed markedly due to ongoing interaction between the speakers and the listeners in conference discourse. In contrast to

written articles, medical conferences involve personal contact, and there is the possibility for

participants to ask questions and for the speakers to receive immediate feedback. The first person pronoun I, as noted by Webber, collocates strongly with think, and I think is generally

used to hedge or to declare speaker’s stance (p. 164); however, there is no example of the

personal pronoun singular found in written articles, which might be owing to the research

papers published by more than one author. The even more frequent use of the first personal

plural, we, occurs almost 5 times more frequently in spoken corpus than in written corpus

(100 instances in writing and 450 instances in speaking). The inclusive we is used for

showing deference or affiliation, where the speaker tries to include the audience in the

utterance. Many talks in the spoken corpus start with an assumption of shared knowledge, as

in ‘As we will know’; however, Webber argues that this phrase is unlikely to appear as an

initial clause in written articles. The point which Webber holds is that “the personal element”

and “the suggestion of modesty” implied in the personal plural are more characteristic of

conference discourse among peers even though starting from given knowledge is a common

feature shared by both spoken and written discourse (p. 165). The likely utterances to be a

start of written texts may be It is well known that or It has long been established, as suggested

by Webber (p. 165). The exclusive we also used frequently, which might be explained as the

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presenter speaking on behalf of a team of researchers. Imprecise quantifiers, such as

approximately, about, rather, and a little, are utilized to show the speaker’s less than full

commitment to the absolute truth of a proposition, to tone down claims so as to give an

impression of modesty, and to mitigate arguments which the speaker considers unimportant or disagrees with.

2.5 Functions of hedges in academic discourse

As mentioned earlier, hedges are realized as multifunctional, and hedging devices used in various disciplines give rise to different communicative purposes. Varttala (2001: 242) indicates that “the use of hedges is linked to the kind of scientific frame of mind that scholarly discourse is expected to reflect.” It is generally assumed that in specialist to specialist discourse, such as RAs, it is important to “incorporate an awareness of audience”

(Hyland 2001: 551). The writers should be cautious while presenting their augmenting propositional information, they need to anticipate the possible objections from the readers, and they should acknowledge the familiar ways to gain ratification from their audience.

Although politeness is the most pervasive motive for hedging application, one “cannot settle for the notion of face or for politeness as the only motivational dimension of our communicative behavior” (Caffi 1999: 887). According to the aspects of menaing they involve, the communicative purposes of which are commonly assigned to by a great majority of scientific discourse can be classified into four types, as reviewed in the following.

2.5.1 Expressing politeness and saving faces

The function of hedging devices is most frequently correlated with politeness theory

(Brown and Levison 1987, Myers 1989, Salager-Meyer 1994, Ferguson 2001, Meyer and

Pawlack 2010). Politeness, both positive and negative, can be adopted to avoid potential Face

Threatening Acts (FTAs) (Brown and Levison 1987). When a speaker is too assertive, then he/she may impose his/her opinion upon the hearer, which threatens the hearer’s negative

54 face (the want to be unimpeded in one’s action); when a speaker offends the hearer, the hearer’s positive face (the desire to be approved of) may be threatened. Myers (1989) extends

Brown and Levinson’s (1978, 1987) politeness model in conversational data to the genre of scientific writing, and he advocates that the maintenance of ‘face’ is crucial in scientific discourse. Scientific discourse consists of interactions among scientists; therefore, certain

FTAs are unavoidable while claims are asserted. A range of politeness strategies, both positive and negative, are then adopted to redress those FTAs. Positive politeness is directed at showing the writer’s acceptance of the wants of rival researchers, which can be used to militate both claims and denials of claims. For example, in Myers’ data, pronouns are found to be utilized by the writer to make a criticism while minimizing the FTA simultaneously; emotional responses, such as the word amazing or unexpectedly, to results show the writer’s solidarity with the community; even jokes, which seem to be an unscientific device, can be used to establish a sense of shared knowledge or assumptions. Negative politeness is manifested when writers assure the readers that their wants will not be infringed. While making a claim, the researcher may deny or supersede the claims of others, which threatens the negative face of other researchers (Myers 1989: 5). In fact even the denial of an entrenched claim is likely to threaten not only the research who proposes it but also a group of researchers or readers who take the challenged claim as the assumptions of their research

(p. 6). Most conventional features in scientific writing, such as hedging, impersonal constructions, and the assertion of general rules, can be considered as negative politeness devices. The use of hedges as politeness strategies enables the writers to deal with the social interactions between the writer and the reader in an appropriate way.

2.5.2 Avoiding full commitment and convey uncertainty

Since the 1980s, hedges have been taken to be modifiers of the speaker’s commitment to the truth of propositions, not just the notion of categorical membership. (Prince et al. 1982,

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Hübler 1983, Vande Kopple 1985, Markkanen and Schröder 1989, 1992, 1997, Hyland 1998,

Caffi 1999, 2007). In Prince et al.’s (1982) study, uncertainty is the main underlying cause of

hedges in physician-physician discourse. Hyland (1998) argues that hedging is one part of epistemic modality since “it indicates an unwillingness to make an explicit and complete commitment to the truth of propositions” (p. 3). Channell (1994) proposes that the choice of precision varies depending on different purposes and different target audience. For example, hedges are often used to withhold information deliberately when a speaker does not want to commit himself or herself to the information given. This strategy functions as a defensive tactic; hedges are also employed in the situation when the language in question does not have the lexical items for precise expression. By exploring the role of hedges in scientific texts,

Markkanen and Schröder (1989, 1992, 1997) see hedges as modifiers of the writer’s responsibility for the truth value of the propositions, modifiers of the weightiness of the information given, and the attitude of the writer to the information. They suggest that hedges are present at various levels of textualization but are not inherent characteristics of texts. In other words, no linguistic items are inherently hedgy, but the quality of hedging can be obtained through the author-reader interaction. In Chinese study, Lo (2010) examines academic writing in biology, business, and history & literature, and her results show that hedges in Chinese are “mainly used to indicate authors’ uncertainty about the reliability of the statements or to mitigate the force of research suggestions” (p. 197). In academic writing, the motivation for hedging utilization is to avoid negation and present statements with appropriate degree of certainty.

2.5.3 Presenting tentativeness and cautiousness

Nowadays, modesty, cautiousness, and honesty are valued highly in scientific writing.

Salager-Meyer (1994: 150) argues that “argumental arrogance and exuberance are not well regarded by the scientific community: whereas contrast, humility, coyness, and cautiousness

56 are.” Among a variety of linguistic devices, hedges are widely utilized to tone down the researchers’ statements. The concealing tentativeness and vagueness make those statements more acceptable to the audience. By examining communicative purpose of different rhetorical sections of research papers (RP) and case reports (CR) in medical English written discourse, Salager-Meyer (1994) finds that the Discussion sections of RP as well as their equivalent Comment sections of CR are the most heavily-hedged divisions of these two genres, and the most frequently used hedging device in both genres falls into “shields”. Since the primary rhetorical function of Discussion section is to make claims about the research findings, it is therefore in this last section of RPs that writers speculate, argue, and make contrasts from the results. The writer needs to be cautious while making a claim as any hypothesis is by nature tentative and understated. Any absolute claims should be avoided because in scientific world there might always be alternative explanation that other researchers might detect. Salager-Meyer’s (1994: 163) examples demonstrate that “hedges are a consequence of the fact that research results are indicative rather than definitive.” In the

Case Report section of CR, “approximators” mostly take the form of adverbs of quantity (e.g. almost, quite, markedly/greatly enlarged), and those hedges are generally used when exact figures are irrelevant or unobtainable or when the authors want to convey the idea of a range.

In Ferguson’s (2001: 72) study, hypothetical conditionals appear the most in the Discussion section of RAs, and it is attributed to “the tendency for the writing in this section to become more argumentative and speculative.” Hyland (1996a, 1998, 2006) points out that hedging is the expression of tentativeness and possibility, and it is central to academic writing.

Appropriate use of rhetorical and interactive features is essential to form successful academic writing, and hedges are among the most important. Since all the statements require ratification, writers need to evaluate their material and acknowledge alternative views. There is always the possibility that claims will contradict or challenge the beliefs of other

57 researchers; therefore, writers need to anticipate the potential opposition. Two types of hedges are then proposed to cope with the opposition, namely “content-oriented” hedges and

“reader-oriented” hedges (Hyland 1996a, 1998). “Content-oriented” hedges serve to mitigate the relationship between a proposition and a representation of reality, and they can be delicately subcategorized into “accuracy-oriented” hedges and “writer-oriented” hedges

(Hyland 1998: 162). “Accuracy-oriented” hedges manifest writers’ desire to present information as accurately as possible; “writer-oriented” hedges enable writers to restrict personal commitment and self-protect themselves from possible objections. “Reader- oriented” hedges incorporate an awareness of interpersonal factors. Categorical propositions imply a certainty in arguments, leaving no room for negotiation, which relegates readers to a passive role. The ‘reader-oriented’ use of hedges takes readers into consideration by showing deference to the readers, leaving a discursive space in which readers are able to dispute the writer’s arguments.

2.5.4 Showing solidarity and asserting in–group membership

Hedges reflect not only the degree of probability of a statement, but the relationship between a writer and the readers. In science, hedges play a crucial role in gaining ratification for claims from a power peer group (Hyland 1994, 1996a, 1996b, 1998, 2001, 2006, 2008).

As Hyalnd (1994: 241) indicates, writers must be cautious in how they define their relationship to the research community, so they should “present themselves as servants of the discipline while asserting an individual contribution.” Since new ideas may somehow challenge existing literature, the use of hedges for expressing ideas or making claims helps researchers achieve a closer fit between their statements and the consensus of the discourse community. By employing hedging devices, a rhetorical convention, academic texts can be convincing and persuasive to the community members. Anticipating potential oppositions to their claims, writers must display familiarity with the persuasive practices of their disciplines.

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That is, writers “galvanise support, express collegiality, resolve difficulties, and negotiate

disagreement through patterns of rhetorical choices which connect their texts with their

disciplinary cultures” (Hyland 2008: 4). Myers (1989: 8) suggests that “writers can show their solidarity with the community more subtly by exhibiting responses that assume shared knowledge and desires” rather than responses or desires of an individual. Every scientific report states a claim which always involves tension. The writer must be aware of possible objections and stay within a certain consensus in his/her discipline. The utilization of hedges

reflects the appropriate attitude for offering a claim to the community as “the hedging of

claims is so common that a sentence that looks like a claim but has no hedging is probably

not a statement of new knowledge” (p. 13). With hedges, writers show their solidarity with

the readers, avoid of direct criticisms, or show deference towards the scientific community.

By examining interactive features from a spoken corpus which comprises seven plenaries and

sever paper presentations given at international medical conferences, Webber (2005: 173)

suggests that “members of the medical community have a particularly strong sense of affiliation.” Speakers in the medical conferences, adopting a tone of modesty or deference,

seem to “express a desire to share their experiences with others of similar interests and hear

what they have to say” (p. 173). Cutting (2000, 2001, 2007) conducts a longitudinal study to examine the in-group code used by an academic discourse community of applied linguistics students in the University of Edinburgh. It is found that hedging functions as a marker of intimacy, given that the longer the students know each other, the denser their hedging features become. In the study, hedging devices “are used mostly in moves that have an interactional function and solidarity-giving speech acts” (Cutting 2007: 225). Cutting (2007) concludes that “using VL is a high-involvement strategy for claiming in-group membership” (p. 226).

2.6 Categorization of hedges

Just like the impossible mission in finding a united hedging definition, it is also difficult

59 to have an agreement on what should be consentaneous forms while dealing with hedging phenomenon. As pointed out by Varttala (2001), there seems to be no absolute uniformity among studies as to which linguistic phenomena should be regarded as falling within the category, and it appears that “the devices cannot be classified exhaustively by referring to any clearly delimited traditional linguistic categories” (Varttala 2001: 24). In Lakoff’s (1973) study, there are relatively limited set of hedging expressions, around 70 items, selected as hedges, such as sort of, more or less, strictly speaking, and in a manner of speaking. Skelton

(1988) argues that there are a large number of ways in which one can hedge in English, including the use of impersonal phrases, the modal verbs like seem, look, and appear, sentence-introductory phrases like I think and I believe, and the suffix –ish to some adjectives, to name just a few. Markkanen and Schröder (1992, 1997) consider that hedging devices include pronouns, impersonal expressions, the passive and other agentless constructions, modal verbs, adverbs, and particles. The categories proposed by Chanell

(1994) include vague additives (e.g. approximately, about), round numbers, non-numerical vague quantifiers (e.g. bags of, heaps of), reference to categories (e.g. or something, or something like that), and placeholders. Salager-Meyer (1994) examines hedges and textual communicative function in English medical written discourse by means of a contextual analysis. The analysis is carried out from a linguistic and medical standpoint, and the taxonomy of hedges is adopted under the consideration of both formal and functional criteria.

The five categories used in Salager-Meyer’s study include shields, which consist of all modal verbs expressing possibility (e.g. can, may), semi-auxiliaries (e.g. to appear, to seem), probability adverbs (e.g. probably, likely) and their derivative adjectives, and epistemic verbs

(e.g. to suggest, to speculate); approximators (e.g. roughly, somewhat, occasionally); expressions which express the authors’ personal doubt and direct involvement (e.g. I believe, to our knowledge); emotionally-charged intensifiers (e.g. extremely difficult/interesting, of

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particular importance, surprisingly); and “compound hedges” which comprised “strings of

hedges” (e.g. It may suggest that, it would seem likely that) (p. 155). From those studies, we

see that the scope of hedging devices has been broadened since Lakoff’s initial work, and most studies in literature tend to deal with hedging phenomenon in terms of lexical expressions (Prince et al. 1983, Mosteller & Youtz 1990, Bonanno 1994, Varttala 2001,

Jucker at al. 2003, Mauranen 2004, Ruzaite 2004, Fetzer 2010, Mihatsch 2010).

Holmes (1984, 1988) and Hyland (1998) point out that although lexical mitigation is overwhelmingly preponderant, there are other linguistic forms employed to manifest hedging strategies, such as questions, conditional clauses, and contrast markers. Hyland (1998) indicates that in addition to lexical expressions, questions, if-clauses, and contrastive markers can serve to “qualify certainty and indicate a measure of the writer’s doubt by making the truth of a proposition relative to the current state of (limited) knowledge” (p. 4). Webber

(1994) asserts that the interrogative form is one of the various rhetorical devices for scientific writers to persuade the readers. In medical writing, interrogatives serve a variety of purposes; they can be used to arouse interest, to express doubt or caution, to point to the future, and to criticize or attack opponents. Besides serving the writer as support for the discourse structure, interrogatives also serve the reader since they lead the reader along the way the author wishes to take him/her. Cater-Thomas & Rowley-Jolivet (2008) point out that if-conditionals are potentially highly valuable resource in academic discourse. They can be used to hypothesize, hedge, manage interaction with the addressee, and promote or circumscribe the scope of research claims.

In the English literature, many studies in various disciplines focus their hedging exploration on lexical hedges. As mentioned earlier, there is still not unanimously endorsed categorization which can cover up all hedging devices. Lewin (2005) points out that if a

hedge is defined as any device that qualifies the speaker’s commitment to the truth of the

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proposition, then “almost any linguistic item or expression can be interpreted as a hedge” (p.

165). In the present study, a hedge is identified in accordance with the attenuating sense it

conveys; therefore, the scope of linguistic expressions which can be counted as hedges is

narrowed down. And as demonstrated in several studies, both in English (Holmes 1984, 1988,

Hyland 1996a, 1998, Webber 1994) and in Chinese (Chen 2008, Lo 2010, Chang 2012),

lexical hedges is just one of the hedging strategies. Hedging expressions may stretch across

words or utterances as in the forms of questions, conditionals, or sentences to address

limitations on experimental conditions, model, theory, or methods used in a study at issue.

In the present study, hedging devices will be categorized into modal auxiliaries, lexical

hedges, and non-lexical hedges. Modal auxiliaries are the most salient instrument for the connection of the speaker’s/writer’s attitude and the proposition. They are essentially

associated with the speaker’s/writer’s assessment of probabilities and often applied to convey

the degree of the speaker’s/writer’s commitment to the truth of the proposition (Lyons 1977,

Perkins 1983, Coats 1983, 1987, 1995, Palmer 1986, 1987, 1990, Bybee et al. 1994). Palmer

(1987, 1990) indicates that modality and proposition are the two main constituents of

sentences. Modality is mainly expressed by a modal verb while a proposition is mainly

expressed by all that follows the modal verb, including the main verb. The relationship

between these two constituents within a sentence can be well demonstrated by Crystal’s

(1997: 313) illustration, “SentenceModality + Proposition”, which suggests a basic

distinction between the modal verb and the other elements of a sentence. Therefore, in this

study modal auxiliaries are hived off from the lexical category for separate discussion.

Lexical hedges are content-based expressions which generally lie in the proposition. Lexical

hedges are verified experimentally and well documented to be the most commonly used

hedging devices since they are based on regularly used grammatical categories and they are

the most common means of realizing epistemic modality in English. Epistemic modality has

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been characteristically linked to hedges since the notion of both epistemic modals and hedges

is strongly related to the speaker’s degree of confidence concerning the information that is

presented (Lyons 1977, Perkins 1983, Coats 1983, 1987, 1995, Stubbs 1986, Palmer 1986,

1987, 1990, Thompson 1993, Hyland 1998, 2000). Following other researchers (Hyland

1996a, 1998, Varttala 2001, Chen 2008, Lo 2010), lexical hedges in the present study are

classified by means of grammatical categories, which include verbs, adverbs, adjectives, and

nouns. Non-lexical hedges contain syntactic structures larger than words or phrases, such as

conditionals, questions, and sentences addressing limitations of studies. The non-lexical,

discourse-based hedging strategies are by no means less significant but have unfortunately

been overlooked in the literature (Hyland 1996a). The realization of these hedging devices in

both English Chinese literature will be reviewed in the following subsections.

2.6.1 Modal auxiliaries

Lyons (1977) points out that the semantic definitions of syntactic categories rest upon

notions such as reference, predication and denotation. For example, sentence adverbs can generally “be seen as having some kind of evaluative function” (p. 452). Lyon’s discussion of

adverbs virtually gives a broad definition of modality, which is “used by the speaker in order

to express, parenthetically, his opinion or attitude towards the proposition that the sentence expresses or the situation that the proposition describes” (p. 452). Two kinds of modality are

recognized by Lyons: epistemic modality and deontic modality. The term ‘epistemic’ is

derived from the Greek word meaning “knowledge” (p. 793) and “our belief in the validity of

some general truth may be based upon our knowledge of what is usually the case” (p. 681).

Epistemic modality is concerned with the truth of propositions. In other words, it deals with

the speaker’s attitude towards the propositional content of his/her utterance, as it occurs in

“any utterance in which the speaker explicitly qualifies his commitment to the truth of the

proposition expressed by the sentence he utters” (p. 797). The following statements which

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contain a modal verb ‘may’ in (27), a modal adverb ‘perhaps’ in (28), or a modal adjective

‘possible’ in (29) are the typical utterances which denote the notion of epistemic modality.

(27) He may have gone to Paris. (28) Perhaps he went to Paris. (29) It’s possible that he went to Paris. (Lyons 1977: 796)

It can therefore be seen that epistemic modality is associated with matters of opinion rather

than fact. Deontic modality is concerned with “the necessity or possibility of acts performed by morally responsible agents” (p. 823). The term ‘deontic’ is derived from the Greek word

meaning “what is binding” (p. 823), which implies notions of obligation and permission. The

notion of permission is related to possibility, and in the same way the notion of obligation is

related to necessity (p. 832). Examples (30) and (31) demonstrate this correlation.

(30) You may open the door. (31) You must open the door. (Lyons 1977: 832)

Sentence (30) can be interpreted as “I (hereby) permit you to open the door” (p. 840), and

(31) can be interpreted as “I hereby impose upon you the obligation to open the door” (p.

832). According to Lyons, the origin of deontic modality has been suggested to be sought in

two functions: the desiderative function and the instrumental function. The desiderative

utterance is used to express or indicate wants and desires while the instrumental utterance is

used to get things done by imposing one’s will on other agents (p. 826). Deontic modality

mainly involves notions of volition, ability, and obligation. Besides epistemic and deontic

modality, Palmer (1986, 1987, 1990) recognizes a third type, dynamic modality. For Palmer

(1987: 98), an epistemic modal is used to “express a judgment by the speaker about the truth

of the proposition he is presenting”; a deontic modal is “performative in that the speaker

gives permission, lays an obligation or in some way influences or directs the behavior of his

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addressee (or, with shall, of himself)”; a dynamic modal “predicates something (‘says

something about’) the subject of the sentence.” The dynamic modality is subclassified into subject-oriented modality and neutral (or circumstantial) modality. While subject-oriented modality is concerned with the ability or volition of the subject of the sentence, as in (32), neutral (or circumstantial) modality indicates what is possible or necessary in the circumstances which is expressed by can and must, as in (33) and (34).

(32) John can speak Italian. (Palmer 1986: 102) (33) I know the place. You can get all sorts of things here. (Palmer 1990: 37) (34) I must have an immigrant’s visa. Otherwise they’re likely to kick me out you see. (Palmer 1990: 37)

Sentences (32) and (33) demonstrate the distinct meanings the modal auxiliary can convey.

Although both are dynamic, can in (32) does not involve the speaker’s attitude or opinion but simply asserts that John has the ability, whereas in (33), can indicates the possibility under certain circumstance. Coats (1987, 1995) later offers a general definition of epistemic modality by stating that:

Epistemic modality is concerned with the speaker’s assumptions or assessment of possibilities, and in most cases it indicates the speaker’s confidence or lack of confidence in the truth of the proposition expressed (Coats 1995: 55).

Similar with Lyons’ (1977) and Coats’ (1983) ideas, Bybee et al. (1994: 179) see epistemic modality “applies to assertions and indicates the extent to which the speaker is committed to the truth of the propositions…and markers of epistemic modality indicate something less than a total commitment by the speaker to the truth of the proposition.” The three commonly expressed episteme modalities defined by Bybee et al. are possibility, probability, and inferred certainty. Possibility “indicates that the proposition may possibly be true” (p. 179), as in (35); Probability “indicates a greater likelihood that the proposition is true than possibility does” (p. 180), as in (36); Inferred certainty contains a stronger senses of probability, which 65

“strongly implies that the speaker has good reason for supposing that the proposition is true”

(p. 180), as in (37).

(35) I may have put them down on the table; they’re not in the door. (Coates 1983: 133 cited by Bybee et al 1995: 180) (36) The storm should clear by tomorrow. (Bybee et al 1994: 180) (37) There must be some way to get from New York to San Francisco for less than $600. (Bybee et al 1994: 180)

Researchers (Adam Smith 1984, Hyland 1994, 1996a, 1998, Varttala 2001) who explore hedging phenomena in English find that several modal auxiliaries are utilized frequently to

convey epistemic meaning, such as ‘may’, ‘can’, ‘will’, ‘would’, ‘should’, ‘could’, ‘might’,

and ‘must’. In Adams Smith’s (1984) examination of hedges on medical journal articles,8 modal auxiliaries are the chief means for medical writers to introduce the subjective element, with may and should occurring the most frequently. The modals in scientific RAs are mostly used epistemically (Hyland 1996a, 1998), with may, would, and could appearing the most.

Varttala (2001) investigates the utilization of hedges in three scientific disciplines: economics, medicine, and technology, and he compares the incidence of hedges in the corpus of RAs and the corpus of popular scientific articles9 in these three fields. The results show that may, might, and could are the three most commonly employed auxiliaries in different

disciplines of both genres, with may appear the most frequently across all three disciplines. In the RA data, modal auxiliaries occur the most frequently in economics (5.18 per 1,000 words), whereas they are employed relatively less frequently in medicine (3.42 per 1,000 words) and technology (1.95 per 1,000 words); In the popular scientific articles, the highest concentration of modal auxiliaries is find in medicine (6.65 per 1,000 words), followed by economics (4.37), and then technology (4.08).

8 The three categories of medical journal articles examined by Adams Smith (1984) are clinical case notes, research papers, and editorials. 9 The articles are drawn from Scientific American (SA). 66

In Chinese, the modal system is one of the most controversial topics in the twentieth

century or earlier, as pointed out by Li (2004). Hsieh (2009) also indicates that “modality has

been studied in a comparatively less comprehensive manner in Chinese linguistics”, and it

could be said that “Chinese modality is not yet clearly defined within a unified functional

framework” (p. 2). The notion of modality in Li’s (2004) study refers to the semantic

domains that involve possibility and necessity. Two classes of epistemic modal auxiliaries are

recognized to correspond with the notion of possibility and necessity: uncertainty and

probability. The semantic class that express uncertainty is that of huoran 或然 ‘uncertainty’,

which is used to estimate “whether something will become a fact or not” (p. 138). The

Mandarin modals that express epistemic possibility include keneng 可能 ‘may’, hui 會

‘may’, neng 能 ‘can’, nenggou 能夠 ‘can’, de 得 ‘can’, and keyi 可以 ‘may’. The

semantic class conveying epistemic probability is biran 必然, which “predicts the necessity

about a future event or state or concludes about the necessity of a current event” (p. 144). The

Mandarin modals expressing epistemic probability are gai 該 ‘should’, yingai 應該

‘should’, yao 要 ‘will’, and dei 得 ‘must’. Liu et al (2011: 94) indicate that Chinese modal

auxiliaries (能願動詞,也叫助動詞) constitute a closed class. They are limited in amount but

complicated in meanings. Most Chinese modal auxiliaries express volition (意願), and few of

them express possibility (可能) such as keneng 可能 ‘may’, hui 會 ‘may’, yao 要 ‘will’,

dei 得 ‘must’, and neng 能 ‘can’.

Chen (2008) examines hedging phenomena in naturally occurring Mandarin conversation, and it is observed that keneng 可能 ‘possible’, hui 會 ‘can’, yinggai 應該

‘should’, neng 能 ‘can’, nenggou 能夠 ‘can’, and yao 要 ‘want’ are the six modal

auxiliaries used as hedges to express speakers’ uncertainty and less than full commitment to a

proposition , with keneng 可能 ‘possible’ constitutes almost half (193/399 tokens) of the total auxiliaries. In Lo’s (2010) Chinese academic written corpus, keneng 可能 ‘may’, ke 可

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‘can’, keyi 可以 ‘can’, yin 應 ‘should’, yinggai 應該, yingdang 應當, hui 會 ‘can’,

‘should’, neng 能 ‘can’, and nenggou 能夠 ‘can’ are modal auxiliaries used in all three

disciplines, with keneng 可能 ‘may’ occurs more frequently in biology and business fields

and ying(gai/dang) 應(該/當) ‘should’ the most commonly used in history & literature. Lo

indicates that the Chinese auxiliaries are employed by authors to evaluate “the possibility or

probability of their statements derived from their reasonable judgment or available

information” (p. 66). The negative forms binbuhui 並不會 ‘will not’ and binguneng 並不能

‘will not’ are also found to convey the author’s lack of full commitment.

2.6.2 Lexical hedges

There are a number of lexical classes treated as central items associated with epistemic

modality in English, such as modal lexical verbs (e.g. suggest, appear, think), certain adjectives (e.g. potential, probable), adverbs (e.g. perhaps, approximately), and nouns (e.g. assumption, possibility). Chinese epistemic modality can also be verbalized by other lexical forms, such as modal main verbs (e.g. cai 猜 ‘guess’, rewei 認為 ‘think’, juede 覺得

‘feel’, jushuo 據說 ‘it is said that’), epistemic adverbs (e.g. huoxu 或許 ‘perhaps’, dagai

大概 ‘probably, shishishang 事實上 ‘actually’), adjectives (e.g. kenengde 可能的

‘possible’, dabufende 大部分的 ‘most of’, youxie 有些 ‘some’), and nouns (jianyi 建議

‘suggestion, ganjue 感覺 ‘feeling’, chingxiang 傾向 ‘tendency’). In addition to the four

categories of lexical hedges, there is a great majority of lexical items particularly used to

denote indefiniteness or impression in quality and quantity. These vague expressions are

frequently employed as they serve various hedging functions in academic discourse (Prince

eat al. 1982, Channell 1999, 1994, Bonanno 1994, Salager-Meyer 1994, Ruzaite 2004). The

linguistic items used to qualify imprecise quality and quantity are usually realized under

different grammatical categories, adverbs, adjectives, and nouns; therefore, I generalize this

group of lexical terms as ‘vague expressions of quality and quantity’ in this review chapter. In

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the following subsections, lexical verbs, adverbs, adjectives, nouns, and vague expressions

expressing indefinite quality and quantity will be reviewed in turn.

2.6.2.1 Lexical verbs

Epistemic verbs, such as suggest, propose, and predict, are common means of

expressing mitigation. In the literature regarding epistemic modality, two types of epistemic

verbs are generally identified, namely judgmental verbs and evidential verbs (Palmer 1986,

Hyland 1998, Hsieh 2002, 2006, Lo 2010). Epistemic judgmental verbs (e.g. suggest, believe,

tuice 推測 ‘speculate’, kaolü 考慮 ‘consider’) refer to verbs used to qualify the degree of

commitment to the truth of a proposition, and the judgments are based on the

speaker’s/writer’s subjective evaluation or deductive conclusion. Epistemic evidential verbs

(predict, seem, juede 覺得 ‘feel’, jushuo 據說 ‘it is said that’) refer to devices which

denote that the information presented is less than definite. The evidentiary justification is

based on the speaker’s/writer’s senses, hearsay evidence, or researches of others.

Hyland (1996a, 1998) examines hedges used in scientific RAs, and the results show

that lexical verbs occur the most frequently among various grammatical categories since they

“represent the most transparent means of coding the subjectivity of the epistemic source and

are generally used to hedge either commitment or assertiveness” (p. 119). Hyland suggests

that epistemic lexical verbs can be classified into four categories: speculative and deductive

categories involve the writer’s epistemic judgments, which allow uncertainty and the

tentative assertion of hypotheses; quotative and sensory categories concern the nature of the

evidence the writer employs to support his/her claim, which imply that evidence is required

to justify the writer’s doubt. In Varttala’s (2001) RA corpus, lexical verbs are utilized the

most frequently in the fields of economics and medicine, while they are the second most

common hedges in technology. In his popular scientific articles, lexical verbs only occupy the

third place in descending order of frequency for all three disciplines.

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Epistemic lexical verbs in Chen’s (2008) conversation data involve the speaker’s attitude or judgments towards a proposition. Based on Chafe’s (1986) ‘modes of knowing’,

Chen’s classifies hedging verbs into three categories: verbs of belief (e.g. siang 想 ‘think’, rewei 認為 ‘think’), verbs of induction (e.g juede 覺得 ‘feel’, jide 記得 ‘remember’), and verbs of hearsay (e.g. tingshuo 聽說 ‘hear of’, jushuo 據說 ‘it is said that’). As argued by

Chafe (1986: 266), “mode of knowing implies something about reliability”. Belief is a mode of knowing in which concern for evidence is downgraded since belief is always based on something other than evidence alone. For instance, people may believe things because other people believe so, or simply because, for whatever reason, they want to believe them. The second mode of knowing is acquired from induction on a specific kind of evidence, and sensory evidence is one of the kinds. Sensory verbs, such as juede 覺得 ‘feel’, kan 看

‘see’, and tingqilai 聽起來 ‘sound’, are employed to demonstrate that speakers’ opinions or judgments are based on their direct experience. The third mode of knowing, i.e. via hearsay verbs, is acquired through what have been told by others as “we know many things because people have told us about them” (Chafe 1986: 268). Since the information is based on other source rather than direct experience, it is then possible to make false remarks. By applying verbs of hearsay, such as tingshuo 聽說 ‘hear of’ and jushuo 據說 ‘it is said that’, speakers are able to lower their commitment to the proposition. In Lo’s (2010) academic written corpus, lexical hedging verbs are classified into five categories, Judgmental verbs, evidential verbs, verbs of attempt, non-active reporting, and verbs of focus. The first two categories are applied from Hsieh’s (2002, 2006) classification of Chinese epistemic modal expressions, while the other three types are based on observation of her data. Judgmental verbs are verbs refer to speakers’/writers’ subjective judgment to the truth of the propositions, whereas evidential verbs are verbs used to indicate speakers’/writers’ objective judgment to the truth of propositions. Judgmental verbs are further divided into speculative verbs (e.g. tuice 推測

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‘speculate’, yuqi 預期 ‘predict), assertive verbs (e.g., renwei 認為 ‘consider’, xianxin 相

信 ‘believe’), and tentative verbs (e.g. ke(yi)shuo 可(以)說 ‘(we) can say’, shi(wei/zuo) 視

為/做 ‘view…as’). Evidential verbs are divided into quotative verbs (e.g. jushuo 據說 ‘it is said that’) and sensory verbs (e.g. kansi 看似 ‘look like’). Verbs of attempt (e.g. shi(tu) 試

圖 ‘try’, xiwan 希望 ‘hope’) are used to express writers’ intention or the potential probability to complete certain events; non-factive reporting verbs (e.g. tichu 提出 ‘propse’, jianyi 建議 ‘suggest’) appear to tentatively report writers’ findings and to make suggestions; verbs of focus (e.g. zhezhong-(yu) 著重(於) ‘focus on’, piangzhon-(yu) 偏重(於) ‘focus on’) serve to withhold writers’ commitment to the details of the information.

2.6.2.2 Adverbs

In English, a number of adverbs can be employed to express epistemic meaning associated with hedging, such as likely, probably, and occasionally. In Hyland’s (1998) study,

adverbs appear to be the second most frequent means of hedges in the scientific journal

articles after lexical verbs. Over 36 different adverbs are found in the corpus, the most

frequent being probably, apparently (each 2.8 per 10,000 words), relatively and essentially

(2.4 each), and generally (2.1). The great utility rate of epistemic adverbs is attributed to their unique linguistic characteristics, as indicated by Hyland (1998: 134) that adverbs “are not syntactically integrated as an element of the clause but can appear in a number of positions without affecting the meaning relation between clause and adverb.” In Varttala’s (2001) RA corpus, 61 different adverbs are identified as hedges, with technology containing the highest

number, followed by economics and medicine. Hedging adverbs are classified into four

categories in accordance with their basic meaning potential. Probability adverbs (e.g.

potentially, probably) are used to “express degrees of probability between the absolutes of

‘true’ and false’” (p. 128); Adverbs of indefinite frequency (e.g. often, typically) allow writers not to commit him/herself to categorical assertions or to exact figures; Adverbs of indefinite

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degree (e.g. relatively, slightly) enable writers to render their statements less than absolute;

Approximative adverbs (e.g. about, approximately) are used to provide tentative

approximations rather than exact numerical data. It is observed that hedging adverbs are most

commonly found in the RAs on technology (5.57 per 1,000 words), followed by economics

(4.72), whereas medicine is the discipline with the lowest number of adverbs (2.61). In

Varttala’s corpus of popular scientific articles, adverbs are the most frequent hedge type

across all three disciplines. 60 different adverbs are identified as hedges in this corpus, which

is nearly as many as in the RA corpus (61 adverbs).

The results of Chen’s (2008) conversation data show that adverbs are the most common

hedging means, representing 42.2% of all hedges retrieved. Hedging adverbs are classified

into five subcategories: epistemic adverbs (e.g. qishi 其實 ‘actually’, shishishang 事實上

‘in fact’), adverbs of probability (e.g. hoaxing 好像 ‘seem to’, dagai 大概 ‘probably’), and

adverbs of frequency (e.g. you(de)shi(hou) 有(的)時(候) ‘sometimes”, yiban 一般

‘generally’), adverbs of degree (e.g. (yi)xie 一些 ‘some’, bijiao 比較 ‘relatively’), and adverbs of approximation (e.g. dagai 大概 ‘approximately’, chabuduo 差不多 ‘almost’).

According to Chen (2008), speakers utilize those various types of epistemic adverbs to

“encode a kind of attitude toward the proposition to lower their commitment to the truth of the proposition” (p. 76). As well as in Chen’s (2008) study, adverbs are also found to be the most frequent grammatical category of lexical hedges in Lo’s (2010) written corpus, and the tendency is consistent in all three academic fields. Lo adopts Varttala’s (2001) and Chen’s

(2008) classifications and divides the adverbs into four subcategories, including stance

adverbs (e.g. si(hu) 似乎 ‘seem to’, huo(xu) 或許 ‘perhaps’), adverbs of indefinite degree

(e.g. zhu(yao) 主(要) ‘mainly’, (bi)jiao(wei) (比)較(為) ‘relatively’), adverbs of indefinite frequency (e.g. (da)duo (大)多 ‘mostly’, wangwang 往往 ‘frequently’), and adverbs of approximation (e.g. ji(hu) 幾(乎) ‘almost’, dazhi(shang) 大致(上) ‘approximately’). Stance

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adverbs are used to express writers’ subjective uncertainty and tentative attitude concerning

the propositional information, while adverbs of indefinite degree, adverbs of indefinite

frequency, and adverbs of approximation are employed by academic writers to “present situations that best support their argument or when their claims are greatly supported by

previous studies” (p. 142).

2.6.2.3 Adjectives

Adjectives can serve as hedges to express the speaker’s/writer’s uncertainty or doubts.

In Hyland’s (1998) study, 20% of the lexical hedges in the RAs are adjective, with (un)likely, and possible occur the most frequently (each 3.1 per 10,000 words), followed by most (2.3), and then consistent with (2.0). All the hedging adjectives function to reduce the writer’s categorical commitment. Varttala (2001: 134) argues that hedging adjectives are not always quite common in the RAs; however, many adjectives mark the information presented as

“uncertain, tentative, or not quite precise”, in much the same way as their corresponding adverbs. The categorization of hedging adjectives is identical with that in hedging adverbs, which includes probability adjectives (e.g. likely, possible), adjectives of indefinite frequency

(e.g. usual, common), adjectives of indefinite degree (e.g. slight, considerable), and adjectives of approximation (e.g. approximate, virtual). Altogether 57 different adjectives are identified in the four subcategories. The incidences of hedging adjectives in the popular scientific articles are somewhat lower than those observed in the RAs, and there are 40 different adjectives found in the corpus.

In Chen’s (2008) study, the reduplicated adjective xiaoxiaode 小小的 ‘small’ is the only hedging adjective found in her corpus, which is used to minimize the extent of the effect conveyed by the proposition. In Lo’s (2010) study, the subcategories of hedging adjectives are identical with those of hedging adverbs as adjectives and adverbs share most of the hedging concepts. Yet the application of different subcategories vary in terms of disciplines.

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Lo observes that among those four subcategories, writers of biology tend to employ more adjectives of indefinite degree (41.30%), writers of business use more stance adjectives

(41.40%), while writers of history & literature make great use of adjectives of indefinite frequency (68.24%).

2.6.2.4 Nouns

Many of the hedging nouns are found to be nominal forms of their corresponding verbs and adjectives. Varttala (2001: 139-140) claims that hedging nouns are all “characterized by a component of tentative or indefinite meaning that make them useful for hedging purposes”, and many of these nouns are derived from their corresponding verbs and adjectives. Varttala categorizes the hedging nouns into three general types. Nonfactive assertive nouns (e.g. prediction, implication) are used to convey different degrees of tentativeness in reporting the writer’s own opinions and findings or those of others; Tentative cognition nouns (e.g. assumption, belief) denote that what is being said is not to be taken categorically as it is based on the rationale, subjective viewpoints, or limited knowledge of the authors or another source; Nouns of tentative likelihood (e.g. possibility, tendency)are used to indicate degrees of probability, indefinite degree or frequency. 56 different nouns are identified in the RA corpus, while 58 are found in the popular scientific articles. In Hyland’s (1998) scientific corpus, hedging nouns are the least frequent lexical hedges, which occupy only 6.4% (1.1 items per 1,000 words) among various grammatical categories. Hyland argues that biologists appear to make considerably less use of epistemic nouns than other language users.

A lot of hedging nouns found in Chinese data are also derived from verbs and adjectives. In Chen’s (2008) data, some of hedging nouns (e.g. ganjue 感覺 ‘feeling’, jianyi

建議 ‘suggestion’, kanfa 看法 ‘opinion’) are the nominal forms of lexical verbs, which are used to indicate that what is said is only based on personal belief, memory, or feeling. A speaker may employ those noun hedges to express his/her lower degree of responsibility for a

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proposition. Many nouns identified as hedges in Lo’s (2010) academic corpus are nominal

forms of verbs and adjectives, and they are classified the same way as that in hedging verbs.

Like hedging verbs, the majority of hedging nouns fall into the subcategory of judgmental

nouns. In spite of the lower frequency of nouns, the hedging meanings that hedging nouns

convey are similar to those of hedging verbs. Academic writers apply hedging nouns to

express the degree of cautiousness and confidence while presenting claims.

In addition to the nominal forms of verbs and adjectives, Chinese question words (e.g.

sheme 什麼 ‘what’, ji 幾 ‘how many’) are also found to be frequently utilized as hedges to

convey the sense of uncertainty and indefiniteness. In Mandarin Chinese, question words,

such as sheme 什麼 ‘what’, zenme(yang) 怎麼(樣), ‘how’, ji 幾 ‘how many’ duoshao 多

少 ‘how many’ , are generally “occur in the same position in the sentence as do nonquestion words that have the same grammatical function” (Li and Thompson 1997). That is, question words may be nominal as in (38), or adverbial as in (39), or they may modify a head noun in a noun phrase as in (40).

(38) nimen zuo sheme? you do what ‘What are you doing?’ (Li and Thompson 1997: 522) (39) zenme ni bu qu shang – ke? Why you not go attend – class ‘Why aren’t you attending your class?’ (Li and Thompson 1997: 523) (40) sheme dongxi zheme xiang? what thing this fragrant ‘What kind of thing is this fragrant?’ (Li and Thompson 1997: 523)

Li and Thompson indicate that “the nominal question words, however, may also function as

indefinite pronouns denoting such as ‘whoever’, ‘whatever’, ‘wherever’, ‘anyone’,

‘anything’” (p. 527). sheme “contains no semantic features and merely refers to an indefinite

‘entity’” (Biq 1990: 144). Chinese question word sheme 什麼 ‘what’ is presumably first

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realized as a hedge by Biq (1990) who examines the diverse uses of question word, sheme 什

麼 ‘what’ in Chinese conversation. Biq finds that in spontaneous conversation, sheme can behave as a hedge and it displays three discourse functions. Sheme can function as an interactional hedge, in which it is used as a filler for blanks in ongoing talk. The ‘empty’ sheme is employed during the flow of speech in older to hold the speaker’s right to talk since the speaker may loses the floor if he/she does not speak within an appropriate span. Sheme can function as a referential hedge (disclaimer) when a speaker deliberately disclaims responsibility for the accuracy of truthfulness of what he or she is saying. From Biq’s examples, referential hedges, the attitude towards the referentiality of a speaker’s speech, can be interpreted differently depending on distinct circumstances. It renders an indefinite and vague interpretation when the speaker is indeed uncertain about what he/she has just said; while it renders a void and rejectionary interpretation when the speaker conveys a sarcastic attitude toward what he/she is saying. Sheme can also function as an expressive hedge

(mitigator in negation), in which it occurs with negation only. As Biq’s example illustrates:

(41) a. Ta shuo de hua mei (you) daoli. 3s speak NOM speech NEG justification There is no truth in what he said. b. Ta shuo de hua mei (you) sheme daoli. 3s speak NOM speech NEG what justification There isn’t much truth in what he said. (Biq 1990: 151)

The truth condition of (41a) and (41b) remain the same in that they are both negative statements, and yet the negation with sheme, as in (41b), sounds less straightforward and is de-emphasized. The uses of sheme as expressive hedges is parallel to euphemisms and indirect speech acts, and they are motivated by the politeness strategy to avoid FTAs. Biq further notes that the uses of sheme as interactional hedges and as a referential hedge appear

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primarily in spoken language only, whereas the uses as expressive hedges are found in both

spoken and written genres. Chen (2008) investigates hedging phenomena in Mandarin talk-

in-interaction, and there are four question words found in her corpus, namely sheme 什麼

‘what’, ji 幾 ‘how many’, ‘zen(me)(yang) 怎(麼)(樣) ‘how’, and duoshao 多少 ‘how many’. In addition to elicit information, question words function as hedges for speakers to lower their commitment to a proposition. Chen’s conversation data shows that 95% of hedging nouns are realized in the forms of question words, such as sheme 什麼 ‘what’, ji 幾

‘how many’, zen(me)(yang) 怎麼樣 ‘how’, and duoshao 多少 ‘how many’. Among those questions words, sheme 什麼 ‘what’ is not only the most common hedging noun but also the most frequent lexical hedge. Sheme inherently possesses a quite vacuous figure, which enables speakers to refer to any possible reference without specifying the type. The deliberately vague usage helps speakers escape from full responsibility for the accuracy or the truth of what is uttered. Furthermore, sheme serves as a vague substitute while the speaker cannot find a proper word for description due to lack of specific information or when they purposely avoid saying things directly. In Lo’s academic written corpus, questions words ji

幾 ‘how many’, sheme 什麼 ‘what’, duoshao 多少 ‘how many’, and duo 多 ‘how’ are employed by writers to express their uncertainty. Among those words, ji 幾 ‘how many’ is found in all of the three fields to denote indefinite quantity, whereas sheme 什麼 ‘what’ is only observed in the field of history & literature. Most of the sheme are used to mitigate the force of negation, which share the identical function as ‘expressive hedges’ in Biq (1990) conversation study.

2.6.2.5 Vague expression of quality and quantity

Precision in earlier centuries was treated as a major principle in the academic world; however, the traditional perception has been challenged and re-evaluated. There has been a

substantial amount of researches discussing about the imprecision in terms of quality and

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quantity in different disciplines (Prince et al. 1982, Kennedy 1987, Bonanno 1994, Channell

1990, 2004, Ruzaite 2004, Mauranen 2004, Miskovic-Lukovic 2009). Linguistic expressions

conveying the notion of imprecision are mostly attributed to Price et al.’s (1982)

“approximators” category of hedges, such as almost, somewhat, sort of, about,

approximately, and essentially. In Prince et al.’s physician- physician discourse,

“approximators” occur “when a speaker is attempting to correlate an actual situation with

some prototypical, goal-relevant situation” (p. 88), and they are used to introduce fuzziness

within the proposition that the speaker utters. Uncertainty is concluded to be the underlying

cause of the application of “approximators” for those medical specialists. Channell (1990)

examines precise and vague quantities in three writings on economics, and she interviewed

two of the three authors to elicit comments on their choices of particular words and

expressions. The results show that the choice of vague versus precise rests on writers’

perceptions of the purposes of their writing.

For example, in the sentence (42) below:

(42) He’s producing about ten pages a week and they’re all getting published. Channell (1990: 98)

An interval of something like 8 to 12 may be understood as the perceived length of the

interval cannot be determined precisely in any given case. However, according to Channell,

the general length is influenced by a set of contextual and situational factors, such as the size

of the given number, how many significant figures it contains, purpose of the vague, type of

item being quantified, and situation of use. In the economic written texts, round numbers10 and nonunmerical quantifiers (e.g. low, high, extensive) are favored for the writer to avoid

10 Round numbers are numbers which are structuring points of a number system. E.g. in the base 10 system used in the UK, 5, 10, 20, 30, 100 etc.. (Channell 1994: 220) A round number may be perceived as an approximation, as in the wedding cost £800, whereas a nonround number cannot be, as in the wedding cost £802.47. (Channell 1990: 101) 78

giving exact information, which is uncertain for the writer or it is unnecessary to give. In her

book of vagueness, Channell (1994) provides a thorough description of various ways of

approximating quantities in English through reference to copious examples of language in

use, which include examples of vague additives, i.e., approximators (e.g. about, around,

approximately), downtoners (e.g. a bit of ), and vague category identifiers (e.g. or something like that, and stuff, or whatever), and examples of lexical vagueness, i.e., vague quantifying expressions (e.g. many, some, few), vague adverbs of frequency (e.g. sometimes, usually), and placeholder words (e.g. thingy, whatsisname11). It is argued that “vagueness in communication is part of our taken-for-granted world, and that normally we do not notice it unless it appears inappropriate” (p. 4). Those vague quantifiers enable a speaker to talk about matters he/she is not very knowledgeable about or lack of the necessary vocabulary. The vague quantifiers are also utilized as a defensive tactic when the speaker does not want to commit him/herself to the proposition, as in the following example:

(43) B: Could you give me some idea of how long it would take? C: Well the quote might be done within three or four days but the job won’t be done for at least five weeks. (Channell 1994: 178)

Channell (1990, 1994) proposes that Gricean maxims (1975, 1981) of Quality and Quantity

are particularly relevant in the description and explanation of vague language use. On the one

hand, vague language may be used to follow the maxims, and on the other hand, vague

language is often employed while one of the maxims is violated. For instance, someone might

reply “around six o’clock” as being asked what time he/she would be home from work since

the workload and traffic cannot be genuinely anticipated. In this case, the speaker follows the

maxim of Quality by being informative, but not overinformative. As Grice (1975) observes,

11 Whatsisname is probably derived from what’s his name, what’s its name, or what’s her name. (Channell 1994: 160) 79

speakers often break rather than follow one or more maxims. When the violations occur,

special effects are created for hearers, which are called “implicatures” (p. 43). The following

example illustrates a violation of Quantity:

(44) [paper reporting informant work at a linguistics conference] We’ve got about five or six of them but I’m only going to talk about three of them today. (Channell 1994: 33)

In this case, the speaker (a linguist engages in phonetics research) must know how many informants he has; therefore, the adherence of the maxim of Quantity is expected. However, the speaker chooses not to give the exact number. Channell (as a hearer in his audience) assumes that he must have intended something else, which is that the total amount of informants is not important and the focus is the three people the speaker is going to talk about. Hyland (1998) argues that writers depend more on context than on linguistic form while conveying meanings; therefore, Grice’s implicatures serve as an important way to draw on and exploit knowledge shared with readers. The maxim of Quality, “Do not say what you believe to be false” and “Do not say that for which you lack sufficient evidence” (Grice 1975:

46) fit the requirements of honesty and truthfulness in scientific statements, which may explain the employment of some hedged expressions. The high frequency of approximations found in Hyland’s (1998)’s corpus can be explained by reference to the maxim of Quality since writers can “manipulate the quantity maxim to express the tentativeness of their beliefs”

(p. 41):

(45) These data suggest that the ACC synthase isoenzyme expressed in E. coli behaves more or less like the native ACC synthase enzyme(s) of ripe tomato fruit in its response to substrate inactivation. (Hyland 1998: 42)

With the hedging adverb, more or less, the writer of (45) withholds full commitment to the proposition expressed. Hyland points out that a great amount of hedges in science involves 80

the manipulation of precision in quantification, and the most frequently employed expressions are about, approximately, some, and around. Numerical approximations often employ ‘degree of precision’ adverbs (p. 140), which enables writers to specify the accuracy with an acceptable degree of imprecision. In some cases, these adverbs are used to foreground more important quantities. The writers also utilize imprecision as a rhetorical means to strengthen their arguments, in that comparative phrases, such as at least, less than,

and more than are commonly used, as in (46)

(46) The concentration of asparagine in the blade of infected plants was more than

four times that in uninfected plants at the high rate of KNO3 fertilisation and

nearly twice as great as the high rate of (NH4)2SO4.

A wide range of adverbial forms are employed by the scientific writers. Hyland (1998)

asserts that adverbs are predominately utilized as popular epistemic devices due to “their

sentential mobility” and “semantic diversity” (p. 141). The writers often use epistemic

adjectives to “‘objectify’ the modality and obscure the source of the judgment through

impersonal expressions,” while nominalization is used to “present the writer’s belief as an

abstraction” (p. 141).

In Chinese, expressions used to denote the imprecise quality and quantity are normally

realized under various grammatical categories which convey indefinite degree, frequency,

and approximation. These grammatical categories comprise adverbs (e.g. you(yi)dian 有(一)

些 ‘a bit’, (da)duo (大)多 ‘mostly’, (da)yue (大)約 ‘approximately’), adjectives (e.g.

mouzhongchengdude 某種程度的 ‘a certain degree of’, buda 不大 ‘not big’, dabufen(de)

大部份(的) ‘most of’, and nouns (e.g yier 一二 ‘a little’, yu 餘 ‘more than’, sheme 什麼

‘what’).

In Chen’s (2008) conversation data, the adverbs of degree are used to “weaken the

force of a statement by minimizing the extent of the effect conveyed by a proposition” (p.

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60), as in (47), while in Lo’s (2010) academic written texts, the adverbs of indefinite degree

“enable writers to withdraw their full commitment to the precise degree of the quality or

quantity” (p. 97), as in (48).

(47) …你對現在的男女的愛情觀呢，似乎是有一點兒悲感呢。 ‘You seem to take a pessimistic stance on the views of men and women nowadays on love.’ (Chen 2008: 61)

(48) …顯示估計的 225 個利率期限結構中，線性估計法的 Calibration 效果皆比 非線性估計法佳，這倒是比較與直覺不符。 ‘…This shows that among the 225 term structures, the effects of Calibration in linear optimization method are all better than those in nonlinear optimization method. This is relatively not consistent with our intuition.” (Lo 2010: 99-100)

In (47), the degree adverb youyidian 有一點 means ‘a little’, which is used by the speaker to reduce the intensity of the adjective beigan 悲感 ‘pessimistic’. The adverb bijiao 比較

‘relatively’ in (48) is used to modify the author’s judgment to lower the degree of the following predicate. Negative degree adverbs (e.g. butai 不太 ‘not very’, buda 不大 ‘not very’, buyi 不易 ‘not easy’) are observed in both Chinese spoken and written copra to denote the notion of indeterminacy in precision. Those negative expressions are utilized to lower the force of their following predicates and simultaneously help the speakers/writers avoid making full commitment to the propositions. In Lo’s academic corpus, negative degree adverbs occupy a significant proportion of all adverbs of indefinite degree, around 20% in

Business, 22% in Biology, and 27% in History & Literature. Adverbs of frequency are utilized to indicate the indefinite frequency of events. In conversation, speakers sometimes prefer to use adverbs of frequency instead of providing an exact number, which is attributed to two purposes. First, adverbs of frequency reduce the speaker’s commitment to the numeral figures because sometimes the precise number may not be obtained. Second, the situation described by the utterance occurs only occasionally. That is, when the situation changes, the

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numeral figures may not apply. By using adverbs of frequency, such as you(de/xie)shi(hou)

有(的/些)時(候) ‘sometimes’, changchang 常常 ‘often’, speakers can avoid taking full responsibility for their utterances. In Chinese academic writing, the most frequently employed adverbs of indefinite frequency are those denote the sense of higher frequency, such as (da)duo (大)多 ‘mostly’, wangwang 往往 ‘frequently’, tongzhang 通常 ‘usually’.

As well as adverbs of higher degree, adverbs of higher frequency are utilized frequently when

the authors intend to focus the readers’ attention to the information that best support their

argument or claims, whereas adverbs of lower frequency are used when authors’ subjective

speculation are expressed or when previous literature is not supportive enough. Adverbs of

approximation are often employed by speakers to hedge numerical expressions or quantities

when the precise information is unnecessary or unavailable. The imprecise expressions

protect speakers from making a false statement and mitigate their commitment to the truth

value of utterances. For example:

(49) 因為巧克力裡面，它的成分其實，百分之七十左右，是所謂的碳水化合 物。 ‘The so-called carbohydrate accounts for about seventy percent of the ingredients of chocolate.’ (Chen 2008: 63-64)

The adverb of approximation zuoyou 左右 ‘about’ in (49) is used with the numerical

expression to indicate that the exact figure is uncertain but close to seventy percent. The

speaker shows her lack of full commitment to the proposition and meanwhile protects herself from being accused of making a false statement. In academic writing, adverbs of approximation are not only used to modify quantity but also quality. In Biology, adverbs of

approximation are mainly used to modify numerical figures. In the fields of Business and

History & Literature, adverbs of approximations (e.g. ji(hu) 幾乎 ‘almost’, dazhi(shang) 大

致(上) ‘approximately’, and zhengtieryan 整體而言 ‘overall’) are exploited to hedge

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quality, as in the following example extracted from business field:

(50) 因此，消費者理想主義特性會與道德決策有關在本研究大致獲得驗證。 ‘Therefore, the hypothesis that the idealism of moral philosophy is related to ethical decision-making is approximately proved in this study.’ (Lo 2010: 110)

The higher degree of approximator dazhishang 大致上 ‘approximately’ in (50) draw readers’ attention to the findings that best support the author’s argument.

2.6.3 Non-lexical Hedges

As compared with lexical hedges, non-lexical hedges have received relatively much less attention. Hyland (1998) identifies three discourse-based strategies as non-lexical hedges in his scientific RAs, which include reference to limiting experimental conditions, reference to model, theory, or methodology, and admission to a lack of knowledge. In the present study, three types of syntactic constructions larger than single words or phrases constitute the category of non-lexical hedges. Hyland’s discourse-based strategies will be reviewed as one

type of the non-lexical hedges. The other two types of non-lexical hedges are constructions of

conditionals and questions.

2.6.3.1 Conditionals

Perkins (1983: 110) points out that if is a linguistic device which “enables the speaker

to qualify his commitment to the truth of a proposition or the actuality of an event,” and if-

clauses imply uncertainty about the actual circumstances referred to. If-conditionals are a highly valuable resource in academic discourse (Mead & Henderson 1983, Ford & Thompson

1986, Ferguson 2001, Carter-Thomas 2007, Carter-Thomas & Rowley-Jolivet 2008, Warchal

2010). With the inherent non-assertiveness characteristic, conditional clauses can be used to hypothesize, hedge, negotiate terms and concepts, ward off possible criticism, manage interaction with the addressee, promote or circumscribe the scope of research claims, and acknowledge other points of view or potential threats to the cogency of argumentation.

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Conditional sentences typically consist of two clauses, a protasis (the if-clause) and an

apodosis, and there is some sort of dependent relationship between the protasis (p) and the

apodosis (q), such as cause-effect, enablement, inference, or some looser connection. “The if-

protasis typically sets up some situation p that departs in some degree from the actual world and the apodosis considers the consequences obtaining given that p” (Ferguson 2001: 63).

That is, with the conditional protasis, the proposition encoded in the clause is not being asserted in any ordinary sense. In Hyland’s (1998) study, writers of RAs employ conditionals to qualify commitment to the methodology, theory or model as “they make one circumstance dependent on another and thereby hedge the certainty of outcomes” (p. 145). The conditional clauses serve to remove propositions to a possible alternative world where “the expressed facts are not epistemically accessible, but relate to a speculative state of affairs” (p. 146).

As well as observed in RAs, conditionals functioning as a hedging device are also found in spoken discourse, and they are not a marginal phenomenon in medical communication. The frequency and functions of conditionals vary with different purposes of genres (Ferguson

2001, Carter-Thomas & Rowley-Jolivet 2008). In Ford and Thompson’s study, conditionals appear more in spoken than in written discourse, and this tendency holds true in Carter-

Thomas & Rowley-Jolivet’s (2008) medical research as it is important for the speaker to provide the background for the subsequent assertion in Q in real-time processing. The most occurrences of conditionals are obtained in conference presentations (CP), the second in editorials (ED), and the least in research articles (RA). In the face to face encounter, conditionals can function as a politeness strategy which enable the speaker to redirect the audience during the talk; in the authoritative surveys of the editorials, conditional protases (if- clauses) are frequently used “to qualify the scope of recommendations, to modulate predictions or prognostications, and to present cautious generalizations” (Ferguson 2001: 80); in the research articles, conditionals are mainly used in the operational definitions of the

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methods section while in the discussion section they are used in predictive contexts and in the

construction of arguments. As to the preferred positions of if-clauses, Ford and Thompson

(1986) argue that initial if-clauses are language universal, which is borne out by the results of the CP and ED data but not the RA in Carter-Thomas & Rowley-Jolivet’s (2008) study. In their corpus, final if-clauses (54.6%) are preferred in medical research articles.

In Mandarin, conditionals are viewed as one of the linking constructions which are used to link successively related clauses to make communication comprehensive and smooth.

In English, conditionals are typically introduced by if, whereas in Mandarin Chinese, “the

conditional clause may be introduced by a forward-linking adverb that signals “conditional”

as in (51) or “it may be expressed by forward linking with no linking element” as in (52) (Li

and Thompson 1997: 646):

(51) jiaru xia yu, women jiu zai wuli chi-fan if descend rain we then at indoors eat-food If it rains, we’ll eat indoors. (52) baba qu, wo gen ta qu father go I with 3sg go If father goes, I’ll go with him.

With forward linking, one clause is always dependent on the second clause for its meaning to

be complete, and the dependency relationship is established either by a specific linking element (e.g. if) or by the speaker’s intention. In Li and Thompson’s book, ruguo 如果, jiaru

假如, jiashi 假使, and youshi 要是 are the Chinese forward-linking elements, with the

equivalent meaning to English if, typically appearing in the antecedent if-clause (the

protasis), and there are six important linking elements which may go alone with these

forward-lining elements but occur at the end of the same if-clause, de hua 的話 ‘if’, de shihou 的時候 ‘when, while’, yihou 以後 ‘after’, yiqian 以前 ‘before’, and the pause particles ne, me 呢, 麼. These forward-linking elements are movable adverbs since they can

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appear not only in sentence-initial position but also after the subject or topic. The majority of

these forward-linking movable adverbs normally have a corresponding backward-linking

element (e.g. jiu 就 ‘then’, ye 也 ‘also’) in its consequent clause (the apodosis). Example

(53) is a conditional clause which demonstrates this type of pairings:

(53) jiashi mingtian xia-yu, wo jiu bu shang-ban le If tomorrow descent-rain I then not ascent-work CRS12 If it’s raining tomorrow, I won’t go to work. (Li and Thompson 1997: 649)

Liu et al. (2011) address that the common linking pairings in spoken discourse include

you(shi)…, (jiu)... 要(是)…, (就)… ‘if …, then …’ and ruguo…, (jiu)… 如果…, (就)…

“if…, then…’, while in written texts jiaru 假如, tangruo 倘若, ru 如, tangshi 倘使, sheruo

設若 are used in the protasis corresponding with jiu 就 and bian 便 in the apodosis.

In common with English, Chinese conditionals may function as a hedging device whether in conversation (Chen 2008) or in academic written discourse (Lo 2010). Chen argues that both subjectivity and intersubjectivity motivate the use of conditionals in spoken

Mandarin. Conditionals enable the speaker to indicate the indeterminacy of a proposition and mitigate undesirable utterances which might threaten the address’s negative face. The following example demonstrates how conditionals may function as a hedging device and how subjectivity and intersubjectivity are signaled within it.

(54) 如果是說氣氛好。我覺得西華一樓的 Toscana，很好。 If we were to consider the ambiance in restaurants, I feel that Toscana on the first floor of Sherwood Taipei would be a good choice. (Chen 2008: 102)

The speaker in (54) employs the conditional to make a suggestion. Giving a suggestion or

offering a recommendation is generally taken as a speech act which may be harsh to the

hearer and thus threaten the hearer’s face. With conditionals, the speaker can soften her

12 Currently Relevant State 87

utterance in a more indirect way which helps to mitigate the FTA. Simultaneously, the

conditional helps the speaker to avoid full commitment to the comment she made on the

restaurant since the proposition in the apodosis depends on the fulfillment of the condition

profiled in the protasis. In other words, the comment is valuable only when the premise in the

if-clause is emphasing on the atmosphere of a restaurant. If the premise is switched to another

perspective such as price of the meal or taste of the food, the comment may not be true any

longer. Therefore, in this case, we see that the conditional is utilized by the speaker to reduce

full commitment to her comment, and at the same time mitigate the illocutionary force of her

utterance. Conditionals are the most frequent structural category in Lo’s (2010) academic

texts. The two main hedging functions of conditionals in Lo’s corpus are “indicating the

authors’ uncertainty or lack of confidence in the truth of the information” and “weakening the

illocutionary force of research suggestions” (p. 148), with the former observed in all three

academic fields and the later in business and biology. Example (55) and (56) illustrate these

two functions respectively.

(55) 如果筆者推測無誤的話，那麼，這次的糾紛純粹是因為風水所引起。 If my speculation is not incorrect, then this conflict results simply from geomancy. (56) 若能改良本法應用在偵測土壤是否殘存白銹菌，如此可於寄主植物尚未種 植前，種植非寄主植物或將土壤進行清潔動作，降低土壤中白銹菌殘存密 度，… If we could improve this method and apply it to the detection of Albugo species in the soil, the density of the remaining Albugo species will be lowered by planning some non-host plants or clean the soil before the host plants are planted… (Lo 2010: 146)

2.6.3.2 Questions

Questions are regarded as ‘addressee-oriented’ epistemic modality by Perkins (1983:

111) since questions semantically “qualify the truth of a proposition by making it relative to

the speaker’s uncertainty”, and they pragmatically function to elicit some kind of response

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from an addressee. Interrogative forms are tightly related to indirect speech acts and

politeness (Leech 1983, Brown and Levinson 1987, Mey 1993).There are four interrogative

forms functioning as hedges, namely wh-qustions, yes-no questions, rhetorical questions, and

tag questions. For example, a yes-no question may be used to “qualify or ‘tone down’ a direct

command” as in (57); a tag question appear to be “equivalent in expressing addressee- oriented modality” as in (58):

(57) Go away, will you! (Perkins 1983: 113) (58) Shirley’s your sisiter, isn’t she? (Perkins 1983: 114)

Similar to Perkins’ viewpoint, questions are regarded as ‘reader-oriented’ hedges by Hyland

(1998) as they engage the reader in the research. In scientific RAs, questions can be used as a hedging device, referring to a writer’s state of knowledge towards the truth of a proposition

(Hyland 1998, Varttala 2001). In Hyland’s (1998) study, besides eliciting a response from the reader, questions are used to “withhold commitment from a claim” (p. 143), or to “signal an important unresolved issue or the tentativeness of a solution” (p. 183). In Varttala’s (2001) corpus, the RA data contains few questions of any type, and even some of them cannot always be seen as hedges. There are only five occurrences realized as hedges in economics, one in medicine, and four in technology. In the popular scientific articles, the hedging use of questions is also uncommon. Questions are utilized by writers while drawing attention to

“issues where full certainty or accuracy might not have been achieved” (p. 225). The incidence of questions occurs much higher in the popular scientific articles than in the RAs on technology and medicine, whereas the figures for the popular scientific articles on economics are quite similar to those for the RAs. Webber (1994: 266) states that rhetorical questions represent “a statement of opinion rather than a question”, and they are in fact “a way of expressing disagreement, or even mockery, ironically or indirectly” since the answer for rhetorical questions is assumed to be obvious. Webber (1994) investigates the use of 89

questions in medical English publications, and she finds that the examples (112 interrogative

sentences) are not always traditional rhetorical questions that the writer knows the answer or

those used to express criticism.13 As a matter of fact, interrogatives serve a variety of

purposes. Questions are frequently used in the titles of articles, which attracts attention and

challenges the reader to think about the subject. Some headings may heighten the effect of medicine while some may imply doubt. A single question or a series of questions may be posed in the first paragraph for the author to provide his/her own answer subsequently, and that serves to arouse the reader’s interest and create anticipation. The author may apply interrogative forms to involve the reader’s participation when addressing an extremely obscure matter, which is considered as one of the ‘reader-friendly’ strategies (p. 264). It is found that the utilization of questions not only facilitates comprehension of the message but also enables the author to avoid taking a full responsibility on the still controversial topics.

Questions placed towards the end of a text are used to leave the subject open for debate or further study, or serve as a kind of punch line to end the article. Webber argues that rhetorical questions are found to possess provocative figures serving to attack or criticize other authors

or theories as they are “in a strict sense take a very strong position” (p. 266).

In Chinese, questions are also classified into four types (Li and Thompson 1997, Liu et

al. 2011), which are question-word questions (wh-questions), yes-no questions, disjunctive questions,14 and tag questions. Interrogative forms inherently convey a certain degree of

uncertainty and tentativeness. For example, while asking the yes-no question, ta shi auotian lai de ma? 他是昨天來的嗎? ‘Did he come yesterday?’ (Liu et at. 2011: 462), the questioner is uncertain about the truth of the proposition; question-word sheme can behave as an interactional hedge, a referential hedge, or an expressive hedge (Biq 1990). In Chen’s

13 The corpus consists of written texts from The Lancet, the British Medical Journal, and Diabetic Medicine. 14 According to Li and Thompson (1997: 532), this type of questions “explicitly presents the respondent with a choice of two or more possible answers.” The possible answers of each such question are generally connected by haishi 還是 ‘or’. 90

conversation corpus, rhetorical questions and tag questions are two main interrogatives used to modify a speaker’s commitment to his/her utterances. As mentioned in the previous

section, rhetorical questions are question forms which display the author’s opinion rather than

a question (Webber 1994); therefore, eliciting an answer is not the purpose for this type of

questions. The example offered in Chen’s study is …neng-bu-neng po yi liang ge anai ah, rang rang，zhe ge zonghuofan nenggou shoudao zhe ge hezhi zheyang 能不能破一兩個案

子啊，讓讓這個縱火犯能夠受到這個嚇止這樣。‘Can you solve a couple of cases to deter

the arsonists?’ (Chen 2008: 97-98). Instead of making a direct demand, the speaker employs a

rhetorical question to soften the force of his utterance, which subtly hides the speaker’s

possible imposition on the addressee. Tag questions observed in Chen’s data also function as

a hedging device which enables the speaker to save both his and the addressee’s faces. The

example is extracted from a radio talk, in which the host invites the guest to discuss the

movie ‘Waking Ned Devine’ by asking women xian lai tantan letou..letou wang hao-gu-hou?

我們先來談談樂透..樂透王好不好? ‘Let’s first talk about the movie, Waking Ned Devine, shall we?’ (Chen 2008: 99). To avoid a possible objection from the guest, the host tactfully adds a tag question, hao-bu-hao 好不好, at the end of the imperative sentence to mitigate the illocutionary force of the request. On the one hand, the tag question displays the speaker’s uncertainty so as to lower his commitment to the proposition, and on the other hand, the tag question weakens the speaker’s possible FTA on the addressee. In Lo’s (2010: 165) academic corpus, questions are utilized by writers “to strengthen the uncertainty of the authors’ epistemic reasoning or to reduce the strength of criticism in the discussion of the observed situations.” Hedging questions are classified into neutral questions and rhetorical questions.

Neutral questions are questions that express authors’ uncertainty and “leave the answer unresolved or indefinite” (p. 148), and this type of questions makes up the majority of hedging questions in academic written texts. Rhetorical questions are applied when authors

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try to make claims or when they criticize or challenge others’ viewpoints. Example (59) and

(60) demonstrate these two types of questions respectively:

(59) 那麼，原因是否即為胡漢集團衝突呢?似乎也未必盡然，… Then, does the interference result from the conflict between Hu and Han people? It seems to be not necessary so,…

(60) 然而，批判者卻不重視現代化史學敘述本身的歷史；那麼，批判者與被批 判者之間的認識論差異，又在哪裡呢? However, critics do not value the substance of “modernized” historical narratives: then what is the difference in the epistemology between the critics and those being criticized?” (Lo 2010: 149)

In (59), the question is used to express the author’s uncertainty about the truth of the

statement and leaves room for negation. In (60), the author’s attitude toward the statements is

firm and certain; however the rhetorical question enables the author to tone down his

criticism and minimize the FTA.

2.6.3.3 Reference to limitations of the current study

In addition to lexical hedges, Hyland (1998) induces three clausal hedging strategies

from his RA corpus, which make up 15% of all hedges. These strategies are employed to

refer to particular parts of scientific procedures or reporting: reference to limited knowledge

as (61), reference to limitations of model theory or method as (62), and reference to

experimental limitations as (63):

(61) Nothing is known about the chemical constitution of the fluorescent material. This could be due to protein-metal complexes such as … (Hyland 1998: 142) (62) Based on and consistent with the model proposed above I suggest the flowing mechanism for photoinhibition … (Hyland 1998: 144) (63) We have not been able to determine precisely whether GTS expression and Lotus leghemoglobin synthesis are initiated simultaneously, but … (Hyland 1998: 147)

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The remark on the state of existing knowledge helps writers to distinguish “between conditionally true statements and speculative possibilities” and “‘frame’ the related claim in an appropriate environment of doubt and probabilities” (p. 142); By referring to deficiencies in the search model, theory, or method, writhers can hedge their full commitment and avoid the possible criticism on the accuracy of their results; The comment on the uncertainties of experimental conditions is the most common strategy to reduce the writer’s conviction.

However, this strategy implies a certain level of confidence since “questioning the effectiveness of an experiment can also indicate the conditions under which results might be valid” (p. 147). This strategy typically involves negative determiners and lexeme with negative connotations, as shown in (63). Hyland points out that these three types of non- lexical hedges are recognized by means of its content rather than its form. So far, it is not possible to have a consent characterization for these means since there is no widely accepted realization in the literature. “Nevertheless, they are important means of expressing caution in

RAs and should be considered among the hedging devices available to scientific writers”

(Hyland 1998: 148).

Five types of limitations of the current study is found in Lo’s (2010) Chinese academic texts, which are reference to limitations of method, reference to limitations of scope, reference to limitations of testability, reference to authors’ limited knowledge, and reference to limited resource. These various types of references serve as hedging devices which enable writers to show the acknowledgment of the weakness of their studies. By addressing weaknesses of the study, authors can “avoid being criticized as lack of complete consideration of their research scope or methods, or lack of conclusive discussion of the research findings” (Lo 2010: 166). The type and frequency of the limitations vary in accordance with disciplines. ‘Reference to limitation of testability’ occurs the most frequently in biology since authors of this discipline make a lot of speculations, and they tend to avoid

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making plausible explanations without experimental evidence. Both ‘reference to limitation

of method’ and ‘reference to limitations of testability’ are used frequently in business since

these two types of limitations are interrelated in this discipline. In business, the limitations of

testability are normally resulting from insufficient variables included. Writers of history &

literature employ the most ‘reference to limited resource’ and then ‘reference to limited

knowledge’ because claims in this discipline are mainly based on relevant literature. Authors

tend to hedge their statements if they cannot have enough supporting resource, and

meanwhile authors try to avoid taking responsibility for their claims because the arguments are greatly depending on authors’ interpretation of the available literature.

2.7 Summary of Chapter Two

As reviewed in the last few sections, attention given to hedges has been shifted from pure semantic accounts to explorations in their pragmatic meanings and their significance in applied linguistics. Although for decades precision was treated as a major principle on the world of academia, a great deal of studies argues that sometimes vague language is preferred, and it works more effectively in academic communication (Prince et al. 1982, Holmes 1984,

1998, Myers 1989, Channell 1994, Hyland 1994, 1996a, 1996b, 1996c, 1998, 2000, Salager-

Meyer 1994, Markkanen and Schröder 1997, Zhang 1998, Varttala 1999, 2001, Ruzaite 2004,

Lo 2010).

The utilization of hedges is realized as a common phenomenon in our daily life. Jucker

et al. (2003) note that when we speak or write, we are rarely very clear or precise about what

we mean but rather vague and indirect about what we are committed to. People usually comprehend hedging language without effort, and vagueness is tolerated in everyday

communication because inappropriate use of precision might cause negative effects (Tannen

1989), as they can be boring, insulting, or spoil the basis of humor. The use of hedges for

academic writing varies from discipline to discipline and from language to language;

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however, the exploration of hedging phenomenon is especially thriving in English. There are

relatively limited studies focusing on investigation of hedges in Chinese. Both Biq’s(1990)

and Chen’s (2008) studies explore hedges in conversational Chinese while Lo’s(2010) and

Chang et al.’s (2012) studies examine hedges in terms of written academic Chinese.

It was not until the last few decades that researchers started to touch on the hedging phenomenon in the field of medicine (Prince et al. 1982, Adam Smith 1984, Bonanno 1994,

Salager-Meyer 1994, Skelton 1997, Caffi 1999, 2007, Varttala 1999, 2001). The traditional

belief that doctors were supposed to know everything regarding the patient’s discomfort and

disease has been shaken as people have gradually realized that there will always be some

uncertainty in medical setting. Uncertainty, an inherent feature in the medical profession, has

been exhibited in medical discourse via the linguistic expressions of hedges. While different types of hedging devices have been examined in medical writing (e.g. clinical case notes,

research articles, editorials) and doctor-patient interaction, Prince et al.’s (1982) study is the

only research which aims at exploring the hedging phenomenon in physician-to-physician

spontaneous discourse.

As advocated by Hyland (1998) and Varttala (2001), hedges are normally realized as

multifunctional. One hedging device may serve more than one function, while a certain

communicative purpose may be fulfilled by distinct hedging strategies. Hedges are most

frequently associated with politeness theory. Myers (1989) argues that the maintenance of

face is crucial in scientific discourse. Since FTAs (Brown and Levinson 1987) are

unavoidable in either scientific or academic discourse, the application of politeness strategies

allows speakers/writers to show modesty and redress potential FTAs. Hedges can be used to

convey speakers’/writers’ uncertainty towards events. When a speaker/writer does not want to

commit him/herself to the information given, hedging devices are then employed to avoid taking full responsibility for the proposition being stated. Hedges can be utilized to present

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speakers’/writers’ tentativeness and cautiousness as there might always be alternative

explanation for an argument or claim. Absolute claims or categorical statements leave no

room for negotiation, which should be avoided in academic or scientific community. Hedges

can be employed by speakers/writers to show solidarity with the community and assert in-

group membership. Hedges function as markers of intimacy. Being familiar with the

particular consensus of their disciplines, speakers/writers are able to employ appropriate

hedging devices to avoid direct criticisms, to show solidarity with the readers, and to show

deference to their community.

In the present study, categorization of hedges is reviewed in line with three categories,

namely modal auxiliaries, lexical hedges, and non-lexical hedges. Modal auxiliaries are

essentially correlated with the speaker’s/writer’s attitude towards the truthfulness of a

proposition. It is proposed that modality and proposition are two distinct constituents of

sentences (Palmer 1987, 1990, Crystal 1997, Li 2004). Therefore, the modals are

individualized from lexical category. Lexical hedges are classified in terms of grammatical categories, which include verbs, adverbs, adjectives, and nouns. The classification of those lexical expressions are mostly equivalent with those in English literature; however, the

subcategory containing Chinese question words is seen as linguistic-specific. In Chinese, question words (e.g. sheme 什麼 ‘what’, ji 幾 ‘how many’) are frequently utilized as

hedges, either in speaking or writing, to indicate the speaker’s/writer’s uncertainty towards

indefinite entities, events, or people. Based on their syntactic features, those question words

are attributed to the category of nouns. Non-lexical hedges refer to linguistic expressions

extending beyond words or phrases. Although most studies in the literature limit their focus

on lexical hedges, non-lexical hedges are by no means uncommon. Three categories of non-

lexical hedges are reviewed in this chapter, including conditionals, questions, and expressions

addressing limitations in various aspects of methodology.

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CHAPTER THREE METHODOLOGY

In this chapter, I recount in detail the medical database used in this study, which is

composed of both spoken and written discourses. Section 3.1 is the description of both spoken and written data and the introduction of data collection procedure. The adopted approaches for data analysis are discussed in 3.2. Section 3.3 describes the working definition of hedges for the present study. Data analysis which includes statistical methods, data transcription, word segmentation, and data categorization are then presented in section 3.4.

Section 3.5 is a summary of this chapter.

3.1 The database

The data consists of both spoken and written genres: ten lectures obtained from a teaching hospital located in central Taiwan (HOS hereafter) and forty research articles selected from two leading medical journals in Taiwan.

The spoken database

The hospital employs over 3,800 people and receives approximately 5,000 patient- visits daily. To best serve emergency patients, outpatients, and inpatients, the hospital offers

the most advanced laboratory, examination facilities, invasive procedures and operation

theaters. HOS provides “patients-centered” services as its top guiding principle, and bring

“Respecting patients’ rights and dignity” into each service ideology and program.

Besides providing a range of excellent healthcare services, education and research is

one of the four missions of HOS. They believe the improvement and development of medical

quality, service, and research are achieved through the backing of education; therefore, there

are regular seminars and conferences held in the hospital. They invite medical specialists,

either from their own hospital, other local hospitals, out-of-town institutions, or even

overseas, to share advanced knowledge and up-to-date medical technologies. Among those

various educational activities, there is one conference called “intra-hospital conference”

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which is held every Friday morning before the outpatient service. It starts from 7:15 in the

morning and lasts for around one hour. Since the conference is held early in the morning and

is defined as an intra-hospital conference, almost all the audiences are employees working for

HOS, including physicians, residents, interns, nurses, and others from various departments.

The conference is a specialist-to-specialist discourse since the participants are composed of

medical specialists, and the invited speakers are experts of different medical departments,

either from HOS itself, other medical institutions of Taiwan, or foreign countries. Each

speech is videotaped and uploaded to a unit named “EAR online meeting” of HOS website.

“EAR online meeting” is part of educational training for staff of HOS. All the employees of

HOS have the access to the webpage to obtain new medical knowledge. It is convenient for the employees who cannot make it to participate in the conference or for the specialists who did attend the conference but need to review the contents of the speech.

Ten speeches, which amount to 12 hours and 13 minutes, from the “intra-hospital conference” were chosen as the spoken corpus for the present study. The information of each speech is provided in Table 1 below, including lecturers, topics of the lectures, department where each lecturer serves, and the length of the speech. S1 to S10 represents the ten physicians who gave the lectures.

Table 1. Information of the ten speeches

Lecturers Topics of the lectures Departments Length S 1 新制 ICF 身心障礙鑑定 The New ICF Physical Medicine 01:00:32 & Rehabilitation S 2 欺矇與告知 Concealing and Informing Psychiatry 01:19:52 S 3 提升氣管內管插管品質與病人生命安全 Improve the Chest Medicine 01:08:10 Quality of Endotracheal Intubation and the Patient’s Life S 4 抗生素使用的劑量問題 Antibiotic dosing-the Infection Disease 01:20:19 implementation PK and PD concept in clinical practice S 5 問題傷口照顧現狀與展望 Current Situation and Prospects Orthopedics 01:15:16 of Wound Care Issues S 6 最新雙射原雙能階電腦斷層之臨床運用簡介 The Radiation 01:05:43 Introduction of clinical application in the use of the latest Dual Source Dual Energy CT Scanner Oncology S 7 百日咳的今與昔 Bordetella pertussis infection and Pediatric Infection 01:17:01 98

vaccination Medicine S 8 傾聽不孕症病人之心聲 Listen to infertility patients’ voice Reproductive 01:10:50 Medicine Center S 9 針扎防治 Prevention of needlestick injury Infection Disease 01:17:17 S 10 糖尿病照護繼續教育訓練:糖尿病照護指標及藥物治療簡 Endocrinology & 01:18:42 介 Diabetes Care Continuing Education Training: diabetes Metabolism care indicators and medication profile

All the chosen speakers are Taiwanese physicians who work in HOS. ‘Peer lecture’ is termed specially for my spoken data because those physician-to-physician speeches seem to embrace a hybrid characteristic which mixes features from lecture and seminar. Normally the lecture is regarded as a formal interaction which involves information and knowledge transmission in a hierarchical relationship between participants, and the information transference is mainly made through monologue rather than dialogue. The seminar in academic research is generally understood as the graduate or student-mentor seminars in the Anglo-Saxon academic culture

(Shalom 1993, Weissberg 1993, Thompson 1994, Webber 2005, Hyland 2009), and it is essentially seen as “relatively informal, small group, tutor-led events at which everyone present is asked to participate” (Hyland 2009: 105). As aforementioned, the spoken corpus consists of regular inter-hospital specialist-to-specialist discourse, and normally a great deal of participants are expected. Therefore, it is different from a typical seminar which involves only a small group of people. In addition, in the peer lecture, the audience only participates in the Q and A part after the speaker finishes his talk. Furthermore, the participants are medical specialists rather than a hierarchy between the professional and lay people. Therefore, I term the interaction among those medical professionals as ‘peer lectures.’

In the spoken data, each speech is composed of three parts, the introduction, the main content, and the Q and A. Each speech is initiated by a host who is a physician in a superior position of HOS, and the host introduces the speaker’s background, medical specialty, and the topic; The speech constitutes the second part. After the talk, the host will ask the audience if they have questions about the speech content, which is the Q and A part. The first two parts of

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the speech are each demonstrated by one physician respectively, while the Q and A part is

contributed by several medical specialists. The length of each lecture lasts for around an hour,

and the time varies from one hour to one hour and 20 minutes. The respective total length for

the three components in the spoken database is: 31 minutes for the introduction; 8 hours and

37 minutes for the main lecture; 3 hours and 5 minutes for the Q and A. The hosts and

speakers are all male physicians, and there is only one female physician who asked a question

in the Q and A. Most of the speakers use Mandarin and Taiwanese fluently. Code-switching is

then expected to occur in the speeches. On the “EAR online meeting” of the HOS website,

they provide a list of those uploaded speeches, specifying the dates, titles of the speeches, and

names of the speakers. 10 speeches given during year 2011 and 2012 were selected as my

spoken corpus. The acquisition of the speeches is based on three elements instead of random

choice: the speeches should be related to clinical practice and medical technology; the speakers should be physicians employed in HOS; the speakers would be willing to participate in my research. The reasons for the data selection will be explained as follows. As being the intra-hospital conference, there surely are certain medical-unrelated or less medical-related topics needed to be introduced or announced to the employees, such as how to improve writing on case reports, let Jesus become the doctor of one’s soul, and ways to maintain the completion of medical ethics. Those less or nonmedical-related topics are then left out. As mentioned earlier, the invited speakers are not only physicians from HOS but also specialists from medical institutions in other cities of Taiwan or even from foreign countries. I chose only speakers who work in HOS because I might have more chances to reach them and ask for their permission to use their speeches as my research data. After selecting 18 befitting speeches, I tried to contact those speakers by phone. Since all the speakers are busy physicians, few of them could not be reached, and a few of them, for some reasons, were not comfortable to let strangers examine their speeches. Eventually I had 10 physicians who were

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willing to participate in my research. I met with those physicians in person and obtained their

signatures on the consent form. They all understand that all contents of their speeches are used for my research only and the results are confidential, not for public. Besides, the participants have the right to know every step and the results of my research. These 10

speeches amount to a total of 12 hours and 13 minutes of transcribed data. As to the written

data, both Journal of Internal Medicine of Taiwan and Taiwan Medical Journal have electronic versions, so I selected 40 recent articles published in 2012 and 2013, with 20

articles from each journal.

The written database

The written database is composed of 40 Chinese medical research articles from two

leading medical journals in Taiwan, namely Journal of Internal Medicine of Taiwan (內科學

誌) and Taiwan Medical Journal (台灣醫界). Journal of Internal Medicine of Taiwan is issued by Taiwan Society of Internal Medicine and Taiwan Medical Journal is issued by

Taiwan Medical Association. As the spoken data cover not only Internal Medicine (e.g.

Infection Disease, Chest Medicine, Endocrinology & Metabolism) but also other medical specialties (Orthopedics, Radiation Oncology, Physical Medicine & Rehabilitation), these

two journals are recommended by several speakers as the written counterpart on a par with

the academic spoken corpus, given that both journals own accredited reputation and are well-

acknowledged in Taiwan medical field. Journal of Internal Medicine of Taiwan is a bimonthly

publication initiated in 1990 whereas Taiwan Medical Journal began the publication in 1958

on a monthly basis. For both journals, the research articles were written by medical

professionals from various disciplines, and the contents include clinical studies, medical

opinions, insights gained from medical experience, medical administration and professional

affairs. All articles are subject to review by the peers, as well as by the editorial board. Once a

paper is accepted for publication, it then appears in the journals. Electronic versions of these

101 two journals are available on the websites of their medical associations. 20 articles with average text length are selected from each journal, 7-11 pages in Journal of Internal Medicine of Taiwan and 4-7 pages in Taiwan Medical Journal.

The information of the RAs selected from Journal of Internal Medicine of Taiwan is provided in Table 2, while the information of RAs from Taiwan Medical Journal is shown in

Table 3 below. The information includes authors, titles of the RA, departments where authors serve, and length of the articles.

Table 2. Information of RAs from Journal of Internal Medicine of Taiwan

Authors Titles of the articles Departments Page length 最新常見成人原發性腎病症候群致病機轉及治療 Update on 1. Dr. Kuo & Dr. Nephrology 11 Chen Mechanisms and Management of Common Idiopathic Nephrotic Syndrome in Adults 2. Dr. Young & Dr. 多重抗藥性結核病之現況 Multi-Drug Resistant Tuberculosis: the Internal Medicine 9 Huang Current View 鼻-腸管置放方法的歷史演變及最新趨勢 Historic Progress and New Gastroenterology, 3. Dr. Lin et al. 8 Trend of Nasoenteric Tube Placement Internal medicine Internal Medicine, 經皮氣管切開術在加護病房重症患者的運用 Percutaneous ICU, Pulmonary & 4. Dr. Chang et al. 9 Dilatational Tracheostomy in Critically III Patients in Intensive Care Critical Care Units Medicine 慢性腎臟病貧血的治療新進展 New Treatment of Anemia in Chronic 5. Dr. Zheng et al. Internal Medicine 7 Kidney Disease 二甲雙胍類降血糖藥物「Metformin」：過去、現在與未來 6. Dr. Lin et al. Internal Medicine 10 Metformin: the Past, Present, and Future 7. Dr. Lai et al. 氣候變遷與人類健康 Climate Change and Human Health Family Medicine 8 心肌梗塞之重新定義與臨床分類 Redefinition and Classification of 8. Dr. Lin et al. Internal Medicine 11 Myocardial Infarction 9. Dr. Lai & Dr. Internal Medicine, 維生素 D 的最新進展 Recent Advances in Vitamin D 8 Fang Medicine Endocrinology & 糖尿病足感染的最新診斷與治療建議 Diagnosis and Treatment of 10. Dr. Liu et al. Metabolism, 11 Diabetic Foot Infections Internal Medicine 上消化道內視鏡恐懼症的救星：經鼻內視鏡 Transnasal Endoscopy: Internal Medicine, 11. Dr. Luo et al. 7 Savior for Patients with Endoscopy Phobia Medicine 糖尿病緩解之定義與新進展 Definition and Recent Advances in Endocrinology & 12. Dr. Kuo et al. 11 Achieving Remission of Diabetes Metabolism 慢性 B 型肝炎治療的現況 Current Treatment of Chronic HBV 13. Dr. Jian Medicine 8 Infection 葛瑞夫茲氏眼病變–從致病機轉到處理 Graves' Ophthalmopathy: 14. Dr. Chang Internal Medicine 7 from Pathogenesis to Management 原發性腎上腺機能不全-案例報告及台灣本土文獻之回顧 Primary Internal Medicine, 15. Dr. Xu et al. Adrenal Insufficiency - A Case Report and Review of Literature in Dermatology, 9 Taiwan Surgery Fidaxomicin：擺脫困難梭狀芽孢桿菌感染復發的新武器 16. Dr. Hsieh & Dr. Internal Medicine, Fidaxomicin: A new Drug that Can Decrease Recurrence of 7 Chen Medicine Clostridium difficile Infection 以心臟科醫師的角度來看糖尿病藥物的使用 Anti-diabetic Drugs 17. Dr. Zhu et al. Internal Medicine 7 from A Cardiologist's Point of View 102

抗血小板藥物的使用對消化道內視鏡相關治療影響之探討 The Internal Medicine, 18. Dr. Wu et al. Influence of Antiplatelet medication in Patients Receiving 9 Pharmacy, Medicine Gastrointestinal Endoscopic Procedure 嚴重之粟粒狀肺結核合併巨細胞病毒感染：一病例報告 Severe 19. Dr. Su & Dr. Yu Miliary Tuberculosis Co-infected with Cytomegalovirus Infection: A Nursing, Medicine 7 Case Report Clinical medicine, 慢性 C 型肝炎治療的新進展：從干擾素到直接抗病毒藥物 Internal Medicine & 20. Dr. Liu et al. Advances in the Treatment of Chronic Hepatitis C: From Interferon to Hepatitis Research 9 Direct Acting Anti-virals Center, Internal medicine

Table 3. Information of RAs from Taiwan Medical Journal

Authors Titles of the articles Departments Page length 冠狀動脈心臟病治療新進展 New Progress in the Treatment of 1. Dr. Ying Cardiology 4 Coronary Artery Diseases. 偏頭痛的急性及預防性治療準則比較 Comparison of Acute and 2. Dr. Lin et al. Neurology 7 Preventive Migraine Treatment Guidelines Neurology 停經期荷爾蒙療法簡介 2012 年趨勢 Trends of Menopausal Hormone Obstetrics & 3. Dr. Tsai 4 Therapies in 2012 Gynecology 簡介免疫系統對抗惡性腫瘤之機轉 Introduction of New 4. Dr. Li et al. Dermatology 4 Developments of Immune Systems in Fighting Cancers 癌症的免疫細胞療法新進展 Progress of Immune Cell Therapies for 5. Dr. Zhao Internal Medicine 5 Cancers 糖尿病清晨空腹高血糖的認知及其處置－兼論黎明現象及 Somogyi Family Medicine, 6. Dr. Tan & Dr. Endocrinology & 5 Hong effect The Awareness and Treatments of Fasting Hyperglycemia in Diabetes – Also on Dawn Phenomenon and Somogyi Effect Metabolism 大腸直腸癌的篩檢與監測及台灣施行現況 The Screening and 7. Dr. Ou et al. Monitoring of Colorectal Cancer and the Current Medical Gastroenterology 4 Implementations in Taiwan 8. Dr. Chen & Dr. 撤除心肺復甦術與病人生命權保障之爭議 The Controversy in the Chest Medicine 7 Lu Timing of CPR Removal and Patients’ Right to Life 早期乳癌乳房保留手術治療之新利器－部份乳房近接放射治療 A 9. Dr. Wang & Dr. Radiation Oncology 5 Kao New Breast Conserving Treatment for Early Breast Cancer - Breast Brachytherapy 男性勃起障礙為後續心臟血管疾病和腦中風的預測指標 Male 10. Dr. Zheng & Urology 4 Dr. Hong Erectile Dysfunction Is an Indicator for Subsequent Cardiovascular Disease and Stroke 11. Dr. Lin & Dr. 老年人癌症病人的治療現狀與展望 Treatment and Prospects of Geriatric Medicine 5 Chang Elderly Cancer Patients 12. Dr. Wang & 狂犬病 Rabies Surgery 4 Dr. Chang 13. Dr. Zheng & 環境熱急症 Environmental Heat Emergency ICU, Surgery 6 Dr. Chang 14. Dr. Hsieh & 末期腎臟病病人的手術前及手術後照顧 The Pre-op and Post-op Care Orthopedic Surgery, 7 Dr. Changh of Late-Stage Renal Patients Nephrology 15. Dr. Chen & 肢體缺血的治療策略 The Treatment Strategies of Limb Ischemia Traumatology 5 Dr. Lin 醫藥新知：Tolvaptan 在抗利尿激素不適當分泌症候群的使用－病例 報告及使用建議 New Discovery in Medicine: The Use of Tolvaptan 16. Dr. Lin et al. Cardiology 4 on the Syndrome of Inappropriate Antidiuretic Hormone Secretion - Case Report and Recommendations 17. Dr. Pan 淺談兒童泌尿道感染 Topics on the Children's Urinary Tract Infections Pediatrics 4 令病人、醫師困擾的纖維肌痛症候群 The Fibromyalgia Syndrome 18. Dr. Kao Neurosurgery 5 that Troubles Patients and Physicians. 女性癌病人最常見的身心煎熬－疲憊、失眠與疼痛 The Most 19. Dr. Chang Common Physical and Mental Sufferings Seen in Female Cancer Patients Surgery 5 - Fatigue, Insomnia and Pain

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尿蛋白與尿液蛋白質體：簡介一種去除高豐度蛋白的新方法 Urine 20. Dr. Lu & Dr. Urology, Aesthetic Protein and Urine Protein Body: A High-Abundance Protein Removal 5 Wu Medicine Method

The research articles in these two Chinese medical journals do not follow a standardized

IMRD format as applied in English RAs, and upon my observation, there seems not a strict

format to regulate the writing structure. As expounded in the last chapter, hedges are context- dependent; therefore, the written data analyzed includes only the main body of RAs. The research titles, authors’ names and affiliation, abstracts, keywords, endnotes, pictures, figures, charts, tables, and references are excluded.

3.2 Discourse analysis and corpus-based approach

In this study, discourse analysis and a corpus-based approach are adopted to analyze the data. Discourse analysis is used to examine how humans use language to communicate and “in particular, how addressers construct linguistic messages for addressees and how addressees work on linguistic messages in order to interpret them” (Brown & Yule 1983: ix).

Since discourse analysis is essentially the analysis of language in use, it cannot be restricted to the description of linguistic forms. Linguistic forms are considered to be inseparable from the functions or purposes which those forms are designed to serve. In appealing to the pragmatic approach, Brown & Yule (1983) suggest that:

Discourse analysis on the one hand includes the study of linguistic forms and the regularities of their distribution and, on the other hand, involves a consideration of the general principles of interpretation by which people normally make sense of what they hear and read (p. x).

For exploring the relationship between theoretical concepts and actual language use, an

empirical study is indispensable. Corpus data is a useful and significant means for the

empirical analysis, which not only provides a basis for establishing categories, but also helps

assessing existing classification systems. Kaltenböck et al. (2010) point out that with the

widening of the concept of hedging from semantics to pragmatics, corpus-based approaches 104

have gained importance since genuinely attested language data are required rather than

invented sample sentences. One important advantage of corpus-based approaches Kaltenböck

et al. observe is:

Corpora give access to co(n)textual information of linguistic items, which provides an important basis for qualitative research. This is of particular value for the investigation of a pragmatic phenomenon such as hedging, whose precise function depends to a large extent on co(n)textual features, with different contexts giving rise to different implicatures (p. 2).

Although I have only a mini-corpus comprising spoken and written data, which

consists of 253,468 Chinese words (426,960 morphemes), it deals with a specialized field that

few people touch on. So far as I know, there is no corpus providing Chinese academic spoken

data, especially for the medical setting in the context of Taiwan. I claim that all my spoken

data is immediate spontaneous instantiation, and I believe that it is worth further

investigation.

3.3 Working definition of hedges

Since obtaining a unified definition of hedges is a difficult task, and as indicated in

Chapter Two, the hedging strategies vary in terms of contexts and disciplines, I adopt a multi-

functional concept of hedges in the present study. Furthermore, I focus on the attenuating

sense that hedges convey rather than the intensifying sense. Linguistic expressions

characterized as hedging devices for this study include those used by the speakers/writers to

(a) express tentativeness and possibility in the realization of actuality of a situation, as in

(64); (b) downgrade the commitment to the validity or force of propositions, as in (65); (c) express vagueness to the exact accuracy or quantity, as in (66).

(64) 一旦有懷疑糖尿病性酮酸中毒的可能性，就立刻抽血中的酮體(ketone)濃 度。 (W2) Yídàn yǒu huáiyí tangniàobìngxìng tóngsuān zhòngdú de kěnéngxìng, jiù lìkè chōu xiě zhōng de tóngtǐ (ketone) nóngdù

105

‘Once the possibility of Diabetic ketoacidosis is suspected, the blood ketone in the body concentration should be examined immediately’ (65) 而根據目前 ESGE 的建議是施行內視鏡乳頭切開術是不需要停用 aspirin， 但要停止使用 clopidogrel 和 prasugrel， (W1) Er gēnjù mùqián ESGE de jiànyì shì shīxíng nèishìjìng rǔtóu qiēkāishù shì bù xūyào tíngyòng aspirin, dàn yào tíngzhǐ shǐyòng colpidogrel hàn prasugrel ‘According to the current proposal of ESGE, it is unnecessary to disable aspirin while practicing implemented endoscopic sphincterotomy, but the uses of clopidogrel and prasugrel need to be suspended.’ (66) 對一個..ehn..infection..DM foot infection 的病人 hon,一般我們都..如果有吃到 bone 的話,一般都要住到四到六個禮拜 hon, (S5) duì yíge..ehn..infection..DM foot infection de bìngrén hon, yìbān wǒmen dōu.. rúguǒ yǒu chīdào bone dehuà, yìbān dōu yào zhùdào sì dào liùge lǐbà hon. ‘For a diabetic patient with DM foot infection, if the infection reaches to the bone, normally the patient should be hospitalized for four to six weeks.’

It is necessary to mention here about the parentheses and the number within them, which

locate after the end of each example. The number and the parentheses are used to signal the

source of the example. The S or W in the parentheses stands for the (S)poken or (W)ritten

data. The number put after S refers to the order of the lecture marked in Table 6. For example,

(S4) means the example is produced by the speaker in lecture 4. The umber goes along with

W indicates that the example is either from Journal of Internal Medicine of Taiwan (W1) or from Taiwan Medical Journal (W2).

3.4 Data analysis

The focus of the analysis is on the communicative purposes arising along with those various hedging strategies. The analysis is both qualitative and quantitative. I explicate the discourse of both medical genres through representative examples and theoretical supports.

The quantitative analysis, including statistic numbers, tables, and figures, is used to characterize distribution and frequency of various hedging devices utilized in both the spoken and written data, and for their further comparison. In the following, the statistical methods used to calculate the significance and relations among different categories of hedge will be 106

introduced in 3.4.1. Section 3.4.2 describes the data transcription and word segmentation. The

basis of data categorization will be discussed in 3.4.3.

3.4.1 Statistical methods

Microsoft Excel 2010 and SPSS 18 are two statistics software applied as statistical

methods in the present study. Different types of raw data regarding eight categories of hedges

are listed in Excel, including category types, subcategory type, subtypes of each categories, lexeme, and examples. With Excel, all the figures and tables are managed and formed based on the raw data. The Mann-Whitney U-test from SPSS is applied to demonstrate whether the usage of different categories of hedges shows statistical significance in terms of genres.

Mann-Whitney U-test is a nonparametric test which is basically used in order to overcome the underlying assumption of normality in parametric tests. This test does not assume that the difference between the samples is normally distributed, or that the variances of the two populations are equal (https://explorable.com/mann-whitney-u-test). Owing to the above features, Mann-Whitney U-test fits better for the present study.

3.4.2 Data transcription and word segmentation

The speeches are transcribed verbatim, with Mandarin data being transcribed in Pinyin

Romanization. The Taiwanese data are transcribed in The Taiwanese Romanization System, with angle brackets encircling each Taiwanese segment. The Taiwanese Romanization

System (台灣閩南語羅馬字拼音方案) is often referred to as Tâi-lô, which is a transcription system for Taiwanese Hokkien. It is derived from Pe̍ h-ōe-jī (白話字) and since 2006 has been officially promoted by Taiwan's Ministry of Education

(http://en.wikipedia.org/wiki/Taiwanese_Romanization_System).15 Given that hedges can be

expressed by different linguistic categories, we expect to find systematic patterns of register variation in both spoken and written data.

15 Pe̍ h-ōe-jī is abbreviated as POJ, literally vernacular writing, also known as Church Romanization 107

The Chinese Word Segmentation System is used to segment my data into words.

Unlike English, a Chinese word may contain more than one character, and each character

may stand alone as another Chinese word.16

My data consists of spoken and written discourses, and three languages are observed in

the medical communication. In the written data, Mandarin and English (indicated with

encircling brackets ) are the main codes, whereas in the spoken discourse, three

different codes are used, which are Mandarin, Taiwanese, and English. As mentioned in

section 3.1, most of the speakers are native speakers of Mandarin and Taiwanese, so they

code-switch unconsciously with both languages. In addition, as all the participants are

medical professionals, English medical jargons are employed frequently in the speeches. In

medical specialist-to-specialist communication, either in speaking or writing, medical jargons

are usually transmitted in their original forms. Since each of these three codes is used in a

considerable amount in the spoken discourse, they are all included in the counting. If we only

focus on Mandarin and exclude Taiwanese and English, the utterances would become

fragmented and the meanings would be incomplete, such as examples (67) and (68):

(67) 常用的麻醉藥物如以及由於具有腎毒 性，是不能使用的。(W2) chángyòngde mázuì yàowù rú methoxyflurane yǐjí enflurane yóuyú jùyǒu shèn dúxìng, shì bùnéng shǐyòng de ‘Commonly used drugs, such as methoxyflurane and enflurane, cannot be used due to the renal toxicity.’ (68) 啊 Dr. Monnier 在兩千零三年. (就跟咱們講了喔.) (這時候什麼的)貢獻度 (較大?)空腹血糖. (S10) a Dr. Monnier zài liǎngqiānlíngsān nián jiù gēn zánmen jiǎng le ō. jiǎng jiǎshè nǐ yíge tángniàobìng bìngrén, tā tánghuàxiěsèsù shì jiào gāode, zhè shíhòu shénme

16 The Chinese Word Segmentation System is a free program offered online by Academia Sinica of Taiwan, which can be accessed at http://ckipsvr.iis.sinica.edu.tw/. 108

de gòngxiàndù jiào dà? kōngfù xiětáng. ‘In 2003, Dr. Monnier said that if the glycated hemoglobin of a diabetic patient is higher, and then what has a larger contribution? Fasting glucose.’

In (68), the parentheses are the Mandarin translations of those Taiwanese words and phrases.

With the translations, the meanings of the utterances remind the same. Therefore, in this study all the three codes are included in the counting and gone through the Chinese Word

Segmentation System.

3.4.3 Data categorization

In order to make a thorough investigation on hedging phenomena observed among

Chinese medical professionals, we need both lexical and non-lexical hedging devices to be deliberately looked into. The hedging devices found in the corpus are classified into three types, modal auxiliaries, lexical hedges, and non-lexical hedges. Lexical hedges are classified into four categories by means of their grammatical categories, namely verbs, adverbs, adjectives, and nouns. Non-lexical hedges are categorized in terms of functions, which contain conditionality, rhetorical questions, and addressing limitations. The list of different hedging categories discussed in the present study is provided in Table 4:

Table 4. Categories and subcategories of hedges identified in the present study

A. Keneng 可能

B. Keyi 可以 1. Modal C. Hui 會 Auxiliaries D. Yinggai 應該

E. Nengou 能夠

Hedges i. Speculative verbs

a. Judgmental verbs ii. Assertive verbs

2. Lexical iii. Resembling verbs A. Verbs Hedges i. Quotative verbs b. Evidential verbs ii. Sensory verbs

c. Others

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a. Stance adverbs

b. Adverbs of indefinite degree B. Adverbs c. Adverbs of indefinite frequency

d. Adverbs of approximation

a. Stance adjectives

b. Adjective of indefinite degree C. Adjectives c. Adjective of indefinite frequency

d. Adjectives of approximation

a. Judgmental nouns

b. Evidential nouns

c. Nouns of indefinite degree

d. Nouns of definite and indefinite D Nouns frequency

e. Nouns of approximation

e. Question words

f. Others

A. Conditionality 3. Non-lexical B. Rhetorical questions Hedges C. Addressing limitations

As claimed by Hyland (1998) and Varttala (2001), hedges are realized as multifunctional. One single hedge may fulfill various pragmatic functions depending on different communicative circumstances, and my Chinese data manifest this phenomenon. The

Chinese reduplicated verb kankan 看看 ‘look’ and the adverb dagai 大概 ‘approximately’ can be taken as examples. These two lexical hedges not only perform different functions but also distinct meanings depending on contexts:

(69) 那他們..uh..在這一兩年的..他們的..診斷,他們是..先…用,診 斷..用 DMSA,看看..他有沒有,然後再..回過頭來,他們叫..叫..叫 做 的..啊.. (S6) Nà tāmen..Uh.. Zài zhè yī liǎng nián de.. Tāmen de.. Zhěnduàn, tāmen shì.. Xiān…yòng vena scan, zhěnduàn.. Yòng DMSA, kàn kàn.. Tā yǒu méiyǒu scaring, ránhòu zài.. Huí guòtóu lái, tāmen jiào.. Jiào.. Jiàozuò top down.. de.. a..Procedure

110

‘Then they ..uh .. in this .. two .. their diagnosis, they are .. first ... with vena scan, diagnose .. with DMSA, and inspect .. he has no scaring, then again .. back to, they call .. call .. called top down .. the .. ah ..procedure’ (70) 那我們看看 流程,事實上這個很重要 hon.你說這個 流 程,大家不要捨不得進入 hon. (S3) Nà wǒmen kàn kàn fail liúchéng, shìshí shàng zhège hěn zhòngyào hon. Nǐ shuō zhège fail liúchéng, dàjiā bùyào shěbudé jìnrù hon. ‘Let’s take a look at the process, in fact, this is very important and you say this fail process, we should not hesitate to enter.’ (71) 啊..再六個禮拜之後,傷口好像有點起..起色 hon,但是,那個露出 來,那個..肉沒辦法包起來,那我就建議他,把拿掉,他就不答應 hon,那我就跟他說,那你就考慮看看 (S5) A.. Zài liù gè lǐbài zhīhòu, shāngkǒu hǎoxiàng yǒudiǎn qǐ.. Qǐsè hon, dànshì, nàgè tendon.. Lùchū lái, nàgè.. Ròu méi bànfǎ bāo qǐlái, nà wǒ jiù jiànyì tā, bǎ tendon ná diào, tā jiù bù dāyìng hon, nà wǒ jiù gēn tā shuō, nà nǐ jiù kǎolǜ kàn kàn ‘ah .. six weeks later, the wound seemed like a little .. improving, however, that the tendon .. exposed, that .. no way to wrap the meat, then I would recommend him to remove the tendon, but he did not agree, then I told him, then you might want to think over it.’ (72) 那..不過他那個藥一天就是差不多三萬塊 hon,打一個療程下來大概是七百五 十萬.hon,那..我..我們沒有多少人有那個實力啦 (S4) Nà.. Bùguò tā nàgè yào yītiān jiùshì chàbùduō sān wàn kuài hon, dǎ yīgè liáochéng xiàlái dàgài shì qībǎi wǔshí wàn.Hon, nà.. Wǒ.. Wǒmen méiyǒu duōshǎo rén yǒu nàgè shílì la ‘but the drug one day .. it cost almost thirty thousand, the course cost approximately 7.5 million., That .. I .. we ..not many people can afford it.’ (73) 啊..既然那個很深的傷口會補起來,啊就可以癒合,ah..我就是這樣..像這樣的 傷口大概..以後要請你..照顧啦 hon,不過,我..我.我想了解一下,謝謝. (S5) A.. Jìrán nàgè hěn shēn de shāngkǒu huì bǔ qǐlái, a jiù kěyǐ yùhé,ah.. Wǒ jiùshì zhèyàng.. Xiàng zhèyàng de shāngkǒu dàgài.. Yǐhòu yàoqǐng nǐ.. Zhàogù la hon, bùguò, wǒ.. Wǒ. Wǒ xiǎng liǎo jiè yīxià, xièxiè. ‘ah .. Since the deep wound will fill up, you can heal ah, ah .. I was like this..the wound .. like this probably needs you..to take care of, but I .. I I would like to know, thank you.’

In Chinese, a morpheme can be repeated so that the original morpheme combining with its

111

duplication to form a new word, which is a morphological process called reduplication. The

new word is generally distinct from the original morpheme semantically and/or syntactically

(Li and Thompson 1997, Liu et al. 2011). The duplication is normally used to signal a small amount of time or frequency, but sometimes it can denote the implicature of attempt. The reduplicated form kankan 看看‘look’in example (69) acts as a judgmental verb, whereas it behaves as an evidential verb in (70). The meaning of kankan 看看 of (69) is equivalent to

‘inspect’, and it is used to perform an action, examining one function of the medicine DMSA

which serves to assess children’s kidneys scaring. In (70), kankan 看看 is utilized to direct

the audience to the slides, which is equal to ‘take a look’. Besides performing action as a

verb, kankan 看看 can also be classified as an adverb, as in example (71). In this example, the speaker suggests the patient to kaolü kankan 考慮看看 ‘think over a little’ his recommendtory treatment. The kankan 看看 here functions as an adverb to modify the verb kaolü 考慮 ‘think over’. Similar to kankan 看看 ‘look’, the semantics and pragmatic functions of dagai 大概 approximately’ in examples (72) and (73) are realized differently; with the meaning of ‘approximately’ in (72) to lower the speaker’s full commitment to the exact amount and with the meaning of ‘probably’ to convey the speaker’s prediction. Owing to lack of the exclusive one-to-one relationship, certain lexical hedges may be classified into

different grammatical categories in my analysis.

3.5 Summary of Chapter Three

In this chapter, I introduced the source of my database, the procedures of data

collection, the approaches adopted for my data analysis, and the working definition of hedges

for the present study. Furthermore, I explained the devices applied for my data analysis,

including the software used for Statistical calculations, transcription systems for both

Mandarin and Taiwanese data, and Word Segmentation System specifically for Chinese. In

the last section, I expounded how hedges observed in the corpus are categorized.

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The database comprises of both spoken and written discourses. Ten physician-to-

physician lectures make up the spoken discourse, which are selected from the regular intra-

hospital conference held every week in HOS, one of the premier academic medical centers in

central Taiwan. The speeches amounts to 12 hours and 13 minutes, and all the speakers are

male physicians who speak both Mandarin and Taiwanese fluently. The written corpus

consists of forty RAs selected from two comparable leading medical journals of Taiwan. The

structure of the RAs does not follow a standardized IMRD format, and only the main body is

used for analysis. The titles, authors’ names and affiliation, abstracts, keywords, figures,

tables, and references are precluded. Microsoft Excel 2010 is used to record all the raw data

and make figures and tables according to the raw data. The Mann-Whitney U-test in SPSS 18

is applied to do statistic calculations on each category of both genres. As code-switching

between Mandarin and Taiwanese is commonly observed in the spoken discourse, different

transcription systems are necessarily to be applied. Pinyin Romanization is used to transcribe

Mandarin data, while The Taiwanese Romanization System is used for Taiwanese. Besides

these two codes, English medical jargons are also used often by both speakers and writers.

For keeping the propositions complete and comprehensible, all the three codes are included in the word counting. In order to make a thorough investigation on hedging devices employed by medical professionals, both lexical and non-lexical hedges are necessary to be deliberately examined. The hedging devices identified in the corpus are classified into modal auxiliaries, lexical hedges, and non-lexical hedges. The results of hedging phenomena found in both medical genres will be further discussed in detail in Chapter Four.

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CHAPTER FOUR RESULTS AND DISCUSSION

In this chapter, I successively discuss my research questions and provide evidence found in my data. The five research questions which guide my study are repeated here again for the readers’ reference: 1. What linguistic devices are used as hedges in the spoken and written Chinese discourse in the medical profession? What are their frequencies and distributions? 2. What communicative purposes do the hedging devices serve in the spoken and written medical discourse? 3. What are the differences among the hedges used in the two genres? 4. Are there any differences between the Chinese spoken medical discourse and the daily conversation? If yes, what are they? 5. Are there any difference between the Chinese written medical discourse and other written disciplines? If yes, what are they? Section 4.1 presents the overall distribution of hedges with figures and statistical results. In Section 4.2, I examine the use of modal auxiliaries in both genres. Lexical hedges which are classified into verbs, adverbs, adjectives, and nouns will be discussed in Section 4.3 where examples from both spoken and written discourses will be illustrated for detailed explanation and comparison. Non-lexical hedges, including conditionality, rhetorical questions, and addressing limitations, will be discussed in section 4.4.

4.1. Overall distribution of hedges

Modal expressions convey a wide range of meanings and they “do not relate to particular meanings in a convenient one-to-one relationship” (Holmes 1988: 21). In this study, the linguistic devices used to express epistemic modality include modal auxiliaries, verbs, adjectives, adverbs, nouns, and some longer and more complex syntactic structures, such as if-conditionals, questions, and addressing limitations. All the above hedging devices are observed in my Chinese corpus, and are classified into modal auxiliaries, lexical hedges, and non-lexical hedges. After word segmentation, the raw data yields 133,889 words in the spoken corpus and 119,579 words in the written corpus, and as expounded in Section 3.5.2,

114 the raw data comprises Mandarin, Taiwanese, and English. I code all the hedging devices depending on the context. The total numbers of hedges used by the speakers are 8,049, whereas 6,242 hedges are employed by the writers. Table 5 below illustrates the frequency of total amount of words and hedges found in the spoken and the written genres respectively:

Table 5. Frequency of hedges in the spoken vs. written genres

Spoken Written Number of Hedges 8049 6242 Total of words 133889 119579

From Table 5, we may see that the application of hedges between the spoken and written corpora seems not to differentiate much; however, there is not a statistical data to verify the seemingly observation. The statistical result is unobtainable due to the incidences of non- lexical hedges. Since the structure of non-lexical hedges typically extends across several words, the statistical result would not be reprehensive and convincing if we simply divide numbers of hedges by total of words. However, the utilization of different categories of hedges in both spoken and written genres can be compared by Mann-Whitney U test. The results are shown in Table 6 below.

Table 6. Results of Mann-Whitney U test on the relation of hedging devices used in the spoken and written discourses

Spoken Written Mann-Whitney U test Z statistics P 1. Auxiliaries 1599 1118 2.463E7 -2.954 .003 2. Verbs 939 786 2.489E7 -1.685 .092 3. Adverbs 2885 2311 2.482E7 -1.455 .146 4. Adjectives 484 618 2.414E7 -8.640 .000 5. Nouns 719 924 2.427E7 -5.989 .000 6. Conditionality 486 313 2.486E7 -2.642 .008 7. Rhetorical questions 877 50 2.242E7 -26.381 .000 8. Addressing 2.482E7 -6.326 .000 60 121 Limitations 115

Total of hedges 8049 6242 * p < .05 ** p < .01 ***p < .001

Table 6 shows numbers of hedges used in each hedging category and the statistical results of

Mann-Whitney U test. These U-test p-values reflect the significant statistical differences in the occurrences of hedges calculated in terms of categories and genres. The increasing p-

value indicates decreasing difference of the two distributions, and p-value of 1 indicates that

the two distributions are statistically indistinguishable. In other words, the lower the p-value,

the greater the significance of the results. The value 0.05 is the significant level for the

observed results. In Table 6, besides the categories of verbs and adverbs, the statistical results

of the other six categories display significant correlation between genres. That is, the speakers

and the writers tend to use relatively similar amounts of hedges in the categories of verbs and

adverbs. However, there exist significant discrepancies concerning the employment of hedges

in the categories of auxiliaries, adjectives, nouns, conditionality, rhetorical questions, and

addressing limitations while comparing the respective frequency between the spoken data and

the written data. Take auxiliaries as the example, the statistics indicates that in medical

communication auxiliaries are used more in the spoken than written discourse, and the result

is statistically significant (p < 0.01).

In Table 6, we only see numbers of hedges in each category of both genres. The

histogram in Figure 1 below clearly shows the overall distribution, including occurrences and

percentages, of hedges found in my corpus:

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40.00% 35.00% 30.00% S W 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% 1. Auxiliaries 2. Verbs 3. Adverbs 4. Adjectives 5. Nouns 6. Conditionality 7.Rhetorical 8. Addressing questions limitations

7. Rhetorical 8. Addressing Auxiliaries Verbs Adverbs 4. Adjectives 5. Nouns 6.Conditionality Hedges questioning limitation S 19.87%(1599) 11.67%(939) 35.84%(2885) 6.01%(484) 8.93%(719) 6.04%(486) 10.90%(877) 0.75%(60)

W 17.91%(1118) 12.59%(786) 37.02%(2311) 9.90%(618) 14.80%(924) 5.01%(313) 0.80%(50) 1.95%(122)

Figure 1. Overall distribution of hedges found in the spoken vs. written genres

Figure 1 shows that adverbs are used the most frequently, which occupy 35.84% in speaking

and 37.02% in writing, and modal auxiliaries rank the second, with 19.87% in speaking and

17.91% in writing. The ranking of adverbs the first and auxiliaries the second holds true for both genres. In the following sections, the three main hedging strategies, namely modal auxiliaries, lexical hedges, and non-lexical hedges, will be explicated in line with context. For comparison purpose, the forms, communicative purposes, and examples of hedging devices will be juxtaposed and explained in detail.

4.2 Auxiliaries

As reviewed in Chapter Two, the notion of modality is associated with the nature of the possible world to which the validity of an utterance is based on (Lyons 1977, Coates 1983,

Perkins 1983, Palmer 1986, 1987, Bybee et al 1994, Hyland 1998). Saeed (2003) views modality as a cover term for “devices which allow speakers to express varying degrees of commitment to, or belief in, a proposition” (p. 136). Modal systems are utilized to signal a speaker’s judgments about “the way the real word is” (epistemic modals) and about “how people should behave in the world” (deontic modals) (p. 137). By examining Chinese

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sentences, Tiee (1995: 220) argues that “the modal auxiliary verb adds to the proposition an

element indicating the speaker’s subjective feeling regarding the predication in the

proposition; possibility, probability, obligation, necessity, certainty, willingness, capability,

conditionality, etc..” The modality is mainly categorized into epistemic modality and deontic

modality, with the former used to express the speaker’s belief and attitude towards the

propositional content and the latter used to imply the ability, obligation, or permission the

subject of an utterance performs.

As revealed by data in my corpus, hedges are mainly used to express epistemic

modality concern since they both convey the speaker’s degree of commitment towards what

is being said. In my spoken and written corpuses, five different modal auxiliaries, keneng 可

能 ‘may’, keyi 可以 ‘can’, hui 會 ‘will/may’, yinggai 應該 ‘should’, and nenggou 能夠

‘can’, are identified as hedges while they are used to denote epistemic uncertainty or probability. The examples with these five modal auxiliaries are illustrated below respectively:

(74) 其實在 B 肝,如果說真的是沒有..沒有抗體的話 hon,那個..少量的血液 hon,可 能就會造成...傳播 (S9) Qíshí zài B gān, rúguǒ shuō zhēn de shì méiyǒu.. Méiyǒu kàngtǐ dehuà hon, nàgè.. Shǎoliàng de xiěyè hon, kěnéng jiù huì zàochéng... Chuánbò ‘In fact, hepatitis B, if there really is no .. no antibodies then that .. a small amount of blood, may cause ... spread.’ (75) 當發炎消退以後，若病人仍有明顯的突眼，則可做眼窩減壓手術 (W1) Dāng fāyán xiāotuì yǐhòu, ruò bìngrén réng yǒu míngxiǎn dì tú yǎn, zé kě zuò yǎnwō jiǎn yā shǒushù ‘When the inflammation subsided, if the patient still has significant proptosis, you can do the orbital decompression surgery.’ (76) 終其一生，約有 15%到 25%的糖尿病患會得到足部潰瘍，其中有一半會被 感染。(W1) Zhōng qí yīshēng, yuē yǒu 15%dào 25%de tángniàobìng huàn huì dédào zú bù kuìyáng, qízhōng yǒu yībàn huì bèi gǎnrǎn ‘Throughout his life, about 15 percent to 25 percent of diabetes patients will get foot ulcers, of which half will be infected.’ (77) 那因為傳染力太高了,所以基本上所有人幾乎應該被傳染到, (S7) 118

Nà yīnwèi chuánrǎn lì tài gāole, suǒyǐ jīběn shàng suǒyǒu rén jīhū yīnggāi bèi chuánrǎn dào, ‘Because its infectivity is too high, so basically almost everyone should be transmitted to,’ (78) 失眠的性質不同，治療也有不同方法。舉例來說，早期癌症的失眠患者或 許能用抗憂鬱藥，鎮靜劑，或安眠劑，有效地治療。(W2) Shīmián dì xìng zhí bùtóng, zhìliáo yěyǒu bùtóng fāngfǎ. Jǔlì lái shuō, zǎoqí áizhèng de shīmián huànzhě huòxǔ néng yòng kàng yōuyù yào, zhènjìngjì, huò ānmián jì, yǒuxiào de zhìliáo ‘There are different treatment metholds for different nature of insomnia. For example, early cancer patients with insomnia probably can be effectively treated by antidepressants, sedatives, or hypnotic agents.’

As Table 6 demonstrates, auxiliaries are utilized more by the speakers than the writers, and the difference is statistically significant. A higher frequency accordingly appears in certain auxiliaries of the spoken data than that in the written data. Figure 2 presents the distribution of these five modal auxiliaries used in the spoken discourse versus written discourse.

50.00%

40.00% Spoken Written 30.00%

20.00%

10.00%

0.00% 可能 可以 會 應該 能夠

Auxiliary keneng 可能 keyi 可以 hui 會 yingai 應該 nengou 能夠 Spoken 25.27%(404) 16.26%(260) 44.22%(707) 8.76%(140) 5.50%(88) Written 18.25%(204) 29.16%(326) 23.08%(258) 20.21%(226) 9.30%(104)

Figure 2. Distribution of modal auxiliaries used in the spoken vs. written genres

As shown in Figure 2, hui 會 ‘will/may’ is the auxiliary employed the most frequently by

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the speakers, which makes up 44.22% with 707 occurrences, whereas keyi 可以 ‘can’ is utilized the most frequently by the writers, which occupies 29.16% with 326 occurrences.

Nengou 能夠 ‘can’ is the least frequently employed auxiliary in both genres, with 5.50% in

speaking and 9.30% in writing. The frequencies of those modal auxiliaries distribute

distinctly between genres. For a better comprehension, Table 7 shows the hierarchy of

proportion that each auxiliary occupies in the spoken data and the written data:

Table 7. The stratum of auxiliaries used in the spoken vs. written genres

Spoken 1. hui 會 2. keneng 可能 3. keyi 可以 4. yingai 應該 5. nenggou 能夠 Written 1. keyi 可以 2. hui 會 3. yingai 應該 4. keneng 可能 5. nenggou 能夠

In the following sections, the functions that each auxiliary conveys depending on different

communicative circumstances will be explicated with examples.

4.2.1 Keneng 可能 ‘may’

Keneng 可能 ‘may’ semantically denotes the meaning of ‘possibility’. Liu et al.

(2010) indicate that Chinese keneng 可能 ‘may’ is used to express objective possibility, and

it is generally employed to predict future actions or virtual situations. Li (2004: 138) asserts

that keneng 可能 is “a modal verbs specialized for epistemic possibility.” Epistemic modality

helps the speaker to modulate the guarantee of “to the best of my knowledge”, as pointed out

by Saeed (2003: 135). In Chinese conversation, Chen (2008) observes that while making a

conjecture, the speaker uses keneng 可能 to alienate herself from taking full commitment to

the proposition. In Chinese writing, Lo (2010) finds that keneng 可能 is frequently used by the authors to express their uncertainty. For example, when the author is providing tentative

reasons, making possible predictions or inferences, keneng 可能 helps to downplay the

author’s degree of commitment.

In my database, keneng 可能 ‘may’ is employed by the speakers/writers to express

epistemic possibility, as examples in (79) and (80), to make predictions, as in (81) and (82) , 120 and to make suggestions, as in (83) and (84). Two other communicative purposes are identified only in the spoken discourse, in that keneng 可能 ‘may’ is used to show politeness and make tentative invitations. The following examples extracted from my databank demonstrate various hedging functions found in both genres:

(79) 我大概稍微粗..粗.粗..eh 粗估過 hon，所以大約的風險可能還是在環衛人員 hon。大概每一百人裏面 hon,它的..它的發生率可能可以達到十幾 percent hon。 (S9) Wǒ dàgài shāowéi cū.. Cū. Cū..Eh cūgūguò hon, suǒyǐ dàyuē de fēngxiǎn kěnéng háishì zài huánwèi rényuán hon. Dàgài měi yībǎi rén lǐmiàn hon, tā de.. Tā de fāshēng lǜ kěnéng kěyǐ dádào shí jǐ percent hon. ‘I approximately slightly did a rough .. rough..eh roughly estimate, so the possible risk may still fall on sanitation staff. Approximately.. among every one hundred people .. its incidence may be able to reach more than ten percent.’ (80) 體溫過低，發燒，低血壓，心搏過速，呼吸急促都可能是敗血症的徵兆。 (W1) Tǐwēnguò dī, fāshāo, dī xiěyā, xīn bóguò sù, hūxī jícù dōu kěnéng shì bàixiězhèng de zhēngzhào. ‘Hypothermia, fever, hypotension, tachycardia, shortness of breath may be a sign of sepsis.’ (81) 我們致病菌沒有找到的時候，我們在,你可能失敗的機 會就會比較高 hon.所以你..這個時候..有可能會落入沒效的ㄧ個情況。 (S4) Wǒmen zhì bìng jùn méiyǒu zhǎodào de shíhòu, wǒmen zài empiric theropy, nǐ kěnéng shībài de jīhuì jiù huì bǐjiào gāo hon. Suǒyǐ nǐ.. Zhège shíhòu.. Yǒu kěnéng huì luò rù méi xiào deyi1 gè qíngkuàng. ‘when we did not find bacteria, we in empiric therapy, the chance you may fail will be higher, so you .. at this moment .. there may be a case did not fall into efficiency.’ (82) 氣候變遷使得海水中有毒海藻及重金屬增加，加上殺蟲劑的使用，可能會 造成神經系統受損。(W2) Qìhòu biànqiān shǐdé hǎishuǐ zhōng yǒudú hǎizǎo jí zhòngjīnshǔ zēngjiā, jiā shàng shā chóng jì de shǐyòng, kěnéng huì zàochéng shénjīng xìtǒng shòu sǔn. ‘Climate change makes the toxic heavy metals in sea water and algae increase, coupled with the use of pesticides may cause nervous system damage.’ (83) 在這群人員,我們的教育的重點可能就會擺在 hon,就是或許不是在技術上,或 者是..一些新工的提醒 hon.當然不是 hon.可能在在職教育的過程中 hon,可能

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還是要不斷地提醒啦 hon (S9) Zài zhè qún rényuán, wǒmen de jiàoyù de zhòngdiǎn kěnéng jiù huì bǎi zài hon, jiùshì huòxǔ bùshì zài jìshù shàng, huòzhě shì.. Yīxiē xīn gōng de tíxǐng hon. Dāngrán bùshì hon. Kěnéng zài zàizhí jiàoyù de guòchéng zhōng hon, kěnéng háishì yào bùduàn de tíxǐng la hon ‘In this group of people, our educational focus may put in.. that is, perhaps not in the technology, or in the orientation.. Of course not. It may be put in the course of in-service education, or you may still have to constantly remind them.’ (84) 舉例來說，早期癌症的失眠患者或許能用抗憂鬱藥，鎮靜劑，或安眠劑， 有效地治療。而晚期或轉移性癌症病人可能首要的則是適當處理癌症疼 痛。(W2) Jǔlì lái shuō, zǎoqí áizhèng de shīmián huànzhě huòxǔ néng yòng kàng yōuyù yào, zhènjìngjì, huò ānmián jì, yǒuxiào de zhìliáo. Ér wǎnqí huò zhuǎnyí xìng áizhèng bìngrén kěnéng shǒuyào de zé shì shìdàng chǔlǐ áizhèng téngtòng. ‘For example, early cancer patients with insomnia may be treated effectively with antidepressants, sedatives, or hypnotic agents. But for advanced or metastatic cancer patients, the primary treatment may be appropriate treatment for the cancer pain.’

Keneng 可能 ‘may’ of examples (79) and (80) are used as the most common expression to

express the sense of epistemic possibility. In these two examples, (79) deserves particular

attention. The objective possibility of the first keneng refers to the working position and the second keneng to the estimated percentage. Besides keneng, the speaker uses several other hedges in his utterances, which intensely reduce his commitment to the proposition. In the first clause, three lexical hedges, dagai 大概 ‘approximately’, shaowei 稍微 ‘slightly’, and tsuku 粗估‘roughly estimate’ are employed while in the second clause, dayue 大約

‘approximately’ is utilized. The intentive use of hedges shows the speaker’s tentativeness as well as modesty in communication. Keneng 可能 ‘may’ in examples (81) and (82) are used to make predictions. In (81), the speaker predicts what may be the possible consequences when events occurring under certain conditions. The writers of (82) use keneng 可能 to make a prediction which is based on objective natural phenomena, the climate change. The serious consequence has not yet been scientifically verified, so the writers hedge their 122

statements by using keneng 可能‘may’. As “there will always be some uncertainty in

prognosis” (Smith et al. 2013: 2448), keneng helps the writers to avoid making a full commitment to their predictions. Keneng in (83) and (84) are used to make humble suggestions. In his lecture, the speaker of (83) declares that sanitation workers are the group of people who suffer from the needlestick injury the most. Those people are not educated with how to prevent this problem when they entered the hospital. Therefore, the speaker suggests that this module issue can be included in the orientation and service education for sanitation workers. Keneng in (84) is used to make a remedy suggestion for the advanced or metastatic cancer patients. For those patients, the primary treatment would be appropriately relieving cancer pain. Keneng makes the writers’ proposal sound less assertive and more acceptable to the readers. Without this hedge, the statement would sound like an absolute claim. All in all, keneng 可能 ‘may’ helps to reduce the illocutionary force, and turn the statement into a moderate suggestion.

In addition to the above usages, there are two other communicative purposes of keneng observed only in the spoken data, which go beyond expressing possibility and making prediction. It functions as a politeness strategy and serves as an invitation. Keneng in examples (85) and (86) displays speakers’ politeness, which enables speakers to mitigate the force of the statement and meanwhile minimize the potential FTA:

(85) 那..有些同仁問說..奇怪,以前喔,我們在學校的時候,老師告訴我們說,看病不 能夠看..看--不能夠用..用儀器來看病.最重要的是我們要..有..很好的一些 PE17跟 NE18啊.那現在的--到現在為止說..有時候發現說,啊我們可能不只是 要有很好的..醫學訓練,我們大概也很重要的需要一些..高科技的一些..儀器 啊,來幫助我們診斷. (S3) Nà.. Yǒuxiē tóngrén wèn shuō.. Qíguài, yǐqián ō, wǒmen zài xuéxiào de shíhòu, lǎoshī gàosù wǒmen shuō, kànbìng bùnénggòu kàn.. Kàn--bù néng gòu yòng.. Yòng yíqì lái kànbìng. Zuì zhòngyào de shì wǒmen yào.. Yǒu.. Hěn hǎo de yīxiē

17 Physical Examination. 18 Neurological Examination. 123

PE gēn NE a. Nà xiànzài de--dào xiànzài wéizhǐ shuō.. Yǒu shíhòu fāxiàn shuō, a wǒmen kěnéng bù zhǐshì yào yǒu hěn hǎo de.. Yīxué xùnliàn, wǒmen dàgài yě hěn zhòngyào de xūyào yīxiē.. Gāo kējì de yīxiē.. Yíqì a, lái bāngzhù wǒmen zhěnduàn. ‘then some of my colleagues asked, .. it is strange.. before oh, when we are at school, the teacher told us that the doctor can not see .. can not ..see patients with equipments. The most important is that we have to .. have .. well with some PE NE ah that now - until now .. sometimes it is argued that ah we may not just have a good .. medical training, we probably is also very important to take some .. some .. hi-tech instruments ah, to help us diagnose.’ (86) 那至於第二點,教授所提的那個..像很特殊的疾病,在你那邊治療..應該是..嘖! 她的基本上的問題可能需要在你那邊吶,hon 那如果她有生殖上的問題,那我 們是可以幫忙的.因為那很特殊的治療在我們這領域裡頭,其實我也是不懂, 還是要請沈教授幫忙的. (S8) Nà zhìyú dì èr diǎn, jiàoshòu suǒ tí dì nàgè.. Xiàng hěn tèshū de jíbìng, zài nǐ nà biān zhìliáo.. Yīnggāi shì.. Zé! Tā de jīběn shàng de wèntí kěnéng xūyào zài nǐ nà biān nà,hon nà rúguǒ tā yǒu shēngzhí shàng de wèntí, nà wǒmen shì kěyǐ bāngmáng de. Yīnwèi nà hěn tèshū de zhìliáo zài wǒmen zhè lǐngyù lǐtou, qíshí wǒ yěshì bù dǒng, háishì yàoqǐng chén jiàoshòu bāngmáng de. ‘As to the second point, the professor mentioned that .. like the very special diseases treatment .. should be taken care of in your department. Her fundamental problems may need to be treated by you. If she has questions on reproduction, then we can help. Because it needs a very special treatment, I actuall do not have the knowledge. Thus, we still need Professor Shen, your help.’

In modern times, it is a reality and worldwide tendency to make use of high-tech equipments in the medical field. HOS is an educational hospital; therefore, it always takes a lead to purchase the most recent and advanced facilities to provide the best service for patients.

Example (85) is produced by a host who is introducing the topic of the lecture, and it is concerned with the most advanced model of a CT scanner. Earlier, the speaker mentioned that some colleagues recalled that when they studied in the medical school, they were taught to treat patients with professional training instead of relying on equipments. Recalling this, the speaker adopts the modal verb keneng 可能 ‘may’ to hedge his utterance in order to avoid

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potential FTAs on the traditional medical school professors. If the modal keneng is left out, the statement would sound assertive, and at the same time it may overthrow the theory those physicians learned from their school professors. Furthermore, since some of the audiences from other departments may rely more on their medical training and clinical experience than high-tech apparatus on the diagnoses and medical treatment, statements extolling advanced high-tech apparatus may sound imposing upon those physicians’ specialties. In view of the above possible offenses, keneng 可能 is utilized as a politeness strategy, and it enables the speaker to avoid potential FTAs. The speaker’s attempt in mitigating his assertion is also evidently supported by the following hedging adverb dagai 大概 ‘probably’, which helps to prevent the statement from overvaluing the importance of high-tech apparatus. Keneng of (9)

also serves as a politeness strategy, functioning to alleviate the speaker’s decline. The

interaction occurs in the Q & A section, in that the questioner is an expert in Hematology &

Oncology, and he would like to know how modern technology of infertility may help with his

Hemophilia patients who also suffer from infertility. Since the speaker’s specialty is infelicity,

he may not have professional knowledge about Hemophilia. The auxiliary yingai 應該

‘should’ in the truncated sentence zài nǐ nàbiān zhìliáo..yīnggāi shì..在你那邊治療..應該

是..reveals that the speaker thinks Hemophilia patents should be taken care of in the

questioner’s department since it is a special disease. The unfinished part of the sentence may

probably be zhengque-de 正確的 ‘accurate’ or bijiao shidang 比較適當 ‘more

appropriate’. Presumably the speaker senses the answer may sound like a rebuff, so he

suddenly suspends his utterance. The speaker then reinitiates a sentence with keneng 可能 to

mitigate his refusal to take over the Hemophilia patients as a straightforward rejection would

sound rude. Not to mislead the questioner and the audiences to the idea that the speaker is

unwilling to treat patients with special disease, he then clarifies his thought. The speaker

explains that the fundamental treatment of Hemophilia had better be carried out in

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Hematology & Oncology department since it involves medical specialty, and he then adds on

that if Hemophilia patients have the problem of infelicity, the infelicity team, including the speaker, can offer assistance for them. The speaker further confesses that since Hemophilia is a special disease, he himself does not have the professional knowledge for the treatment. He then gives praise to Dr. Shen, the questioner, by saying that he might need Dr. Shen’s help one day. In this example, keneng 可能 represents two functions. On the one hand, it helps the speaker turn down the questioner’s request while minimizing the FTA simultaneously, and on the other hand, it reveals that the assertion to keep Hemophilia patients in the certain department is due to the questioner’s unmatched profession.

Keneng 可能 in (87) and (88) is used to invite he addressee to give a comment on a certain issue:

(87) 當然這方面我們還需要..肝膽胃腸科的專家,可能孫副幫我們 一下,這雖然是我們的共識啦. (S10) Dāngrán zhè fāngmiàn wǒmen hái xūyào.. Gāndǎn wèicháng kē de zhuānjiā, kěnéng sūn fù bāng wǒmen comment yīxià, zhè suīrán shì wǒmen de gòngshì la. ‘Of course in this regard, we also need .. the specialists from Hepatobiliary Division of Gastroenterology. Dr. Sun may help to give a comment, although this is our common sonsensus.’ (88) 但是執行率 hon,就是一個很大的問題 hon.這個，我想可能待會再請我們劉 主任說明。(S4) Dànshì zhíxíng lǜ hon, jiùshì yīgè hěn dà de wèntí hon. Zhège, wǒ xiǎng kěnéng dài huì zài qǐng wǒmen liú zhǔrèn shuōmíng ‘However, the implementation rate is a big problem and this, I think it may be explained by our Deputy Director Liu.’

Take (87) as an example, one of the audiences asks the speaker how to define liver

dysfunction when the problem is associated with diabetes patients.19 The speaker explains

that so far there is no clear definition on the degree of liver dysfunction on medical textbooks,

19 The speaker is the supervisor of the Endocrinology & Metabolism department. 126

but he still offers the current consensus on liver dysfunction in the realm of Endocrinology &

Metabolism. The Vice Superintendent, Dr. Sun, an expert of Gastroenterology & Hepatology,

happens to sit in the audience, so the speaker finds it a good chance to ask for Dr. Sun’s

professional opinion. The conversation takes place in the Q & A section, which is a naturally

spontaneous conversation; the speaker is unable to predict the audience’s questions. This

invitation is then made impromptu. Without a notification to Dr. Sun beforehand, the speaker

is uncertain whether Dr. Sun is willing to accept his invitation. In order not to make the

request sound robust and coercive on Dr. Sun’s own will, the modal hedge keneng 可能 is

employed as a politeness strategy to save both the speaker’s and the addressee’s faces.

Meanwhile, keneng in these two examples serves as a predicator as they announce to the audience about the possible upcoming comments from the professional.

4.2.2 Ke(yi) 可(以) ‘can’

According to Li (2004) and Huang (1999), ke(yi) 可以 ‘can’ can be used to indicate

epistemic possibility. In my corpus, ke(yi) 可以 ‘can’ is used to express epistemic

possibility, to make conjectures, to indicate possible advantages if a treatment is practiced

under a certain period of time, or to make suggestions, which are functions identified in both

medical genres. One communicative purpose is identified in the spoken discourse

exclusively, where keyi 可以 ‘can’ is utilized to make polite invitations. The various

communicative functions will be discussed with illustrative examples:

ke(yi) 可以 ‘can’ can be used to show epistemic possibility, as examples (89) and (90):

(89) 其實一次針扎案件 hon,真的是會造成很多的..成本 hon.hon 但是其實大部分 的針扎 hon,其實從國外的報告來說,大部分都是可以預防 hon (S9) Qíshí yīcì zhēn zhā ànjiàn hon, zhēn de shì huì zàochéng hěnduō de.. Chéngběn hon.Hon dànshì qíshí dà bùfèn de zhēn zhā hon, qíshí cóng guó wài de bàogào lái shuō, dà bùfèn dōu shì kěyǐ yùfáng hon ‘In fact, a needle case, really will cause a lot of .. cost, but in fact most of the needle, in fact, reports from abroad, most of the cases can be prevented.’

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(90) 對早期的乳癌病人，積極治的療，可使治癒率達 90%以上 (W2) Duì zǎoqí de rǔ'ái bìngrén, jījí zhì de liáo, kě shǐ zhìyù lǜ dá 90% yǐshàng ‘For early breast cancer patients, with the positive treatment, the cure rate can reach over than 90%.’

The objective evidence in the predication of (89) and (90) on the one hand enhances the

speakers’/writers’ arguments, and on the other hand the use of ke(yi) 可以 ‘can’ helps lower the speakers’/writers’ commitment to their propositions, and meanwhile it enables the speakers/writers to shift the responsibility to those attributes.

Ke(yi) 可以 ‘can’ can be used to make conjectures on clinical practices according to subjective viewpoints or professional knowledge, as shown in (91) and (92):

(91) 那..其實就醫療上面的..的事實上的..每天的裡面，其實有時候 你適當地欺矇可以減少病人的焦慮,減少他的疼痛。(S2) Nà.. Qíshí jiù yīliáo shàngmiàn de.. De shìshí shàng de.. Měitiān de practice lǐmiàn, qíshí yǒu shíhòu nǐ shìdàng de qīméng kěyǐ jiǎnshǎo bìngrén de jiāolǜ, jiǎnshǎo tā de téngtòng ‘that .. in fact in terms of clinical practice.. in fact .. in the daily practice, actually the sometimes appropriate concealing properly can reduce the patient’s anxiety, reduce his pain.’ (92) 對腸道內大部份細菌無效(包括 Bacteroides group)，不會 影響這些細菌的生長。故使用治療 感染 時，當可維持腸道內正常厭氧菌的數量。(W1) Fidaxomicin duì cháng dào nèi dà bù fèn xìjùn wúxiào (bāokuò Bacteroides group), bù huì yǐngxiǎng zhèxiē xìjùn de shēngzhǎng. Gù shǐyòng fidaxomicin zhìliáo C.Difficile gǎnrǎn shí, dāng kě wéichí cháng dào nèi zhèngcháng yàn yǎng jùn de shùliàn ‘Fidaxomicin is invalid to the majority of the bacteria in the gut (including Bacteroides group), which does not affect the growth of these bacteria. Therefore, the use of fidaxomicin for the treatment of C. difficile infections can maintain the number of normal intestinal anaerobic bacteria.’

A conjecture naturally inherits sense of uncertainty. The speaker of (91) employs keyi 可以

‘can’ to make a tentative conjecture on what may be the benefits for patients while

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concealment is applied properly, such as concealing on degree of seriousness of the patient’s

disease. As well as (91), the writers of (92) make a conjecture on the benefit of a certain

treatment by applying ke 可 ‘can’. With ke(yi) 可以 ‘can’, the speakers/writers are able to

make their assumptions less assertive and more acceptable to the hearers/readers.

Ke(yi) 可以 ‘can’ can be utilized to indicate what may be the possible advantages

when a treatment is practiced under a certain limit of time, as shown in (93) and (94).

(93) 基本上,如果你在咳嗽剛開始前兩週,卡它期的時候,你用跟是可以測出來 (S7) Jīběn shàng, rúguǒ nǐ zài késòu gāng kāishǐ qián liǎng zhōu, kǎ tā qí de shíhòu, nǐ yòng culture gēn PCR shì kěyǐ cè chūlái ‘Basically, during the first two weeks of your coughing, within the Karta Period, you can use culture and PCR to test out if it is the Pertussis.’ (94) 若在七天內提早實行氣管切開術可以減少呼吸器引起之肺炎、呼吸器使用 時間及在加護病房住院的時間 (W1) Ruò zài qītiān nèi tízǎo shíxíng qìguǎn qiēkāi shù kěyǐ jiǎnshǎo hūxī qì yǐnqǐ zhī fèiyán, hūxī qì shǐyòng shíjiān jí zài jiāhù bìngfáng zhùyuàn de shíjiān ‘If the implementation of tracheotomy is done within seven days, it can reduce pneumonia caused by the ventilator, the period for respirator use, and the hospitalization time in the ICU.’

The speaker of (93) uses keyi 可以 ‘can’ to indicate the possibility on the diagnoses of pertussis, but the premise is that the test should be done within the first two weeks of the coughing symptom. Similarly, seven days is the limit of time to minimize the possible risk of

pneumonia as in (94). The employment of keyi 可以 ‘can’ reduce the speakers’/writers’

commitment to the possibilities being speculated.

In the following examples, similar to keneng 可能 ‘may’, keyi 可以 ‘can’ is used for

the speakers/writers to offer tentative suggestions, either for better resolution, as in (95), or

when the previous treatment is in vain, as in (96) below:

(95) 那如果真的你已經看到那麼大的 nodule,你可以選擇用,你

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可以..^更早期知道..它是 inferedummars, 還是 tu--還是. (S3) Nà rúguǒ zhēn de nǐ yǐjīng kàn dào nàme dà de nodule, nǐ kěyǐ xuǎnzé yòng dual energy, nǐ kěyǐ..^Gèng zǎoqí zhīdào.. Tā shì inferedummars, háishì tu--háishì cancer ‘If you have seen such a big module, you can choose to use dual energy, you can .. ^ know earlier .. if it is inferedummars, or tu-- or cancer.’ (96) 如病患有食道狹窄的情況，例如食道癌，在傳統內視鏡無法通過狹窄處 時，可以嘗試經鼻內視鏡。 (W1) Rú bìng huàn yǒu shídào xiázhǎi de qíngkuàng, lìrú shídào ái, zài chuántǒng nèi shì jìng wúfǎ tōngguò xiázhǎi chù shí, kěyǐ chángshì jīng bí nèi shì jìng ‘If the patients had esophageal stricture circumstances, such as esophageal cancer, the traditional endoscopy could not pass through the narrow position, you can try transnasal endoscopy.’

Ke(yi) 可以 ‘can’ can be utilized to make polite invitations, as in (97) and (98). This communicative purpose is identified exclusively in the spoken discourse:

(97) 所以我們啊各位同仁, (你若有空)， (可以去..啊我們的)教學研究大樓， (咱們的)生殖研究中 心,我們裡面有一個..佳霓..佳霓..這個啊..紀念..啊..生殖實驗室 hon。(S8) Suǒyǐ wǒmen a gèwèi tóngrén, li nann u iann(nǐ ruò yǒu kòng),etang ki..Ah lan e..(Kěyǐ qù.. A wǒmen de) jiàoxué yánjiū dàlóu,lan e (zánmen de) shēngzhí yánjiū zhōngxīn, wǒmen lǐmiàn yǒu yīgè.. Jiā ní.. Jiā ní.. Zhège a.. Jìniàn.. A.. Shēngzhí shíyàn shì hon ‘Therefore, we, ah, colleagues, if you have time, you can go to .. ah… the teaching and research building, our Reproductive Research Center, we have a .. Jia Ni Jia Ni.. this .. ah .. Memorial .. ah .. reproductive laboratory.’ (98) (所以我想)今天我們請蔡教授來這邊講，就是說，我們 有這樣的ㄧ個典範，你用這樣的模子，把它怎樣? (大 家挺做伙)，hon，那如果你們..啊..有興趣，可以到他那邊去。(S8) Sooi gua siunn (suǒyǐ wǒ xiǎng) jīntiān wǒmen qǐng cài jiàoshòu lái zhè biān jiǎng, jiùshì shuō, wǒmen yǒu zhèyàng deyi1 gè diǎnfàn, nǐ yòng zhèyàng de múzi, bǎ tā zěnyàng? Tae king tsehue(dàjiā tǐng zuò huǒ),hon, nà rúguǒ nǐmen.. A.. Yǒu xìngqù, kěyǐ dào tā nà biān qù. ‘So I think.. today we have invited Professor Tsai to make a speech. That is, we have such a model, and you use this mold to put it like what? Everyone unites together, hon, and if you .. ah .. are interested in it, you can ask for his advise .’

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4.2.3 Hui 會 ‘will ; may’

Li (2004: 140) argues that hui 會 has a subjective reading, as in ta hui zai lai de 他會

再來的 ‘He may come again’. Hui 會 is normally used to refer to probability or possibility

of future events, yet it can also denote present events or incidents happening in the past (Lü

2000, Liu et at. 2011). The futurity potentially involves certain degree of uncertainty;

therefore, hui 會 inherently convey the sense of possibility of an event. In Chen’s (2008)

study, the speaker uses hui 會 ‘can’ as a hedge to show his conjecture and uncertainty

towards the occurrence of an event, which implies the possible falseness and his lack of commitment to the proposition. In my databank, hui 會 ‘will/may’ is utilized to express

several communicative purposes. It can be used to express epistemic probability, to make

predictions, to anticipate the audiences’/readers’ possible doubts, or to convey expectations.

One function of hui 會 which is only observed in the spoken data is to announce the topics which will be discussed later or actions that will be accomplished in the future. The functions that are shared by both genres will be introduced first and followed by the exclusive function identified in the spoken discourse.

Hui 會 ‘will/may’ is typically used to express the possibility or probability of events or situations, which is well demonstrated by the following four examples:

(99) 所以,它只要..影響到我們這個 chain 裡面的任何一隻細菌 hon,我們整個 chain 可能就會 break down 掉。 (S4) Suǒyǐ, tā zhǐyào.. Yǐngxiǎng dào wǒmen zhège chain lǐmiàn de rènhé yī zhī xìjùn hon, wǒmen zhěnggè chain kěnéng jiù huì break down diào ‘Therefore, if it just .. affects any one of the bacteria inside the chain, the entire chain may break down.’ (100) 台.台灣是一個地震帶,hon 你新的建築物,可能三年五年 hon 就開始床--窗邊 會有裂.裂痕 hon,所以就可能會有水氣,水氣就會影響我們胚胎培養的品質 hon, (S8) Tái. Táiwān shì yīgè dìzhèn dài,hon nǐ xīn de jiànzhú wù, kěnéng sān nián wǔ nián hon jiù kāishǐ chuáng--chuāng biān huì yǒu liè. Lièhén hon, suǒyǐ jiù kěnéng huì yǒu shuǐ qì, shuǐ qì jiù huì yǐngxiǎng wǒmen pēitāi péiyǎng de pǐnzhí 131

hon ‘Taiwan is in a seismic zone, the new building, possibly within three to five years, will start.. at the bed - the window will crack..crack, so there may be water vapor, water vapor will affect the cultured quality of our embryos,’ (101) 失眠的也可能會因為癌症期別的不同而有差異。在早期癌症，預期性失眠 可能會是擔心和煩惱疾病預後和治療的結果。(W2) Shīmián de yě kěnéng huì yīnwèi áizhèng qī bié de bùtóng ér yǒu chāyì. Zài zǎoqí áizhèng, yùqí xìng shīmián kěnéng huì shì dānxīn hé fánnǎo jíbìng yùhòu hé zhìliáo de jiéguǒ ‘Insomnia symptoms may be different depending on different periods of cancer stages. In early cancer, anticipatory fear and insomnia may be the result of disease prognosis and treatment of annoyance.’ (102) 熱急症的發生常是不知不覺的累積傷害。當任何因素，讓人體處於一個熱 產生超過熱排除速度時，體溫就會上升，熱急症就可能會產生。(W2) Rè jízhèng de fāshēng cháng shì bùzhī bù jué de lěijī shānghài. Dāng rènhé yīnsù, ràng réntǐ chǔyú yīgè rè chǎnshēng chāoguò rè páichú sùdù shí, tǐwēn jiù huì shàngshēng, rè jízhèng jiù kěnéng huì chǎnshēng ‘Heat Emergencies often cause unwittingly cumulative damage. Any of the factors causing the human body in a condition that heat production exceeds removal, body temperature may rise. Then the heat emergencies may occur.’

Hui 會 ‘will/may’ of examples (99) to (102) are used to refer to the possibility of medical

symptoms or natural phenomena. The examples show that the possibility is not necessarily

confined to future incidents since the causation may be a customary situation or a testified experiment. However, it is interesting to note that another modal hedge, keneng 可能 ‘may’ precedes to hue 會 ‘will/may’, and it is consistent in all the four examples. This additional hedge helps to further reduce the speakers’/writers’ commitment to their propositions.

Hui 會 ‘will/may’ is observed to be employed by the speakers/writers to make

subjective predictions, as in (103) and (104).

(103) 是老年人口越來越多,啊現在 disease 越來越複雜 hon,我想這種困難傷口的.. 病人會越來越多啦, (S5) Shì lǎonián rénkǒu yuè lái yuè duō, a xiànzài disease yuè lái yuè fùzá hon, wǒ xiǎng zhè zhǒng kùnnán shāngkǒu de.. Bìngrén huì yuè lái yuè duō la

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‘There are more and more elderly population, ah diseases are now more complex, I think patients with this kind of difficult wounds .. will increase more and more.’ (104) 當地球+1℃：北極圈全年有半天處於無冰的狀態，野火會增加，動物會集 體離開牠們的棲息地。 (W2) Dāng dìqiú +1℃: Běijí quān quán nián yǒu bàntiān chǔyú wú bīng de zhuàngtài, yěhuǒ huì zēngjiā, dòngwù huì jítǐ líkāi tāmen de qīxī dì ‘When the Earth temperature increases by 1 ℃: Arctic ice-free zone will exist half day throughout the year, wildfires will increase, animals will collectively leave their habitats.’

The speaker of (103) predicts that the patients with difficult wounds will increase in the

future owing to the increase in the population of the elderly. The prediction is made on the

basis of the speaker’s knowledge and clinical experiences. In (104), the writers predict the

possible consequence in the natural world while the temperature raises one degree Celsius.

This prediction is the writers’ speculation based on the global warming phenomenon.

Hui 會 ‘will/may’ is utilized by the speakers/writers to anticipate the hearers’/readers’

possible doubts, as in (105) and (106):

(105) 你可能要打二十五到三十的ㄧ個..dose,hon 那大 家可能會覺得說,因為我過去..五年,過去十年,我在治療 MRSA 好像也都沒 有打嘛 (S4) Nǐ kěnéng yào dǎ èrshíwǔ dào sānshí millium gram per kilo deyi1 gè..Dose,hon nà dàjiā kěnéng huì juédé shuō, yīnwèi wǒ guòqù.. Wǔ nián, guòqù shí nián, wǒ zài zhìliáo MRSA hǎoxiàng yě dū méiyǒu dǎ loading ma ‘You might want to make twenty-five to thirty milligram per kilo for a ..dose. Everyone may feel that.. because in the past .. five years... ten years, when I was treating MRSA, I probably did not inject loading either.’ (106) 狂犬病毒是經由感染動物的咬傷中唾液汙染傷口而傳染給人。很多人會覺 得奇怪，為什麼是經由唾液傳染呢？其實狂犬病毒在除了蝙蝠以外所有哺 乳類動物的感染途徑都是一樣的。(W2) Kuángquǎnbìng dú shì jīngyóu gǎnrǎn dòngwù de yǎoshāng zhōng tuòyè wūrǎn shāngkǒu ér chuánrǎn jǐ rén. Hěnduō rén huì juédé qíguài, wèishéme shì jīngyóu tuòyè chuánrǎn ne? Qíshí kuángquǎnbìng dú zài chúle biānfú yǐwài suǒyǒu bǔrǔlèi dòngwù de gǎnrǎn tújìng dōu shì yīyàng de 133

‘Rabies virus is infected through the bite of an infected animal's saliva contaminated wounds and passed the infections to humans. Many people will wonder why it is contagious through saliva. In fact, in addition to the bat rabies virus infection route, all mammals are the same.’

In (105), the speaker employs hui 會 ‘will/may’ to conjecture the audiences’ possible doubt

about the amount of antibiotic dosing, and dajia 大家 ‘everyone’ is applied to represent the

audience. In (106), the doubt is supposed to come from the unknown third party, henduoren

很多人 ‘many people’. Hui 會 ‘will/may’ then serves to involve the hearers/readers

participation and convey issues that the speakers/writers consider important.

Hui 會 ‘will/may’ can also be used to express the speakers’/writers’ expectations, as

shown in (107) and (108):

(107) 你要去整合內政部,那個社會處那麼大的地方 hon,所以我們會希望政府的一 個..它的一個..uh.. 跨部門的整併 hon,要..動作要快,才能夠把事情做好. (S1) Nǐ yào qù zhěnghé nèizhèng bù, nàgè shèhuì chù nàme dà dì dìfāng hon, suǒyǐ wǒmen huì xīwàng zhèngfǔ de yīgè.. Tā de yīgè..Uh.. Kuà bùmén de zhěng bìng hon, yào.. Dòngzuò yào kuài, cái nénggòu bǎ shìqíng zuò hǎo ‘You may need to integrate the Department of Interior, the Department of Social Affairs is such a huge unit, so we will hope that the government .. its a.. the integration of cross-sectoral issue and ..uh .. the action should be fast in order to get things done.’ (108) 原則上會希望病人在手術過程中，尿量維持在 0.5 mL/kg/hr 以上(不過接受 透析的病人多半已無尿或尿量很少)；(W2) Yuánzé shàng huì xīwàng bìngrén zài shǒushù guòchéng zhōng, niào liàng wéichí zài 0.5 ML/kg/hr yǐshàng (bùguò jiēshòu tòuxī de bìngrén duōbàn yǐ wú niào huò niào liàng hěn shǎo) ‘In principle, during surgery, we will hope the patient’s urine output to be maintained at 0.5 mL / kg / hr or more (but dialysis patients have little or no urine);’

In (107) and (108), hui 會 ‘will/may’ is used in conjunction with the verbal hedge xiwan 希

望 ‘hope’ to express the speaker’s/writers’ expectations. The expectation is either aimed at

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the government or the clinical procedure.

The following examples display the very function identified exclusively in the spoken

discourse. Hui 會 ‘will/may’ is utilized to make announcements by the speakers. The

speaker may employ hui 會’way/may’ to announce a topic which will be discussed later, as

in (109) or to announce a possible future plan, as in (110):

(109) 那等一下會稍微..稍微講一下疫苗。 (S7) Nà děng yīxià huì shāowéi.. Shāowéi jiǎng yīxià yìmiáo ‘In a moment .. I will talk about the vaccine a bit.’ (110) 不好意思,今天沒時間.進階課程會教。這些狀況的人，怎麼使用胰島素。 (S10) Bù hǎoyìsi, jīntiān méi shíjiān. Jìn jiē kèchéng huì jiào. Zhèxiē zhuàngkuàng de rén, zěnme shǐyòng yídǎosù ‘Sorry, we have no time for today. The issue will be taught in advanced courses on how to use insulin under these conditions.’

4.2.4 Ying(gai/dang) 應(該/當) ‘should’

Lü (2000) indicates that yinggai 應該 ‘should’ expresses the estimation of a situation

that is necessarily so. Liu et al. (2011) concur that yinggai 應該 ‘should’ conveys the sense of estimation or inference. By applying yinggai 應該 ‘should’, the speaker/writer can make

an epistemic judgment on incidents without taking a full responsibility on the truthfulness of

the proposition. Chen (2008) observes that instead of making a direct comment, the speaker

utilizes the epistemic yinggai 應該 ‘should’ to indicate her deduction and uncertainty.

Yinggai 應該 ‘should’ helps the speaker to soften the strength of her comment and makes

the statement less assertive. In academic written texts, Lo (2010) finds that yinggai 應該

‘should’ is employed for the writers “to make reasonable deduction or inference derived from

their own reasoning or available information” (p. 61). There are five other variants of yinggai

應該 ‘should’ found in my corpus: yingkai (應該), dang 當, gai 該, ying 應, yingdong 應

當. The Taiwanese yingkai (應該) appears only in the spoken discourse just as it should be,

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whereas dong 當 exclusively occurs in the written discourse. Yinggai 應該 ‘should’ in my

corpus demonstrates various communicative purposes, including making estimations, making

inferences, offering suggestions, expressing expectations, making conjectures, and making

predictions. The last two mentioned functions are observed exclusively in the spoken

discourse. Those shared communicative purposes will be explicated with examples from both

genres:

The most common usage of yinggai 應該 ‘should’ is to express estimation on

situations which are necessarily so. Yinggai 應該 ‘should’ can be employed to make

estimation on certain situations, as in (111) and (112), or on numerical figures, as in (113) and

(114):

(111) 我想在目前,整個台灣,啊呼吸治療方面,他應該是最 outstanding,而且具有領 先的很好的一個 leadership.我想我們今天的這個演講裡面,一定是相當地精 彩. (S3) Wǒ xiǎng zài mùqián, zhěnggè táiwān, a hūxī zhìliáo fāngmiàn, tā yīnggāi shì zuì outstanding, érqiě jùyǒu lǐngxiān de hěn hǎo de yīgè leadership. Wǒ xiǎng wǒmen jīntiān de zhège yǎnjiǎng lǐmiàn, yīdìng shì xiāngdāng dì jīngcǎi ‘I think at present, in Taiwan, ah in the field of respiratory therapy, he should be the most outstanding, and he is the leading..has a good leadership. I think today’s speech must be quite exciting.’ (112) 他們認為沒操作過胃鏡的醫師都可以勝任這種治療，但是操作胃鏡畢竟是 一種專業技術，我們認為由專科醫師操作應較能減少對病人的傷害。(W2) Tāmen rènwéi méi cāozuòguò wèijìng de yīshī dōu kěyǐ shèngrèn zhè zhǒng zhìliáo, dànshì cāozuò wèijìng bìjìng shì yīzhǒng zhuānyè jìshù, wǒmen rènwéi yóu zhuānkē yīshī cāozuò yīng jiào néng jiǎnshǎo duì bìngrén de shānghài ‘They believe that physicians who have never operated gastroscope are capable of such treatment, but the operation is a professional technology after all, we believe that the operation manipulated by specialists should reduce more the potential harm to the patients.’ (113) 那這是我們..整個打造以後的生殖中心 hon.那我們的 cycle 數也從零七年開 始 hon,一直..就開始有明顯的增加 hon, 那我們預計今年可以達到四百..接 近..應該可以達到四百五十個 hon,四百二十個到四百五十個 cycle, (S8) Nà zhè shì wǒmen.. Zhěnggè dǎzào yǐhòu de shēngzhí zhōngxīn hon. Nà wǒmen

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de cycle shù yě cóng líng qī nián kāishǐ hon, yīzhí.. Jiù kāishǐ yǒu míngxiǎn de zēngjiā hon, nà wǒmen yùjì jīnnián kěyǐ dádào sìbǎi.. Jiējìn.. yīnggāi kěyǐ dádào sìbǎi wǔshí gè hon, sìbǎi èrshí gè dào sìbǎi wǔshí gè cycle ‘This is our .. the whole reproductive center. Our cycle number has been .. began to increase significantly since 2007, and we expect that this year it can reach to four hundred .. approximately.. it should be able to reach four hundred and fifty, four hundred and twenty to four hundred and fifty cycles.’ (114) 對於急性腎盂腎炎則應以抗生素治療 10-14 天，對於急性細菌性腎炎則應 治療更久(3-4 週)，而腎臟膿瘍則通常須治療 4-6 週。(W2) Duìyú jíxìng shènyú shènyán zé yīng yǐ kàngshēngsù zhìliáo 10-14 tiān, duìyú jíxìng xìjùn xìng shènyán zé yīng zhìliáo gèng jiǔ (3-4 zhōu), ér shènzàng nóngyáng zé tōngcháng xū zhìliáo 4-6 zhōu ‘For acute pyelonephritis, it should be treated with antibiotics for 10-14 days, and for acute bacterial nephritis, it should be treated even longer (3-4 weeks), and renal abscess usually requires treatment for 4-6 weeks.’

It is observed that the form yinggai 應該 ‘should’ is applied by the speakers, as seen in (111) and (113), whereas the writers favor the monosyllabic ying 應 ‘should’ instead, as in (112) and (114). By applying yinggai 應該‘should’, the speakers/writers are able to make subjective judgments without taking full responsibility for their estimations. Among those examples, yinggai 應該 ‘should’ in (111) displays a particular function which is not observed in the others. In (111), yinggai 應該 ‘should’ is utilized not only to express the speaker’s subjective estimation but also to praise the lecturer whom is referred to by the pronoun ta 他 ‘he’.

Yinggai 應該 ‘should’ can be used by the speakers/writers to make inferences in the light of the speakers’/writers’ professional knowledge or experimental results, as in (115) and

(116) below:

(115) 所以意思就是說，你把..有抗藥性的細菌跟沒有抗藥性擺在一起的時候,其 實這個有抗藥性的細菌應該是長不過這個沒有抗藥性細菌 hon，因為它必 須多花一些資源,多花一些能量去維持它的ㄧ個抗藥性。 (S4) Suǒyǐ yìsi jiùshì shuō, nǐ bǎ.. Yǒu kàng yàoxìng de xìjùn gēn méiyǒu kàng yàoxìng bǎi zài yīqǐ de shíhòu, qíshí zhège yǒu kàng yàoxìng de xìjùn yīnggāi 137

shì cháng bùguò zhège méiyǒu kàng yàoxìng xìjùn hon, yīnwèi tā bìxū duō huā yīxiē zīyuán, duō huā yīxiē néngliàng qù wéichí tā deyi1 gè kàng yàoxìng ‘So that is, when you put together the.. drug-resistant bacteria with the non-drug resistant bacteria, actually, the growth rate of the drug-resistant bacteria should not be able to compete with the non-drug resistant ones since it takes more resources and more energy for the drug-resistant bacteria to sustain the resistance.’ (116) 本研究的診斷採用，以台灣各醫院現有設備及人員素質而 言，診斷準確性應可信賴。 (W2) Běn yánjiū de zhěnduàn cǎiyòng ICD-9-CM, yǐ táiwān gè yīyuàn xiànyǒu shèbèi jí rényuán sùzhì ér yán, zhěnduàn zhǔnquè xìng yīng kě xìnlài ‘This study adopts ICD-9-CM for the diagnosis, in terms of the existing equipment of the hospitals in Taiwan and the quality of personnel, the diagnostic accuracy should be reliable.’

Like keneng 可能 ‘may’ and keyi 可以 ‘can’, yinggai 應該 ‘should’ can also be used to make suggestions. The suggestion may come from the speaker/writer him/self, as in (117), or from other source in the literature, as in (118):

(117) 在我們的.的.的,在我們的臨床裡頭 hon,我們應該要考慮,要用 以病人為中心的醫療照護 hon (S8) Zài wǒmen de. De. De clinical, zài wǒmen de línchuáng lǐtou hon, wǒmen yīnggāi yào kǎolǜ, yào yòng yǐ bìngrén wéi zhōngxīn de yīliáo zhàohù hon ‘Clinically, in our clinical practice hon, we should consider to adopt the patient- centered medical care hon.’ (118) 文獻表示器官移植病人處於免疫力低下，應定期檢測血液 CMV-PCR，以 及早發現，及早使用抗病毒製劑，能有效降低併發症與死亡率。 (W1) Wénxiàn biǎoshì qìguān yízhí bìngrén chǔyú miǎnyì lì dīxià, yīng dìngqí jiǎncè xiěyè CMV-PCR, yǐjízǎo fāxiàn, jí zǎo shǐyòng kàng bìngdú zhìjì, néng yǒuxiào jiàngdī bìngfā zhèng yǔ sǐwáng lǜ ‘Literature says that organ transplant patients who are under immunocompromised condition should regularly check blood CMV-PCR, an early detection and early use of antiviral agents can effectively reduce the complications and mortality.’

The last shared function of yinggai 應該 ‘should’ is to express expectations, which

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typically appears towards the end of a lecture, as in (119), or research article, as in (120):

(119) 那我們現在呢,雖然呢,整個醫院吶,現在擴大到十家醫院,那這個呢,應該把^ 整個整合起來,就是..復健,就是以你做中心,把它整合起來,然後呢,要做復健, 不一定到總院來啦,應該就在他家的旁邊就可以做 (S2) Nà wǒmen xiànzài ne, suīrán ne, zhěnggè yīyuàn nà, xiànzài kuòdà dào shí jiā yīyuàn, nà zhège ne, yīnggāi bǎ ^zhěnggè zhěnghé qǐlái, jiùshì.. Fù jiàn, jiùshì yǐ nǐ zuò zhōngxīn, bǎ tā zhěnghé qǐlái, ránhòu ne, yào zuò fù jiàn, bù yīdìng dào zǒng yuàn lái la, yīnggāi jiù zài tā jiā de pángbiān jiù kěyǐ zuò ‘What should we do now, although, the entire hospital system has expanded to 10 hospitals, and then, we should integrate the whole system, that is.. rehabilitation, that is to have you as the center, and make an integration, and then, if patents want to do rehabilitation, it is not necessary to come to the General Hospital, they should be able to do it in the branch hospital nearby.’ (120) 而且無論是醫療人員、病人或社會大眾，對於心肌梗塞應該再重新認識與 學習，才能在預防與治療方面達到效果。(W1) Érqiě wúlùn shì yīliáo rényuán, bìngrén huò shèhuì dàzhòng, duìyú xīnjī gěngsè yīnggāi zài chóngxīn rènshí yǔ xuéxí, cáinéng zài yùfáng yǔ zhìliáo fāngmiàn dádào xiàoguǒ ‘And whether medical staff, patients, or the general public, they should re- recognize and re-learn myocardial infarction in order to achieve the desired effect in terms of prevention and treatment.’

In the following, two exclusive communicative functions, to make predictions and to make conjectures, are identified in the spoken discourse. In (121) and (122), yinggai 應該

‘should’ is used to make predictions, while in (123), it is used by the speaker to make conjecture. yinggai 應該 in these cases convey the speakers’ uncertainty towards the events or situations.

(121) 它在評估的過程,目前很多部分還在..還在共識當中,還在追.但是這應該很快, 很快就會..um..慢慢地新的一個 version 就會出來 hon (S1) Tā zài pínggū de guòchéng, mùqián hěnduō bùfèn hái zài.. Hái zài gòngshì dāngzhōng, hái zài zhuī. Dànshì zhè yīnggāi hěn kuài, hěn kuài jiù huì..Um.. Màn man dì xīn de yīgè version jiù huì chūlái hon ‘In the process of assessment, presently the consensuses in many aspects are

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still .. still in debate, still negotiating, but it should be soon, soon ..um .. a new version will come out soon hon.’ (122) 不過,對於 kidney 的 injury..的..的那個,我想會有..應該會有些新的..新的發展. (S6) Bùguò, duìyú kidney de injury.. De.. Dì nàgè, wǒ xiǎng huì yǒu.. yīnggāi huì yǒuxiē xīn de.. Xīn de fāzhǎn. ‘However, as to the kidney injury .... um..that, I think there should be some .. new .. new development.’ (123) 所以這個 hon, 覆蓋起來,你可以做 或者是說要的, 實際上這些東西應該在台灣啊,豬羊,氣管他們不吃的嘛,所以這些東西應該 是很便宜,那只是說要經過認證啊,要消毒,不然就是會有感染的問題 (S3) Suǒyǐ zhège airway hon, or skin fùgài qǐlái, nǐ kěyǐ zuò cricothyrotomy huòzhě shì shuō yào airway de management, treatment, shíjì shang zhèxiē dōngxī yīnggāi zài táiwān a, zhū yáng, qìguǎn tāmen bù chī de ma, suǒyǐ zhèxiē dōngxī yīnggāi shì hěn piányí, nà zhǐshì shuō yào jīngguò rènzhèng a, yào xiāodú, bùrán jiùshì huì yǒu gǎnrǎn de wèntí ‘So this airway hon, or skin covered up, you can do cricothyrotomy or do the management treatment of airway, in fact, these things should be in Taiwan ah, swine and sheep trachea ..Well they do not eat, so these things should be very cheap, it only needs to be certified ah, should be disinfected, or there will be a problem of infection.’

4.2.5 Neng(gou) 能(夠) ‘can’

According to Lü (2000), nenggou 能夠 ‘can’ expresses the probability of an event. Li

(2004) further points out that nenggou 能夠 ‘can’ can convey epistemic possibility, and with the epistemic possibility, it can be used to replace hui 會 in Mandarin Chinese and in most dialects of North China although in other dialects hui 會 is often preferred instead of nenggou 能夠 ‘can’. Liu et al. (2011) argue that nenggou 能夠 ‘can’ can be used to estimate the possibility of an event. In Mandarin conversation, nenggou 能夠 ‘can’ is employed as a hedge to show the speaker’s hope towards the possibility of the proposition and at the same time signal the speaker’s lack of commitment (Chen 2008). In written

Chinese, neng(gou) 能(夠) ‘can’ is also found to present the writers’ hope for the

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practicability of their research purposes or experimental results. In addition, it is used by the

writer to make epistemic evaluation (Lo 2010). In my corpus, neng(gou) 能(夠) ‘can’ is used

to express possibility of events, to predict probability of events under conditions, to convey

expectations, or to make suggestions. The last function, to make suggestions, is observed

only in the written discourse.

Neng(gou) 能(夠) ‘can’ in examples (124) and (125) are used to express possibility of

events. The speaker of (124) indicates that the infertility center has cooperative plans with a

hospital in China. Since the infertility center of that hospital in China is brand new, the

speaker and his team members communicate with them a lot. They transmit some blueprints

and experiences to this new center and hope the new open center can operate smoothly and

well. Similarly, writers of (125) argue that certain medicine is capable of helping cancer patients with sleeping problems.

(124) 所以常常我們會有一些..一些..圖的ㄧ個來往 hon,我們..把我們的經驗 hon 交 給他們 hon,讓他們能夠讓開幕開幕以後 hon 能夠運作地更順利 (S8) Suǒyǐ chángcháng wǒmen huì yǒu yīxiē.. Yīxiē.. Tú deyi1 gè láiwǎng hon, wǒmen.. Bǎ wǒmen de jīngyàn hon jiāo gěi tāmen hon, ràng tāmen nénggòu ràng kāimù kāimù yǐhòu hon nénggòu yùnzuò de gèng shùnlì ‘So often we have some .. some ..sort of trade on graphs, we put on our experience hon .. to them hon, so that they can run smoothly after the opening.’ (125) 鴉片類藥物和或非鴉片類鎮痛藥來處理疼痛，通常能幫助癌症病人睡眠變 佳。(W1) Yāpiàn lèi yàowù hé huò fēi yāpiàn lèi zhèntòng yào lái chǔlǐ téngtòng, tōngcháng néng bāngzhù áizhèng bìngrén shuìmián biàn jiā ‘By using non-opioid drugs and opioid analgesics to manage pain, usually it can help cancer patients to get better sleep.’

In (126) and (127), the speaker/writers employ nenggou 能夠 ‘can’ to predict the probability of events under certain conditions. If-conditionals jiashe 假設 ‘if’ and ruguo 如

果 ‘if’ are utilized along with nenggou 能夠 ‘can’ to imply that the probability will be

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implemented only when the conditions are fulfilled. The application of if-conditionals helps

the speakers/writers to reduce their commitment to the propositions to an even smaller

degree.

(126) 假設能夠解決困難插管的一些事情,可能讓我們的醫療糾紛,可以減少四十個 percent.我有經過詳細的..啊統計,四十個 percent. (S3) jiǎshè nénggòu jiějué kùnnán chā guǎn de yīxiē shìqíng, kěnéng ràng wǒmen de yīliáo jiūfēn, kěyǐ jiǎnshǎo sìshí gè percent. Wǒ yǒu jīngguò xiángxì de.. A tǒngjì, sìshí gè percent ‘If we can solve some problems of difficult intubation, possibly our medical legal problems can be reduced forty percent, I have made detailed .. ah statistics, forty percent.’ (127) 從胃腸道給予病人營養殊為重要，尤其對重症的病人更有其必要性 。腸道 如果能夠得到養分，可以確保腸黏膜屏蔽功能的完整，減少腸內細菌轉移 到血中的機會。 (W1) Cóng wèicháng dào jǐyǔ bìngrén yíngyǎng shū wéi zhòngyào, yóuqí duì zhòngzhèng de bìngrén gèng yǒu qí bìyào xìng. Cháng dào rúguǒ nénggòu dédào yǎngfèn, kěyǐ quèbǎo cháng niánmó píngbì gōngnéng de wánzhěng, jiǎnshǎo cháng nèi xìjùn zhuǎnyí dào xiě zhòng de jīhuì ‘It is important to give the patient nutrition from the gastrointestinal tract, especially for patients with severe degree. If the ntestinal can get nutrients, then it can ensure the integrity of the intestinal mucosa shielding function, reducing the chance of intestinal bacteria transferred to the blood.’

Neng(gou) 能(夠) ‘can’ can be used to express expectations, as in (128) and (129). The

expectation may be derived from the speaker himself, as in (128), or from other people, as in

(129). Xiwang 希望 ‘hope’ is applied along with neng(gou) 能(夠) ‘can’ to imply that the expectations are merely subjective viewpoints.

(128) 那可是在..醫生的心裡面 hon,我們當然希望至少九成到九成五以上的ㄧ個藥 物能夠..涵蓋我們現在所面臨的ㄧ個感染。 (S4) Nà kěshì zài.. Yīshēng de xīn lǐmiàn hon, wǒmen dāngrán xīwàng zhìshǎo jiǔ chéng dào jiǔ chéng wǔ yǐshàng deyi1 gè yàowù nénggòu.. Hángài wǒmen xiànzài suǒ miànlín deyi1 gè gǎnrǎn ‘However, in the doctor's mind hon, we certainly hope that the medicine can at 142

least cover 90% to 95% of infection .. that we are facing now.’ (129) 許多腫瘤學家希望能用更簡便的篩檢方法，將會干擾老年癌症病人治療的 其他健康問題察覺出來。 (W2) Xǔduō zhǒngliú xué jiā xīwàng néng yòng gèng jiǎnbiàn de shāi jiǎn fāngfǎ, jiāng huì gānrǎo lǎonián áizhèng bìngrén zhìliáo de qítā jiànkāng wèntí chájué chūlái ‘Many oncologists hope that they can find some simpler screening methods to detect other health problems existing in elderly cancer patients.’

Examples (130) and (131) are extracted from the written discourse. Neng 能 ‘can’ in

these two examples are employed to make suggestions, and this function is observed exclusively in writing. The preceding assertive hedge jianyi 建議 ‘suggest’ in these two

cases apparently reinforces the sense of recommendation.

(130) 在病灶範圍分佈較廣或合併有空洞重度肺結核病人，建議能將確認有效藥 物加到 6 種。(W2) Zài bìngzào fànwéi fēnbù jiào guǎng huò hébìng yǒu kòng dòng zhòngdù fèijiéhé bìngrén, jiànyì néng jiāng quèrèn yǒuxiào yàowù jiā dào 6 zhǒng ‘For patients who have wider distribution voids or combine with severe tuberculosis, it is suggested that the confirmed effective drugs can be added to six kinds.’ (131) 即使是緊急手術，也建議病人在術前能至少接受兩個小時的血液透析。 (W2) Jíshǐ shì jǐnjí shǒushù, yě jiànyì bìngrén zài shù qián néng zhìshǎo jiēshòu liǎng gè xiǎoshí de xiěyè tòuxī ‘Even the emergency surgery, it is also suggested that the preoperative patient can receive at least two hours of hemodialysis.’

4.2.6 Summary

In sections 4.2.1 to 4.2.5, I have discussed modal auxiliaries used as hedges by

speakers and writers in the database. The five auxiliaries identified are keneng 可能 ‘may’,

keyi 可以 ‘can’, hui 會 ‘will/may’, yinggai 應該 ‘should’, and nenggou 能夠 ‘can’,

which are mainly used to convey the speaker’s/writer’s attitude or feeling towards the

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proposition being stated. The distribution of those various types of auxiliaries varies in terms

of genres. Hui 會 ‘will/may’ is employed the most frequently in the spoken discourse,

whereas keyi 可以 ‘can’ is the preferred auxiliary in the written discourse.

Although auxiliaries are essentially utilized by the speaker/writer to express epistemic uncertainty or probability, each auxiliary may display certain individual functions by means of its semantic, communication situation, and genre. In my data, keneng 可能 ‘may’ is shared by the speakers/writers to express epistemic possibility, to make predictions, or to make suggestions. Yet the other two functions, to show politeness and to make tentative invitations, only observed in the spoken data, with the former occurring in the Introduction and the latter in the Q & A part. Keyi 可以 ‘can’ is used by both the speakers/writers to express epistemic possibility, to make conjectures, or to make suggestions. Another function of keyi 可以 ‘can’ is to make polite invitations, which is observed exclusively in the spoken discourse. Again, this communicative purpose is identified in the Introduction and the Q & A parts of the lecture. Hui 會 ‘will/may’ is found to express probability, to make predictions, to anticipate the audiences’/readers’ possible doubts, or to convey expectations in both genres. However, one function which is only observed in the written data is to announce in advance the upcoming topics for later discussion or actions that will be accomplished in the future. As to yinggai 應該 ‘should’, several communicative purposes are shared by both genres, such as making estimations, making inferences, offering suggestions, and expressing expectations. Two functions, to make conjectures and to make predictions, occur solely in the spoken corpus. Nenggou 能夠 ‘can’ are found to be used by the speakers/writers to express possibility of events, to predict probability of events under conditions, or to express expectations. The other function of nenggou 能夠 ‘can’, to make suggestions, is exclusively

identified in the written corpus. The above generalization shows that modal auxiliaries are typically utilized by speakers/writers to express their attitude or subjective feelings towards

144 what is being stated.

4.3 Lexical hedges

According to previous studies (Lyons 1977, Perkins 1983, Coats 1983, 1987, 1995,

Markkanen 1985, Stubbs 1986, Palmer 1986, 1987, 1990, Thompson 1993, Hyland 1998,

2000), lexical hedges are utilized predominantly in realizing epistemic modality. This section will discuss the employment of lexical hedges by medical professionals in both spoken and written genres. The lexical hedges consist of lexical items and are classified in terms of grammatical categories, including verbs, adverbs, adjectives, and nouns, which will be discussed respectively in the following.

4.3.1 Verbs

Epistemic verbs are another means employed frequently by the speaker/writer to hedge their statements. As indicated by Hyland (1998: 119), epistemic verbs “represent the most transparent means of coding the subjectivity of the epistemic source and are generally used to hedge either commitment or assertiveness.” In the literature regarding epistemic modality, two types of epistemic verbs are generally identified, namely judgmental verbs and evidential verbs (Palmer 1986, Hyland 1996a, 1998, Hsieh 2002, 2006, Lo 2010). In the present study, these two typical types of verbs are adopted as basic categories. The other hedging verbs found in my corpus are classified into a supplementary category entitled “Others”. The hedging verbs included in this category are of many kinds: some of them may fall into the same group but with extremely small amount, while some of them cannot be included in any established category. In the spoken data, the share of this category is 13.84%, with 130 occurrences, whereas the share is 10.43% in the written data, with 82 occurrences. Figure 3 below displays the distribution of these three categories of epistemic verbs:

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80.00%

70.00%

60.00% S W 50.00%

40.00%

30.00%

20.00%

10.00%

0.00% Judgmental verbs Evidential verbs Others

Verbs Judgmental verbs Evidential verbs Others Spoken 63.58% (597) 22.58% (212) 13.84% (130) Written 71.76% (564) 17.81% (140) 10.43% (82)

Figure 3. Distribution of epistemic verbs used in the spoken genre vs. written genres

Figure 3 shows that judgmental verbs constitute the big majority of all the hedging verbs, and the tendency is consistent in the two genres. Judgmental verbs refer to verbs used to qualify the degree of commitment to the truth of a proposition, such as pingu 評估 ‘assess’ and kaolü 考慮 ‘consider’, and the judgments are based on the speaker’s/writer’s subjective evaluation. Based on my corpus, judgmental verbs are further divided into three subtypes: speculative verbs, assertive verbs, and resembling verbs. Speculative verbs (e.g. renwei 認為

‘consider’, jianyi 建議 ‘suggest’) convey the sense of conjecture, estimation, or doubts;

Assertive verbs denote a greater degree of possibility towards a proposition, which includes expressions to show the speaker’s/writer’s subjective judgments, beliefs, or suggestions.

Resembling verbs (e.g. haoxian 好像 ‘seem’, leisi 類似 ‘resemble’) refer to lexical hedges denoting possible parallelism of events or situations, trends of situations, or sense of implication, reference, or analogy. Epistemic evidential verbs refer to devices denoting that the information presented is less than definite. The evidentiary justification is based on the speaker’s/writer’s senses, hearsay evidence, or researches of others. This type of verbs is 146

divided into quotative and sensory verbs, with the former refers to the external evidence, such

as jüshuo 據說 ‘it is said that’ and tian naxie intern shuo 聽那些 intern 說 ‘according to

those interns’, and the latter refers to the speaker’s/writer’s own senses, such as juede 覺得

‘feel’ and ganjue 感覺 ‘feel’. The classification of judgmental verbs and evidential verbs is

presented in Table 8 below:

Table 8. Subcategories of judgmental verbs and evidential verbs

a. Speculative verbs Judgmental verbs b. Assertive verbs c. Resembling verbs a. Quotative verbs Evidential verbs b. Sensory verbs

In these two types of verbs, combining both spoken and written incidences, judgmental verbs

occur 1,161 times, whereas evidential verbs appear 352 times. Judgmental verbs make up the

majority of epistemic verbs, with 63.58% (597 occurrences) in speaking and 71.76% (564

occurrences) in writing. Evidential verbs occupy 22.58% (212 occurrences) in the spoken

data and 17.81% (140 occurrences) in the written data. In the following sections and

subsections, these two subcategories of verbs including their subtypes will be discussed one

by one. Figures and tables will be presented to show the distribution, forms, and frequency of each subtype. Illustrative examples from both genres will also be provided for better

comprehension.

4.3.1.1 Judgmental verbs

As mentioned in the above section, judgmental verbs are used predominately among

lexical verbs, and they are mainly utilized to convey the speaker’s/writer’s tentativeness

towards the truthfulness of a preposition. Altogether 99 different judgmental verbs, are

employed by the speakers, while 106 different judgmental verbs are used by the writers. In 147

the present study, judgmental verbs are further classified into speculative verbs, assertive

verbs, and resembling verbs. The numbers and percentages of each subtypes are presented in

Figure 4:

60.00%

50.00%

S W 40.00%

30.00%

20.00%

10.00%

0.00% a. speculative verbs b. assertive verbs c. resembling verbs

a. speculative verbs b. assertive verbs c. resembling verbs S 26.47%(158) 52.43%(313) 21.11%(126) W 37.59%(212) 39.72%(224) 22.70%(128)

Figure 4. Distribution of judgmental verbs in the spoken vs. written genres

Figure 4 displays a stratification within the judgmental verbs, with assertive verbs used the

most, speculative verbs the second, and resembling verbs the third, which holds true for both

genres. However, we see that assertive verbs seem to be especially favored in face-to-face

encounter since it is employed more than half among the three subtypes (52.43%). In the

following sections, the syntactic forms and communicative purposes of each subtype will be

thoroughly discussed.

4.3.1.1.1 Speculative verbs

Speculative verbs (e.g. kaolü 考慮 ‘consider’, pingu 評估 ‘assess’, huaiyi 懷疑

‘suspect’), as imply by the name, are normally use to express the speaker’s/writer’s uncertainty towards events or the propositions stated. By applying this group of verbs, the

148 speakers/writers can make conjecture or assessment, present doubts, or express uncertainty, and meanwhile deliver their less than full commitment towards the statements. 52 different speculative verbs are found in the spoken data, while 37 verbs are used in the written data.

Table 9 below illustrates the 10 most frequent speculative verbs employed by the speakers/writers to hedge their statements.

Table 9. Frequency of speculative verbs used in the spoken vs. written genres

Spoken N % Written N % 考慮 26 16.46% 考慮 60 28.30% 評估 18 11.39% 評估 57 26.89% 不曉得 10 6.33% 懷疑 13 6.13% 摹擬 10 6.33% 考量 12 5.66% 看看 9 5.70% 預測 9 4.25% 懷疑 7 4.43% 預估 7 3.30% 考慮到 5 3.16% 估計 6 2.83% 估計 5 3.16% 推估 5 2.36% 想說 4 2.53% 推測 5 2.36% 考量 3 1.90% 質疑 4 1.89%

Table 9 clearly shows that kaolü 考慮 ‘consider’ is utilized the most frequently and pingu

評估 ‘assess’ the second, which applies to both spoken and written genres.

Speculative verbs can be used by the speakers/writers to make conjecture as (132), to make assessment on certain event as (133), to show doubt as (134), or to express uncertainty as (135):

(132) 所以,我們也看到,有時候,我們覺得,ㄟ,藥有效,為甚麼..效果出不來 hon,那也 許你要考慮..有些是 tissue penetration 的一個問題。(S4) Suǒyǐ, wǒmen yě kàn dào, yǒu shíhòu, wǒmen juédé,ei1, yào yǒuxiào, wéishènme.. xiàoguǒ chū bù lái hon, nà yěxǔ nǐ yào kǎolǜ.. Yǒuxiē shì tissue penetration de yīgè wèntí ‘Therefore, we also see that.. sometimes, we feel that why medicine effective does not show up. Maybe you should consider .. some tissue penetration 149

problem.’ (133) hon 那病人的需要,我們會定時地跟他們討論,hon 他們去評估他們整個治療 的ㄧ個..一個療程 hon. (S8) Hon nà bìngrén de xūyào, wǒmen huì dìngshí de gēn tāmen tǎolùn,hon tāmen qù pínggū tāmen zhěnggè zhìliáo deyi1 gè.. Yīgè liáochéng hon ‘The patients' needs, we will discuss with them regularly, hon and they will assess the course of their entire treatment.’ (134) 蝙蝠也是夜行動物，白天撞見蝙蝠，而且還被攻擊，那肯定要懷疑碰到了 感染的蝙蝠。(W) Biānfú yěshì yèxíng dòngwù, báitiān zhuàngjiàn biānfú, érqiě hái bèi gōngjí, nà kěndìng yào huáiyí pèng dàole gǎnrǎn de biānfú ‘Bats are also nocturnal animals. If bats are seen during day time and they try to attack people, then it would be highly suspected that the bats are infected.’ (135) 剛剛提的都是比較 artery, coronary artery,那我不曉得 DVT..可以不可以用. (S6) Gānggāng tí de dōu shì bǐjiào artery, coronary artery, nà wǒ bù xiǎodé DVT.. Kěyǐ bù kěyǐ yòng ‘The situations just mentioned are relatively artery, coronary artery, and I am not sure whether DVT .. can be used or not.’

In examples (132), the speculative verb kaolü 考慮 ‘consider’ is used to suggest a probable reasoning while certain condition is not under expectation. This verb reduces the force of the speaker’s/writer’s suggestion, which make the statement less assertive and more polite. The speaker of (133) claims that the treatment of infertility is a long-termed procedure, and the medical staff in the infertility center will help create a conformable and professional condition for their patients. Yet the procedure is not a fixed routine; the patient can jointly participate to the procedure arrangement. In this example, the speaker utters that the staff regularly discuss the treatments with their patients, and the patients have the right to make assessments on the treatment procedure. Pingu 評估 ‘assess’ is used to explain that the evaluation is a subjective one as it is held in the patient’s hands. The speculative verb huaiyi

懷疑 ‘suspect’ in (134) conveys the writers’ uncertainty and avoids them making a full commitment to their statement. Buxiaode 不曉得 ‘not know’ of example (135) is another

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speculative verb which is observed in the spoken discourse but not in the written data, and this colloquial form is literally translated into ‘uncertain’. The speaker utilizes this verb to confess his lack of confidence on this issue.

4.3.1.1.2 Assertive verbs

As well as speculative verbs, assertive verbs function as hedging devices to convey the speaker’s/writer’s less than full commitment to the truthfulness of a proposition. In my medical corpus, assertive verbs are employed relatively more frequently than speculative verbs regardless of genres, as shown in Figure 4. Such verbs enable the speaker/writer to express subjective judgments and beliefs, such as renwei 認為 ‘consider’, xianxin 相信

‘believe’, yiwei 以為 ‘suppose’, and to make suggestions and recommendations, such as

jianyi 建議 ‘suggest’ and tweijian 推薦 ‘recommend’. The passive forms of assertive verbs

are also observed, but only in written data. Hyland (1998: 122) argues that in English the use

of passive form “allows a writer to hedge a responsibility to statements by appearing more

objective and distanced”, and this tendency is supported by my written data. In my spoken

data, 31 different assertive verbs are identified, while 20 different assertive verbs are used by

the writers. The top 10 most commonly used assertive verbs are illustrated in Table 10 below:

Table10. Frequency of assertive verbs used in the spoken vs. written genres

Spoken N % Written N % 想 122 38.98% 建議 121 54.02% 認為 53 16.93% 認為 52 23.21% 建議 30 9.58% 被認為 15 6.70% 想說 25 7.99% 相信 7 3.13% 相信 23 7.35% 認定 5 2.23% 認為說 14 4.47% 以為 4 1.79% 不建議 7 2.24% 不建議 3 1.34% 覺得 7 2.24% 推薦 3 1.34% siunn(想) 6 1.92% 被推薦 3 1.34% 以為 2 0.64% 也不能排除 1 0.45%

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Table 10 shows that xiang 想 ‘think’ is used the most frequently in face-to-face interaction,

which occupies 39.98%, whereas jianyi 建議 ‘suggest’ is utilized the most by writers, which appears 54.02% of all the assertive verbs. In the spoken data, xiang 想 ‘think’ is essentially a colloquial form which typically used in conversation, and it can be interpreted as ‘consider’ or ‘believe’ depending upon the context. Although xiang 想 ‘think’ and jianyi 建議

‘suggest’ are the most common means employed to hedge the speaker’s/writer’s commitment, there exists a distinction other than the forms. That is, xiang 想 ‘think’ conveys the sense of subjectivity, whereas jianyi 建議 ‘suggest’ is an addressee-oriented hedge. The sense of subjectivity presented by xiang 想 ‘think’ is reinforced by the preceding first person pronoun wu 我 ‘I’ as the speaker is the agent who performs the action xiang 想

‘think’. Among those different forms of verbs, some forms are particularly genre-specific,

such as xiangshuo 想說 ‘think’ and renweishuo 認為說 ‘think’. As well as xiang 想

‘think’, they are virtually colloquial forms and are observed exclusively in the spoken corpus.

The passive forms, berenwei 被認為 ‘being thought’, betuwijian 被推薦 ‘being

recommended’, and bexianxin 被相信 ‘being believed’, are found merely in the written

corpus. The following are examples with the most representative assertive verbs found in my

corpus:

(136) 我想在目前,整個台灣,啊呼吸治療方面,他應該是最 outstanding,而且具有領 先的很好的一個 leadership. (S3) Wǒ xiǎng zài mùqián, zhěnggè táiwān, a hūxī zhìliáo fāngmiàn, tā yīnggāi shì zuì outstanding, érqiě jùyǒu lǐngxiān de hěn hǎo de yīgè leadership ‘I think at the moment, in Taiwan, in the aspect of respiratory therapy, he should be the most outstanding, and owns the great leadership.’ (137) 可是老年人口越來越多,啊現在 disease 越來越複雜 hon,我想這種困難傷口 的..病人會越來越多啦 (S5) Kěshì lǎonián rénkǒu yuè lái yuè duō, a xiànzài disease yuè lái yuè fùzá hon, wǒ xiǎng zhè zhǒng kùnnán shāngkǒu de.. Bìngrén huì yuè lái yuè duō la ‘However, there are more and more elderly population, ah now the diseases are more complex, I think patients with this kind of difficult wounds .. will increas 152

more and more.’ (138) 在早期,很早年代,可能是.hon 比較資深,很前輩的,啊只是他們看到咳很久的, 他們就會認為..ㄟ可能就是百日咳 (S7) Zài zǎoqí, hěn zǎo niándài, kěnéng shì.Hon bǐjiào zīshēn, hěn qiánbèi de, a zhǐshì tāmen kàn dào hāi hěnjiǔ de, tāmen jiù huì rènwéi..Ei kěnéng jiùshì bǎirìké ‘In the early days, probably for more experienced predecessors, when they see patients caugh for a long time, they would probably consider it as pertussis.’ (139) ASGE 將所有大腸息肉切除術均列為高出血性風險，而 ESGE 認為大於一 公分的息肉切除術才為高出血性風險。 (W1) ASGE jiāng suǒyǒu dàcháng xíròu qiēchú shù jūn liè wèi gāo chūxiě xìng fēngxiǎn, ér ESGE rènwéi dàyú yī gōngfēn de xī ròu qiēchú shù cái wèi gāo chūxiě xìng fēngxiǎn. ‘ASGE classifies all colorectal polyps as higher bleeding risk, but ESGE consider only when they are greater than a centimeter, it can be defined as colorectal polyps with higher bleeding risk.’ (140) 我們過去都說,er 我們要適當地使用抗生素,那..過去相信大家也在很多的場 合,已經聽過這樣子的一個演講 (S4) Wǒmen guòqù dōu shuō,er wǒmen yào shìdàng dì shǐyòng kàngshēngsù, nà.. guòqù xiāngxìn dàjiā yě zài hěnduō de chǎnghé, yǐ jīng tīngguò zhèyàng zi de yīgè yǎnjiǎng ‘We used to say, er we should use antibiotics properly, and I believe all of you have heard of that .. in many occasions.’ (141) 有了這些新藥物的加入以及不同類型的合併治療，再加上吾人對宿主代謝 因子及基因變異的更加了解，將使未來 C 肝患者的治療變得更有效率、副 作用也更加減少。相信不久的將來，C 型肝炎會成為一個可以預防和治癒 的疾病。(W1) Yǒule zhèxiē xīn yàowù de jiārù yǐjí bùtóng lèixíng de hébìng zhìliáo, zài jiā shàng wúrén duì sùzhǔ dàixiè yīnzǐ jí jīyīn biànyì de gèngjiā liǎojiě, jiāng shǐ wèilái C gān huànzhě de zhìliáo biàn dé gèng yǒu xiàolǜ, fùzuòyòng yě gèng jiājiǎn shǎo. Xiāngxìn bùjiǔ de jiānglái, C xíng gānyán huì chéngwéi yīgè kěyǐ yùfáng hé zhìyù de jíbìng ‘With these new drugs and different types of combination therapy, coupled with my better understanding of the host metabolic factors and genetic variations, the future treatment for patients with hepatitis C will become more efficient, and the side effects will be reduced more. I believe in the near future, C-type hepatitis will become a preventable and treatable disease.’

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Xiang 想 ‘think’ in examples (136) and (137) can be interpreted as either renwei 認為

‘consider’ or xiangxin 相信 ‘believe’. Xiang 想 of these two examples represents the speakers’ subjective assumptions, which is further enhanced by their preceding first person subject wu 我 ‘I’. In my corpus, xiang 想 ‘think’ is exclusively used in the spoken discourse, which confirms that xiang 想 think is a rather colloquial verb. Renwei 認為

‘consider’ in examples (138) and (139) shows that the statements are made through subject judgments which may come from a group of people or a medical association. In addition to the verb’s transparent meaning in coding the speakers’/writers’ judgments, the attribution to the third party further helps the speakers’/writers’ reduce their commitment to the propositions. The assertive verb xiangxin 相信 ‘believe’ denotes a greater degree of subjective commitment; however, it is generally based on subjective judgments or experimental results. The assumption of (140) is made according to the speaker’s subjective judgment, while the belief the writers have in (141) is based on experimental results as well as the writer’s professional knowledge. In addition to expressing the belief, xiangxin 相信

‘believe’ in (141) conveys the writer’s anticipation for the future.

4.3.1.1.3 Resembling verbs

In my corpus, resembling verbs are typically used by the speakers/writers to draw a parallel between two analogous situations or to indicate the speakers’/writers’ subjective viewpoints towards certain events. They can also be used to imply that the information provided is merely for reference. In other words, resembling verbs enable the speakers/writers to make analogy, to express subjective viewpoint, or to provide reference, and all those actions imply the speaker’s/writers’ lack of full commitment to their statements or arguments. Although the frequency of resembling verbs (21.11%, with 126 occurrences) in the spoken data is closer to that (22.79%, with 128 occurrences) in the written data, the numbers of forms employed in the writing is approximately twice more than those being

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identified in the speaking. There are 23 different resembling verbs used by the speakers,

where there are 50 different ones used by the writers. The 10 most frequently used

resembling verbs for both genres are displayed in Table 11 below.

Table 11. Frequency of resembling verbs used in the spoken vs. written genres

Spoken N % Written N % 好像 57 45.24% 參考 21 16.41% 像 20 15.87% 似乎 14 10.94% 類似 10 7.94% 類似 13 10.16% 算是 6 4.76% 疑似 11 8.59% 參考 5 3.97% 相似 7 5.47% 說不定 5 3.97% 被視為 6 4.69% 搞不好 3 2.38% 接近 5 3.91% 似乎 2 1.59% 視為 4 3.13% 號稱 2 1.59% 好像 2 1.56% 算 2 1.59% 暗示 2 1.56%

Table 11 shows that the speakers tend to use resembling verbs, such as xiang 像 ‘seem’,

haoxiang 好像 ‘seem’, leisi 類似 ‘resemble’, to make analogy while the writers use resembling verbs, such as cankao 參考 ‘refer’, sihu 似乎 ‘seem’, and leisi 類似

‘resemble’ to make both reference and analogy. The examples that best demonstrate the

variety of syntactic forms and communicative purposes are provided as follows:

(142) 病人開始要…劇咳之前,那會咳嗽會很像機關槍那樣子,噴射狀,一直噴 (S7) Bìngrén kāishǐ yāo…jù hāi zhīqián, nà huì késòu huì hěn xiàng jīguānqiāng nàyàng zi, pēnshè zhuàng, yīzhí pēn ‘Before the patient begins to ... cough severely, the cough would seem like machine guns, keep spraying.’ (143) 2011 年 medscape review 中，藥物選擇增加了許多彈性，和成年人選項類 似，讓青少年的治療用藥多了許多選擇 (W2) 2011 Nián medscape review zhōng, yàowù xuǎnzé zēngjiāle xǔduō tánxìng, hé chéngnián rén xuǎnxiàng lèisì, ràng qīngshàonián de zhìliáo yòngyào duōle xǔduō xuǎnzé ‘In 2011 Medscape review, a number of elasticity has been added regarding the 155

choice of drugs, which resembles to the options for adults. The new policy increases a lot more drug treatment selection for the teens.’ (144) 它的一個細菌下降的程度跟它的一個指標,好像沒有一個..正相關的一個關 係 (S4) Tā deyi1 gè xìjùn xiàjiàng de chéngdù gēn tā deyi1 gè zhǐbiāo, hǎoxiàng méiyǒu yīgè.. zhèng xiāngguān deyi1 gè guānxì ‘The indicators and the extent concerning the declination of bacteria seem not to have a positive relationship.’ (145) 癌症篩檢上所謂“早期發現，早期治療＂的觀念，在年齡較大的老年族群 上，似乎有必要做更通盤的考量。(W2) Áizhèng shāi jiǎn shàng suǒwèi “zǎoqí fāxiàn, zǎoqí zhìliáo"de guānniàn, zài niánlíng jiào dà de lǎonián zúqún shàng, sìhū yǒu bìyào zuò gèng tōngpán de kaoliang ‘On cancer screening, the concept of the so-called "early detection, early treatment" seems necessarily to be taken a better reconsideration with regard to the older elderly population.’ (146) 啊這第三部分的話就是身體功能的,就是我們開始評--從那個..er..B1 開始評 過來 hon,這個各位..給各位參考. (S1) A zhè dì sān bùfèn dehuà jiùshì shēntǐ gōngnéng de, jiùshì wǒmen kāishǐ píng-- cóng nàgè..Er..B1 kāishǐ píng guòlái hon, zhège gèwèi.. Gěi gèwèi cānkǎo ‘Ah, this third part is the body functions, that is when we start the assessment -- from the ..er..B1 hon, this everyone .. everyone may refer to this.’ (147) 不熟悉的情況下，如一開始就去區分原發性或續發性問題，就可能於鑑別 診斷上出現困擾。故筆者依此原則做出( 圖一)供讀者參考。(W1) Bù shúxī de qíngkuàng xià, rúyī kāishǐ jiù qù qūfēn yuán fā xìng huò xù fā xìng wèntí, jiù kěnéng yú jiànbié zhěnduàn shàng chūxiàn kùnrǎo. Gù bǐzhě yī cǐ yuánzé zuò chū (tú yī) gōng dúzhě cānkǎo ‘Under unfamiliar circumstances, if we start to distinguish primary or renewal issues at the very beginning, problems may occur in the differential diagnosis. Based on this principle, I made (Figure 1) for readers to refer to.’

Examples (142) and (143) are elicited from the spoken data and written data respectively.

The resembling verbs xiang 像 ‘seem’ in (142) and leisi 類似 ‘resemble’ in (143) are used for the speaker/writer to make a comparison between two situations or two events in terms of their similarity. The resembling verbs haoxiang 好像 ‘seem’ in (144) and sihu 似乎 ‘seem’ in (145) are utilized to convey the speakers/writers subjective viewpoints. These verbs 156 semantically contain the sense of uncertainty, which enable the speakers/writers to avoid making a full commitment to their statements. In (146) and (147), the resembling verb cankao 參考 ‘refer’ is used for the speaker/writer to provide relative information, and the information is modestly regarded as reference by the speaker/writer. It is worth noting that certain resembling verbs seem to be utilized colloquially while others are employed in a formal way. For example, haoxiang 好像 ‘seem’ and xiang 像 ‘seem’ are the first two frequent resembling verbs in the spoken discourse while they only occur twice each in the written discourse. The relatively informal and colloquial forms, shuobuding 說不定

‘suspect’ and kaobuhao 搞不好 ‘suspect’ only observed in the spoken data, whereas the passive form beisiwei 被視為 ‘being regarded as’ is exclusively used in writing.

4.3.1.2 Evidential verbs

Evidential verbs indicate that the speakers’/writers’ acknowledgment of certain events or the deductive judgments of their statements is based either on experimental reports of others, hearsay evidence from someone or somewhere unidentified, or the speakers’/writers’ own perceptions. In order to distinguish the origins of the source, two subcategories of evidential verbs are classified, namely quotative verbs and sensory verbs. Quotative verbs comprise verbs referring to scientific evidence and hearsay evidence, whereas sensory verbs consist of verbs signaling perceptive senses. The evidential verbs used in both spoken and written genres are displayed in Figure 5.

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100.00% 90.00% S W 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Quotative verbs Sensory verbs

Quotative verbs Sensory verbs S 10.38%(22) 89.62%(190) W 77.86%(109) 22.14%(31)

Figure 5. Distribution of evidential verbs in the spoken vs. written genres

Figure 5 distinctly shows the opposite tendency on the employment of evidential verbs between genres. Sensory verbs are overwhelming preferred by the speakers while quotative verbs are used predominately by the writers. The discrepancy is presumably due to genre difference. In the following, the findings of quotative verbs and sensory verbs will be discussed.

4.3.1.2.1 Quotative verbs

Quotative verbs are verbs used to refer to quotative evidence, such as scientific evidence and hearsay evidence, which “demonstrate a reserved position to the material introduced” (Hyland 1998: 124). Even though writers use much more quotative verbs to hedge their statements than speakers (77.86% in writing versus 10.38% in speaking), they use equal number of forms, 7 different forms are identified in each genre. Table 12 below shows all the quotative verbs employed in both genres.

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Table12. Frequency of quotative verbs used in the spoken vs. written genres

Spoken N % Written N % 根據 9 40.91% 根據 76 69.72% 聽說 7 31.82% 依據 17 15.60% 聽到 2 9.09% 據 7 6.42% 依照 1 4.55% 依照 5 4.59% 照 1 4.55% 依 2 1.83% 據他說 1 4.55% 傳說 1 0.92% 聽那些 intern 說 1 4.55% 據稱 1 0.92%

Table 12 demonstrates that genju 根據 ‘according to’ is the most commonly used quotative

verb in both genres; however, it occupies a much greater proportion in the written discourse

(69.72%, with 76 occurrences) than in the spoken discourse (40.91%, with 9 occurrences).

The following examples demonstrate various functions that quotative verbs serve:

With the quotative verbs, the speaker/writers of examples (148) and (149) are able to show that the truthfulness of their propositions is based on some convincing criteria:

(148) 所以根據 CDC 他們的..的..的統計來講 hon,那個..百日咳,嬰兒會得到,那其實 都是成年人傳染的 (S7) Suǒyǐ gēnjù CDC tāmen de.. De.. De tǒngjì lái jiǎng hon, nàgè.. Bǎirìké, yīng'ér huì dédào, nà qíshí dōu shì chéngnián rén chuánrǎn de ‘Therefore, according to the statistical data of CDC .. hon, the pertussis that the baby get, are actually infected from adults.’ (149) 全球目前慢性 C 肝病毒感染的概況根據世界衛生組織的估計，全球目前至 少有一億八千萬以上的人遭到 C 肝病毒的感染，(W1) quánqiú mùqián mànxìng C gān bìngdú gǎnrǎn de gàikuàng gēnjù shìjiè wèishēng zǔzhī de gūjì, quánqiú mùqián zhìshǎo yǒuyī yì bāqiān wàn yǐshàng de rén zāo dào C gān bìngdú dí gǎnrǎn ‘As to the profiles of the global chronic hepatitis C virus infection, according to the estimation of World Health Organization, worldwidely there are more than one hundred eighty million people got infected with hepatitis C virus.’

In (148), the evidence elicited by genju 根據 ‘according to’ comes from the well-known medical association CDC, while in (149), the estimation is made by the international

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authority World Health Organization (WHO). By attributing the evidence to other sources,

the speakers/writers can reduce their commitment to the statements.

The evidence can also be unverified information or folktale, as in examples (150) and

(151) below:

(150) 那甚至最近都還有聽到這個 leukocytosis survey hon,那說不定以後還會有甚 麼 CRP survey 這樣子 hon.我覺得這不是一個..很好的一個..一個..想法 (S4) Nà shènzhì zuìjìn dōu hái yǒu tīngdào zhège leukocytosis survey hon, nà shuō bu dìng yǐhòu hái huì yǒu shénme CRP survey zhèyàng zi hon. Wǒ juédé zhè bùshì yīgè.. hěn hǎo de yīgè.. yīgè.. xiǎngfǎ ‘Even recently I have still heard that there is a leukocytosis survey hon. Maybe in the future there will be a CRP survey like this hon., I think this is not a .. a .. a .. good thought.’ (151) 傳說秦始皇時代就曾為長生不老藥而前往蓬萊尋求「仙丹」，但企圖失敗。 (W2) Chuánshuō qínshǐhuáng shídài jiù céng wèi chángshēng bùlǎo yào ér qiánwǎng pénglái xúnqiú `xiāndān', dàn qìtú shībài ‘It is said that in the legendary era of Qin Shi Huang, Qin Shi Huang sent people to Penglai to search for the "elixir of life", but his attempts failed.’

The quotative verbs tindao 聽到 ‘heard of’ in (150) and chuanshou 傳說 ‘it is said’ in

(151) indicate that the speaker’s/writer’s statements are based on undefined sources, with a hearsay in (150) and an ancient legend in (151). In these two examples, quotative verbs help

the speaker/writer avoid taking a full responsibility to their quotations.

The quotative information may also come from unidentified people, as in (152) and

(153):

(152) 啊我們教育的話,現在..聽說中山跟高醫都有在上這樣的課程 hon,但是..er.. 還.還上得不錯, 聽那些..intern 說 hon,那..所以,我們以前就是沒有受這種教 育訓..好多 hon (S5) A wǒmen jiàoyù dehuà, xiànzài.. tīngshuō zhōngshān gēn gāo yī dōu yǒu zài shàng zhèyàng de kèchéng hon, dànshì..er.. hái. hái shàng dé bùcuò, tīng nàxiē..intern shuō hon, nà.. suǒyǐ, wǒmen yǐqián jiùshì méiyǒu shòu zhè zhǒng 160

jiàoyù xùn.. Hǎoduō hon ‘Ah, our education, now .. I have heard that Zhongshan Hospital offers this type of courses hon, but ..er .. and the courses are good, according to those ..interns hon, that .. so, we did not have chance to accept this kind of education before.’ (153) 這個病人 hon,一個...五十二歲的男性病人,他來我的門診的時候,他是一個彌 漫性的 hon,這是一--這是紅疹,他據他說,這是一個很深的 .這個傷口..大概一點五公分的地方 hon (S5) Zhège bìngrén hon, yīgè... Wǔshí'èr suì de nánxìng bìngrén, tā lái wǒ de ménzhěn de shíhòu, tā shì yīgè mímàn xìng de dermatitis hon, zhè shì yī--zhè shì hóng zhěn, tā jù tā shuō, zhè shì yīgè hěn shēn de operation wound. Zhè gè shāngkǒu.. Dàgài yī diǎn wǔ gōngfēn dì dìfāng hon ‘The patient hon, a ... male patient aged 52, and he came to my clinic, he had a diffuse dermatitis hon, this is a - this is a rash, according to him, it was a deep operation wound and it was probably located in the position of one point five centimeters hon.’

In (152), the speaker uses a quotative verb, tingshuo 聽說 ‘hear of’, and a verb phrase, ting

naxie intern shou 聽那些 intern 說 ‘according to those interns’, to imply that the

information he provides are from unidentified people. By that, the speaker is able to distance

himself from the truth of the information. ju ta shou 據他說 ‘according to him’ is the verb

phrase employed by the speaker of (153) to signal that the information is provided by the patient instead of the speaker himself. Since the patient comes to the speaker with an already- serious condition, the speaker has no way to find out the cause besides hearing from the patient’s own depiction. By restating the patient’s chief complaint with the quotative verbs, the speaker can prevent himself from making a full commitment to his utterance.

4.3.1.2.2 Sensory verbs

Sensory verbs are generally used to indicate that the truefulness of a proposition is based on the speakers’/writers’ subjective perception. Altogether 30 different forms (with 190 occurrences) are utilized by the speakers to express their subjective judgments towards the utterances, while 18 different forms (with 31 occurrences) are employed by the writers. Table

13 illustrate the top 10 sensory verbs used by the speakers/writers. 161

Table 13. Frequency of sensory verbs used in the spoken vs. written genres

Spoken N % Written N % 覺得 97 51.05% 注意 6 19.35% 覺得說 15 7.89% 感到 4 12.90%

看得出來 9 4.74% 察覺 3 9.68% 看起來 8 4.21% 看起來 2 6.45% 感覺到 8 4.21% 感覺 2 6.45%

注意 6 3.16% 覺得 2 6.45% 記得 6 3.16% 回想 1 3.23% 看看 5 2.63% 回想起來 1 3.23%

發覺 4 2.11% 有感於 1 3.23% 發覺說 4 2.11% 自覺 1 3.23%

Table 13, the percentage of juede 覺得 ‘feel’ (51.05%) in spoken data instantly attract attention as it is especially high among those sensory verbs, which implies that the speakers tend to employ juede 覺得 ‘feel’ to express their subjective opinions towards the statements.

In the written data, there is not a preferred sensory verb observed. Sensory verbs are employed evenly in the written discourse. The discrepancy concerning the distribution of sensory verbs may be due to genre difference. The realization of syntax in natural conversation is dynamic and locally managed, so the speakers usually use the forms that pop up at the time while having an instantaneous talk. Thus, juede 覺得 ‘feel’ can be seen as the most favored sensory verb in face-to-face encounter. In writing, repetition is one of the constraints that writers should try to avoid, and that may be the reason that sensory verbs are well-distributed in the written data. The following examples demonstrate how the speakers/writers express their personal viewpoints by applying sensory verbs:

(154) 那最近..er..即使醫學會他們開始想要做一個革命 hon,他們想要給..給醫生 有..有拒絕病人的權利,那..我覺得這事..最..終..終究不會成就啦, (S2) Nà zuìjìn..Er.. Jíshǐ yīxué huì tāmen kāishǐ xiǎng yào zuò yīgè gémìng hon, tāmen xiǎng yào gěi.. gěi yīshēng yǒu.. yǒu jù jué bìngrén de quánlì, nà.. Wǒ juédé zhè shì.. zuì.. zhōng.. zhōngjiù bù huì chéngjiù la 162

‘Lately..er..even if the Medical Association, they started thining of making a revolution hon, they want to .. give doctors the right of refusing patients, .. that .. I feel that this thing .. eventually... eventually.. will not succeed.’ (155) hon 這個也是..er 我個人覺得說,我們..參與了..ICF,就是參與了身心障礙鑑定, 不是只有幫政府做這些一般的事情,我們要有一個..加值,一個邊際效應出來, (S1) Hon zhège yěshì..er wǒ gèrén juédéshuō, wǒmen.. cānyùle..ICF, jiùshì cānyùle shēnxīn zhàng'ài jiàndìng, bùshì zhǐyǒu bāng zhèngfǔ zuò zhèxiē yībān de shìqíng, wǒmen yào yǒu yīgè.. Jiā zhí, yīgè biānjì xiàoyìng chūlái ‘This is ..er, I personally feel that we .. participated in..ICF, the identification of disability, not only help the government do these general things, we expect to have a .. bonus, a marginal effect coming out,’ (156) 像我們以前就是,只有知道患者的就好,那現在,那個 我們也都要注意 hon,心裏層面的啦,啊他的活動部分,我 們都要注意. (S1) Xiàng wǒmen yǐqián jiùshì, zhǐyǒu zhīdào huànzhě de physical condition jiù hǎo, nà xiànzài, nàgè physical social wǒmen yě dū yào zhùyì hon, xīnlǐ céngmiàn de la, a tā de huódòng bùfèn, wǒmen dōu yào zhùyì ‘Before, we only needed to know the patients’ physical condition. And now, we need to pay attention to both their physical and social conditions hon, such as phychological aspect, their daily activities. All of these, we have to pay attention to.’ (157) 可見在處理兒童泌尿道感染時，我們也須同時注意是否有其它潛在危險因 子，(W2) Kějiàn zài chǔlǐ értóng mìniào dào gǎnrǎn shí, wǒmen yě xū tóngshí zhùyì shìfǒu yǒu qítā qiánzài wéixiǎn yīnzǐ ‘While dealing with children who have urinary tract infection, we shall also pay attention to whether there are other potential risk factors,’ (158) 發現高達 11%的健康婦女有偽陽性的報告，12%的婦女對此項檢查感到有 壓力 (W2) Fāxiàn gāodá 11%de jiànkāng fùnǚ yǒu wěi yángxìng de bàogào,12% de fùnǚ duì cǐ xiàng jiǎnchá gǎndào yǒu yālì ‘It is found that up to 11% of healthy women have a false positive report, 12 percent of women feel stressful on this check.’

The above examples show that the subject who performs the sensory verbs is not necessarily the speaker or the writer. It can be a group of people who take part in certain experiments or

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the inclusive ‘we’. juede 覺得 ‘feel’ in (154) collocates with the first person pronoun wo 我

‘I’ to indicate that the utterance is a personal viewpoint; Juedeshuo 覺得說 ‘feel’ in (155)

collocates with both the first person pronoun wo 我 and the reflexive geren 個人 ‘personal’

to emphasize that the statement is merely the speaker’s subjective evaluation, which displays

the strong sense of subjectivity. Examples (156) and (157) contain the inclusive women 我們

‘we’, which show the speakers’/writers’ affiliation to the audience/readers, and zhuyi 注意

‘pay attention’ serve to remind the hearers/readers to sense other aspects during the treatment.

In (158), the subject of the verb gandao 感到 ‘feel’ is a group of women. This type of the third party subject occurs relatively much less in the medical discourse. In general, sensory verbs in great majority focus on the perception of mind. The sensory verbs referring to the auditory or visual sense are uncommon. Those verbs convey the speakers’/writers’ subjective perceptions with the transparent semantics. With sensory verbs, the speakers/writers express that the truthfulness of propositions are based on perceptions instead of scientific evidence, which help them distance themselves from the verifiability of the statements.

Hyland (1998: 124) argues that “scientific writers rely heavily on ‘hearsay’ evidence from the research literature, and the choice of reporting verb can indicate their commitment to what is reported.” The quotative verbs are utilized not only to specify and acknowledge previous findings but also to present the writers’ stance towards those findings. This may explain why quotative verbs are applied overwhelmingly in the written corpus. In face-to- face interaction, the speakers on the one hand ought to express their attitude and feeling to what is being said, and on the other hand need to pay attention to the interaction with their audiences. The sensory verbs greatly serve these two functions since they are typically used to indicate that what is being said is based on the speakers’ subjective viewpoints. As the communicative style of the peer lectures is partially adheres to conversation, the common conversational hedges, such as juede 覺得 ‘feel’ and juedeshuo 覺得說 ‘feel’ are inevitably

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repeated constantly in spontaneous talks. On the contrary, writing is not an instant process,

the writers always can make time to check and cite the references. Owing to the above

reasons, quotative verbs and sensory verbs distribute differently between these two genres.

4.3.1.3 Other verbs

The verbs placed in the category of ‘Others’ are those that cannot be assigned into the previous categories. Some verbs may fall into the same group, but the small amount does not affect the overall distribution of hedging verbs. They make up 13.84% (130 occurrences) in the spoken corpus and 10.43% (82 occurrences) in the written corpus. The verbs in this category contain various kinds of meanings and functions. I sort out those verbs by means of their function and briefly introduce as follows. Among those hedging verbs, the majority are verbs used to express the speakers’/writers’ intention or the potential probability to complete certain events, as jinliang 盡量 ‘try one’s best’, xiangbanfa 想辦法 ‘think of some ways’, qinjiao 請教 ‘consult’, and changshi 嘗試 ‘try’. Some verbs are used to anticipate the occurrences of events, or to expect for the future achievement of certain situations, such as yuqi 預期 ‘anticipate’ and xiwan 希望, and ‘hope’ xiwanshuo 希望說 ‘hope’. There are still some hedging verbs used by the speakers/writers to neutrally describe their research or

raise their findings. They modestly take the lectures or findings as merely a ‘report’ instead of

work with contribution. Baogau 報告 ‘report’, kaisu 概述 ‘outline’, and ticu 提出 ‘put forward’ belong to this type of verbs. A small amount of verbs found in this category are used to indicate that certain portion of an event has gained greater attention or a situation tends to incline to certain direction, such as qinxian 傾向 ‘tend to’ and pianxianyu 偏向於 ‘incline

to’.

4.3.1.4 Summary

Hedging verbs are commonly utilized by the speakers/writers to reduce their

commitment to the propositions. The application of hedging verbs does not show statistical

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significance between the spoken and the written genre. That is, speakers and writers tend to

employ similar amount of hedging verbs. It might be owing to the fact that epistemic verbs

are the most transparent means to code the subjectivity of the epistemic source (Hyland

1998). In the present study, epistemic verbs are mainly classified into judgmental verbs and

evidential verbs. Judgmental verbs are predominately used in both spoken and written genres,

which are used to qualify the degree of commitment towards the propositions according to

the speakers’/writers’ subjective judgments. Judgmental verbs are further divided into

speculative verbs, assertive verbs, and resembling verbs. Their distributions in the spoken and

the written genres are similar. Evidential verbs are used to indicate the speakers’/writers’

acknowledgment of certain events, or to denote that the judgments of the speakers’/writers’

statements are based either on experimental findings of others, hearsay evidence, or their own

perceptions. Evidential verbs are classified into quotative verbs and sensory verbs for

distinguishing the origins of the source. Quotative verbs are used to refer to scientific

evidence and hearsay evidence, whereas sensory verbs are used to signal perceptive source.

My results show that quotative verbs are predominately used by the writers, whereas the speakers favor sensory verbs. The discrepancy is presumably due to genre difference. As scientific writers count on hearsay evidence from the research literature, the quotative verbs serve this purpose. In face-to-face interaction, subjectivity and intersubjectivity play crucial roles in the spontaneous talks. Sensory verbs enable the speaker to modestly express subjective viewpoints. In addition, sensory verbs juede 覺得 ‘feel’ and juedeshuo 覺得說

‘feel’ are typical conversational hedges. In naturally occurring talk, those verbs occur

constantly due to cognitive constraint. Besides judgmental verbs and evidential verbs, some

hedging verbs which cannot be included in previous established categories or subcategories

are classified in the category of ‘Others’. These verbs are mainly used to express the

speakers’/writers’ intention or potential probability to complete certain events, to anticipate

166 the occurrences of events, to expect for the future achievement of certain situations, to neutrally describe their research findings, or to modestly ‘report’ their experimental contribution. The results of my medical corpus, both the spoken and written discourses, confirm Hyland’s (1996a, 1998) written data, which manifest that speakers/writers do not just distinguish judgment from evidence but choose appropriate hedges to modify their commitment to the statements.

4.3.2 Adverbs

As shown is Figure 1, epistemic adverbs are the most frequently used lexical hedges in both the spoken and written discourses, which conform with Chen’s (2008) conversational data and Lo’s (2010) written texts. The application of hedging adverbs between the spoken and the written genre does not show statistical significance. The great majority of the usage may be owing to the specific syntactic and semantic features that adverbs possess. Epistemic adverbs can appear in various positions within a clause and they can be associated with diverse concepts (Perkins 1983, Hyland 1998, Varttala 2001, Chen 2008, Lo 2010). Epistemic adverbs are regarded as “peripheral in clause structure” (Quirk et al. 1972: 421) since they can appear in a number of different positions in a clause without affecting the meaning relation between clause and adverbs. Epistemic adverbs can be used to express the speaker’s/writer’s stance towards events, the probability of situations, the degree or frequency of certain events. Following Lo’s (2010) classification which combine Varttala’s (2001) and

Chen’s (2008) classifications, the epistemic adverbs in the present study are subcategorized into stance adverbs, adverbs of indefinite degree, adverbs of indefinite frequency, and adverbs of approximation. Figure 6 displays the distribution of these four subcategories of epistemic adverbs:

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60.00%

50.00% S W 40.00%

30.00%

20.00%

10.00%

0.00% ABCD

B. Adverbs of C. Adverbs of indefinite D. Adverbs of A stance adverbs Adverbs indefinite degree frequency approximation S 49.46%(1427) 25.68%(741) 12.24%(353) 12.62%(364) W 40.11%(927) 30.07%(695) 17.78%(411) 12.03%(278)

Figure 6. Distribution of subcategories of epistemic adverbs in the spoken vs. written genres

Figure 6 shows that stances adverbs are employed the most frequently in both the spoken and written discourses, and adverbs of indefinite degree the second. As to the other two subcategories of adverbs, the speakers use more adverbs of indefinite frequency than adverbs of approximation, whereas the writers employ more adverbs of approximation than adverbs of indefinite frequency. In the following sections, these four subcategories will be discussed in turn.

4.3.3.1 Stance adverbs

Expressions of stance enable the speakers/writers to present themselves, to express their viewpoints and judgments, to convey the degrees of commitments, as well as to interact with the hearers/readers. According to Hyland (1999), stance refers to “the ways that writers project themselves into their texts to communicate their integrity, credibility, involvement, and a relationship to their subject matter and their readers” (p. 101). Traditionally, academic writing is labelled as objective, impersonal, and faceless; yet from the last decade or so, it has 168

gradually seen as a persuasive endeavor engaging both writers and readers (Hyland 2005).

The results of my study show that stance adverbs are used the most frequently among various subcategories of epistemic adverbs, with 49.46% in speaking and 40.11% in writing, as shown in Figure 6 above. The speakers, in particular, utilize a greater amount of stance adverbs (79 different types) to modify the degree of their commitments towards the propositions, and simultaneously involve interaction with their hearers compared to 37 different stance adverbs identified in the written discourse. Table 14 illustrates the 10 most commonly used stance adverbs in both genres.

Table 14. Frequency of stance adverbs used in the spoken vs. written genres

Spoken N % Written N % 其實 402 28.17% 或 645 69.58% 事實上 221 15.49% 目前 117 12.62% 大概 144 10.09% 或是 63 6.80% 基本上 107 7.50% 其實 12 1.29% 或是 82 5.75% 或者 12 1.29% 或 68 4.77% 或許 8 0.86% 目前 55 3.85% 也許 7 0.76% 或者是 51 3.57% 原則上 7 0.76% 或者 33 2.31% 事實上 6 0.65% 也許 27 1.89% 基本上 6 0.65%

Table 14 shows that qishi 其實 ‘actually’ is employed the most (28.17%) in spoken discourse

while huo 或 ‘alternatively’ (69.58%) is overwhelmingly preferred by the writers. The

commonly used stance adverbs found in my data include adverbs referring to the

speakers’/writers’ subjective attitude, such as qishi 其實 ‘actually’, shishishang 事實上 ‘in fact’, jibenshang 基本上 ‘basically’, and muqian 目前 ‘currently’, adverbs referring to

potential alternatives, such as huo 或 ‘alternatively’, huoshi 或是 ‘alternatively’, and

huozhe 或者 ‘alternatively’, and adverbs referring to degrees of probability, such as dagai

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大概 ‘probably’, huoxu 或許 ‘perhaps’ and 也許 yexu ‘maybe’. The examples below contain the common types of stance adverbs used in both genres:

(159) 來到彰基 hon,其實 case 最多還是在我們的分院,(因為這種..這種)困難傷口,其實跟..跟你的 的有關係啦,其實都是不行了,來到這邊來,來到這邊來其實就 是..也都是困難傷口,照顧起來都是很辛苦 (S5) Dào zhāng jī hon, qíshí case zuìduō háishì zài wǒmen de fēnyuàn,yinwi ji jong..Ji jong(yīnwèi zhè zhǒng.. Zhè zhǒng) kùnnán shāngkǒu, qíshí gēn.. Gēn nǐ de low..Low social economic de patient yǒu guānxì la, qíshí dōu shì bùxíngle, lái dào zhè biān lái, lái dào zhè biān lái qíshí jiùshì.. yě dū shì kùnnán shāngkǒu, zhàogù qǐlái dōu shì hěn xīnkǔ ‘Coming to CCH hon, actually, most of the cases are spreaded in our branches, because this..this kind of difficult wounds, actually is associated with .. with the low..low social economic status of patients. Acutally the wounds looked bad while they came over here. Actually.. they are difficult wounds, and they are very difficult to be taken care of.’ (160) 我們這台 CT,嚴格上講起來,我們對外講,號稱八百切,事實上這一個數字,這 個 magic number,事實上是用,我們推算,就是..喔,在同一個時段,那這樣切,最 多..算出來電腦處理的 (S6) Wǒmen zhè tái CT, yángé shàng jiǎng qǐlái, wǒmen duìwài jiǎng, hàochēng bābǎi qiè, shìshíshàng zhè yīgè shùzì, zhège magic number, shìshíshàng shì yòng, wǒmen tuīsuàn, jiùshì.. Ō, zài tóng yīgè shíduàn, nà zhèyàng qiè, zuìduō.. Suànchū lái diànnǎo chǔlǐ de ‘The CT scanner we have, strictly speaking, we claim that it is 800 slices. Actually it is just a number, the magic number. It is actually an approximative calculation. That is.. oh, within a period of time, the slices number is counted buy .. computer processing.’

The first qishi 其實 ‘actually’ of (159) is to indicate the contrastive relationship between the

current proposition and the previous one. The speaker states that many local clinics cannot

offer proper treatments for difficult wounds, so the patients come to HOS for help. Since the

lecture is held in the main hospital, the speaker uses Qishi 其實 ‘actually’ as a contrastive

marker to specify that those patients were mainly taken care of by the branch hospitals. The

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remaining tokens of the qishi 其實 ‘actually’ are used to express the speaker’s opinion based

on his experience. Shishishang 事實上 ‘in fact’ of (160) contains the sense of correction.

The speaker, the chief of department of Radiation Oncology, claims that the number

indicating the advanced function of CT scanner is actually an estimated rather than an

accurate number. Qishi 其實 ‘actually’ and shishishang 事實上 ‘in fact’ are regarded as

discourse markers in Wang et al.’s (2010) study. They argue that qishi 其實 ‘actually’ and

shishishang 事實上 ‘in fact’ serve several pragmatic functions, such as correcting,

informing, or shifting topic. They can be used to convey the speaker’s attitude towards the

truthfulness of the proposition, to relate the proposition to a pervious assertion or assumption,

and to express concern for the addressee’s face.

Dagai 大概 ‘probably’ is classified as a stance adverb while it denotes the sense of probability. The following example illustrate this communicative purpose of dagai 大概:

(161) 不過不管怎樣 hon,大概一次的針扎..我們大概都不會想去冒這樣的風險. (S9) Bùguò bu guǎn zěnyàng hon, dàgài yīcì de zhēn zhā.. wǒmen dàgài dōu bù huì xiǎng qù mào zhèyàng de fēngxiǎn ‘But anyway hon, probably once a needlestick .. we probably would not want to take that risk.’

In (161), the speaker uses dagai 大概 ‘probably’ to infer that people may not want to

take any chance to get needlestick injury. Although the statement is perfectly true in reality,

the speaker applies dagai 大概 ‘probably’ to make his statement less assertive and more

modest. It is interesting to note that although dagai 大概 ‘probably’ appears as the third

most frequently used stance adverbs, it is not used by the writers at all.

Muqian 目前 ‘currently’ is literally translated into ‘currently’, but it also implies the

meaning of ‘so far’ in the examples of my database:

(162) 偏頭痛目前最被接受的成因及解釋是由於腦部受到不同原因的刺激(包含藥 171

物、食品、失眠、其他誘因等)，造成興奮性物質的釋放 (W2) Piāntóutòng mùqián zuì bèi jiēshòu de chéngyīn jí jiěshì shì yóuyú nǎo bù shòudào bùtóng yuányīn de cìjī (bāohán yàowù, shí pǐn, shīmián, qítā yòuyīn děng), zàochéng xīngfèn xìng wùzhí de shìfàng ‘Migraine, currently, the most accepted cause and explanation is that different kinds of brain stimulation (including drugs, food, sleep, other incentives, etc.) bring about the release of excitatory substances.’

The writers of (162) employ muqian 目前 ‘currently’ to declare the most acceptable explanation for the cause of migraine. There are so many unknown reasons that may result in migraine, so even the specialists do not dare to make determinate assertion regarding unidentified headache. Muqian 目前 ‘currently’ is then employed to make a current tentative inference, and there may be other potential explanations uncovered some day. Therefore, the stance adverb muqian 目前 ‘currently’ is not only used to express the current situations but also to imply that there will always be forthcoming solutions or advanced technology as times goes by.

In addition to uncertainty, the notion of alternatives is another common sense held in medical professionals. The adverb huo 或 ‘or’ is utilized frequently by speakers/writers to express alternatives, especially in the writing. The illustrative example below is extracted from the written discourse:

(163) 心臟長期處於缺氧狀態，最終也會造成心臟衰竭或引發心律不整而危及生 命 (W2) Xīnzàng chángqí chǔyú quē yǎng zhuàngtài, zuìzhōng yě huì zàochéng xīnzàng shuāijié huò yǐnfā xīnlǜ bùzhěng ér wéijí shēngmìng ‘If the heart stays in a long-term hypoxic state, it will eventually cause heart failure or lead to life-threatening arrhythmias.’

As well as uncertainty, there are always alternatives in clinical practices in spite of diagnosis, prognosis, or treatment. The speakers/writer utilize huo 或 to signal that there are existing alternatives or available options, and meanwhile to withdraw their responsibility from giving 172

an absolute answer. The writers of (163) use huo 或 ‘alternatively’ to refer to the possible

consequence of Cardiac hypoxia in terms of their professional knowledge. In the present

study, the frequencies presented in tables are based on the syntactic forms used by the

speakers and the writers; however, in Chinese some words may have variants, such as huo 或

‘alternatively’. In my databank, several variables of huo 或 ‘alternatively’ are observed

including huoshi 或是, huozhe 或者, huozheshi 或者是, haishi 還是, huoshishuo 或是說,

huozheshishuo 或者是說, huozheshuo 或者說, huoshuo 或說, and Taiwanese ah 抑 and asikong 抑是講. All those variables share the identical meaning. If we add up the variants to huo 或, the total number of huo 或 ‘alternatively’ will reach up to 310 tokens in the spoken discourse, and that will make huo 或 ‘alternatively’ becomes the second most frequently used stance adverb. The total number will amount to 720 in the written data, which still keep huo 或 ‘alternatively’ on the top priority.

4.3.3.2 Adverbs of indefinite degree

Adverbs of indefinite degree are generally used to refer to various degrees of epistemic qualification or quantification. Without specifying the precise quality or quantity, the speakers/writers are able to distance themselves from rendering an absolute accuracy. As in the stance adverbs, the speakers employ a greater variety of adverbs of indefinite degree than the writers (75 vs. 58 different adverbs). Table 15 illustrates the top 10 adverbs referring to the degrees of uncertainty.

Table 15. Frequency of adverbs of indefinite degree used in the spoken vs. written genres

Spoken N % Written N % 比較 292 39.41% 較 400 57.55% 一下 78 10.53% 容易 73 10.50% ka(較) 45 6.07% 易 38 5.47% 蠻 43 5.80% 主要 37 5.32% 一點 31 4.18% 比較 26 3.74%

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容易 28 3.78% 偏 15 2.16% 主要 27 3.64% 相對 13 1.87% 不太 25 3.37% 不易 8 1.15% 稍微 22 2.97% 尚 7 1.01% 有點 14 1.89% 不盡 5 0.72%

From Table 15, we see that bijiao 比較 ‘relatively’ is used the most often by the speakers,

and jiao 較 ‘relatively’ is employed the most by the writers. These two adverbs actually

share an identical semantic meaning, and the divergence in lexeme is presumably due to

genre difference. That is, in Chinese, the lexemes in writing seem to be more syllabically

dense in compared with speaking. Therefore, the writers tend to use the monosyllabic form

jiao 較 ‘relatively’ while the speakers prefer the disyllabic form bijiao 比較 ‘relatively’.

Table 15 also shows that besides bijiao 比較 ‘relatively’ and jiao 較 ‘relatively’ which

occur in a relatively high frequency in both genres, the rest of the adverbs of indefinite degree

seem to distribute evenly. The following examples demonstrate the common usage of adverbs

of indefinite degree:

(164) 日本的..他們..er 跟我們的..er 民情是比較接近,所以他們有些地方是可以給 我們做很好的借鏡, (S1) Rìběn de.. Tāmen..Er gēn wǒmen de..er mínqíng shì bǐjiào jiējìn, suǒyǐ tāmen yǒuxiē dìfāng shì kěyǐ gěi wǒmen zuò hěn hǎo de jièjìng ‘In Japan .. their..er and our ..er sentiments are relatively close, so in cetain aspects we can learn from them,’ (165) (咱們大部分都測)空腹. (較簡 單). (S10) Lan taipoohun long tshe(zánmen dà bùfèn dōu cè) kōngfù kha kantan. (Jiào jiǎndān) ‘We usually measure after fasting plasma glucose which is relatively simple.’ (166) 某些糖尿病病人較易發生黎明現象或(W2) Mǒu xiē tángniàobìng bìngrén jiào yì fāshēng límíng xiànxiàng huò Somogyi effect ‘Some diabetic patients are relatively prone to dawn phenomenon or Somogyi effect’ 174

(167) 季節及氣溫的變化容易造成呼吸道感染，進而短暫性增加腦中風的機會 (W1) Jìjié jí qìwēn de biànhuà róngyì zàochéng hūxīdào gǎnrǎn, jìn'ér duǎnzàn xìng zēngjiā nǎo zhòngfēng de jīhuì ‘The changes of seasons and temperature cause respiratory infections easily, and thus increase the chance of transient stroke.’ (168) 高溫易使水中的毒物揮發到空氣中，氣候改變導致極端天氣變得更為頻繁 (W1) Gāowēn yì shǐ shuǐzhōng de dúwù huīfā dào kōngqì zhòng, qìhòu gǎibiàn dǎozhì jíduān tiānqì biàn dé gèng wèi pínfán ‘High-temperature makes easily the poison of the water evaporate into the air, and climate change makes extreme weather change more frequently.’ (169) 那我們再看..這裏.所以,er..這個部分 hon,各位稍微注意一下 hon,有分三大類, (S1) Nà wǒmen zài kàn.. zhèlǐ. Suǒyǐ,er.. zhège bùfèn hon, gèwèi shāowéi zhùyì yīxià hon, yǒu fèn sān dàlèi ‘Let’s look at here .. So, er .. this part hon, please notice a bit hon, it is classified into three categories,’ (170) 那現在就是跟大家稍微..提一下,如何避免這些尖銳物品扎傷 hon? (S9) Nà xiànzài jiùshì gēn dàjiā shāowéi.. tí yīxià, rúhé bìmiǎn zhèxiē jiānruì wùpǐn zhā shāng hon? ‘Now I would like to remind everyone a bit of how to avoid these needlestick injuries hon?’

The speaker of (164) indicates that the Japanese culture is relatively closer to Taiwanese culture, so Japanese norms of ICF can be applied to Taiwan. Bijiao 比較 ‘relatively’ is used to modify the speaker’s evaluation with regard to the closeness of both cultures. It enables the speaker to lower the degree of his judgment. The Taiwanes kha ‘relatively’ is semantically identical to Mandarin jiao 較 ‘relatively’. In (165), kha is used to modify its following adjective, which helps to tone down the degree of the easiness. The writers of (166) assert that some diabetics will have the symptoms of dawn phenomenon and Somogyi effect. The adverb jiao 較 ‘relatively’ is utilized to withdraw the writers’ assertion on the easiness regarding the occurrence of the symptoms. Rongyi 容易 ‘easily’ and yi 易 ‘easily’ are

175

utilized more often in writing than in speaking, and these two words are usually

interchangeable. The writers of (167) and (168) use rongyi 容易 ‘easily’ and yi 易 ‘easily’ to modify their assertions. These adverbs of indefinite degree tone down the writers’ arguments and make their statements less assertive. In Chinese, yixia ‘in a short while’ is a common adverbs used in ordinary conversation. It can serve as a politeness strategy to make a statement less direct; it may be used to express the speaker’s uncertainty towards the proposition. Jiang (2012) argues that the communicational assumptions which V + yixia convey are closely related to speech act types. For example, in offers, V + yixia may function to show politeness, to carry the speaker’s modest evaluation of his/her own ability, or to carry the speaker’s pessimistic estimate of the probability of the desired result. With this sense, V + yixia helps the speaker distances him/herself from making a full commitment to the utterance, and simultaneously prevents him/herself from causing potential criticism. In (169) and (170), yixia 一下 ‘in a short while/a bit’ are used to evoke the audiences’ attention, as well as to show the speaker’s modesty. It is noticeable that another degree adverb shaowei 稍微

‘slightly’ is coincidently utilized by both speakers to enhance the sensation of politeness.

4.3.3.3 Adverbs of indefinite frequency

Adverbs of indefinite frequency refer to adverbs that signal the indefinite frequency of events, such as youshihou 有時候 ‘sometimes’, changchang 常常 ‘frequently/often’, and yiban 一般 ‘generally’. The inherent indefiniteness those adverbs possess allow the speakers/writers to make their assertions less categorical (Vartalla 2001). The writters and the speakers use similar variety of adverbs of indefinite frequency (41 vs. 42). Table 16 demonstrates the top 10 commonly used adverbs of indefinite frequency found in my corpus.

Table 16. Frequency of adverbs of indefinite frequency used in the spoken vs. written genres

Spoken N % Written N % 有時候 89 25.21% 常 86 20.92% 176

常常 74 20.96% 通常 65 15.82% 一般 28 7.93% 一般 57 13.87% 大部分 25 7.08% 平均 37 9.00% 平均 24 6.80% 往往 20 4.87% 通常 23 6.52% 多 18 4.38% 常 11 3.12% 大多 17 4.14% 平常 8 2.27% 常常 16 3.89% tiantian(常常) 7 1.98% 一般而言 14 3.41% 部分 6 1.70% 有時 12 2.92%

Table 14 shows that youshihou 有時候 ‘sometimes’ and changchang 常常 ‘frequently/

often’ occupy relatively higher percentages in spoken discourse, while chang 常

‘frequently/often’, tongchang 通常 ‘usually’, and yiban 一般 ‘generally’ are used slightly

more in written discourse. The percentages among those above mentioned adverbs do not

display a great difference. The other adverbs, such as dabufen 大部分 ‘mostly’, pingjun 平

均 ‘equally’, tongchang 通常 ‘ususally’, and wangwang 往往 ‘frequently’, are used on the average. In other words, the speakers or the writers do not especially favor certain of these adverbs. Some examples with hedging use of adverbs of indefinite frequency are illustrated

below:

(171) 目前口服降血糖藥中，無論單一藥物治療或與其他藥物配合，最常被使用 的藥物就是二甲雙胍類的 metformin。(W1) Mùqián kǒufú jiàng xiětáng yào zhōng, wúlùn dānyī yàowù zhìliáo huò yǔ qítā yàowù pèihé, zuì cháng bèi shǐyòng di yàowù jiùshì èrjiǎshuāngguā lèi de metformin ‘Presently in the oral hypoglycemic agents, either monotherapy or in combination with other drugs, the drug metformin is the most frequetly used class of metformin.’ (172) 使用長效型干擾素治療時通常會有副作用的產生，特別是類似感冒的症 狀，血球細胞的減少及精神上的副作用較常發生，但通常都不致於需要停 藥，(W1) Shǐyòng cháng xiào xíng gānrǎo sù zhìliáo shí tōngcháng huì yǒu fùzuòyòng de chǎnshēng, tèbié shì lèisì gǎnmào de zhèngzhuàng, xiěqiú xìbāo de jiǎnshǎo jí

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jīngshén shàng de fùzuòyòng jiào cháng fāshēng, dàn tōngcháng dōu bùzhì yú xūyào tíng yào ‘The side effects usually occur while using the long-acting interferon treatment, especially in flu-like symptoms which relatively frequently cause the reduction of blood cells and mental side effect, but usually it is not necessary to discontinue the medication.’ (173) 我們常常接到電話,李醫師,這個病人,(CAUGH)..這個 Fumari 己經打..一個禮 拜了,啊要不要繼續用? (S4) Wǒmen chángcháng jiē dào diànhuà, lǐ yīshī, zhège bìngrén,(CAUGH).. zhège fumari jǐ jīng dǎ.. Yīgè lǐbàile, a yào bùyào jìxù yòng? ‘We often received phone calls, being asked, Dr. Lee, this patient,..The Fumari had been used for a week .., ah should we continue to use it?’ (174) 一般女性壽命高於男性，且一再延長，進入老年期女人越來越多，倡導婦 女健康維護更為重要 (W2) Yībān nǚxìng shòumìng gāo yú nánxìng, qiě yīzài yáncháng, jìnrù lǎonián qí nǚrén yuè lái yuè duō, chàngdǎo fùnǚ jiànkāng wéihù gèng wéi zhòngyào ‘Generally life expectancy of the female is longer than the male, and it is continuously extended, more and more women live into old age. It is important to advocate for the maintainance of women's health.’ (175) 我在門診也會翻拍,但是有時候病人太多的時候 hon,一個人也沒辦法做那麼 多事情 hon (S5) Wǒ zài ménzhěn yě huì fānpāi, dànshì yǒushíhòu bìngrén tài duō de shíhòu hon, yīgèrén yě méi bànfǎ zuò nàme duō shìqíng hon ‘I will remake the photos in the clinic, but sometimes when there are too many patients visiting hon, an individual is unable to do too many things hon.’

The adverbs chang 常 ‘frequently; often’ and tongchang 通常 ‘usually’, and changchang

常常 ‘frequently/often’ are typically used by the speakers/writers to indicate that certain

events or situations happen in a high frequency, and yet the exact figures are unknown or unobtainable, as in examples (171), (172), and (173). By applying adverbs of indefinite frequency, the speakers/writers avoid committing themselves to the propositions. These three adverbs are distributed evenly across both genres; however, the monosyllabic chang 常

‘frequently/often’ is preferred by the writers as shown in (171) and (172), whereas changchang 常常 ‘frequently/often’ occur more in spoken discourse as in (173). Yiban 一

178

般 ‘generally’ is used to denote a situation that is normally perceived in a certain way. The writers of (174) use yiban 一般 ‘generally’ to declare that it is a common tendency that females live longer than males. The adverb helps the writers to make the general statement without providing exact statistical figures. Youshihou 有時候 ‘sometimes’ appears the most frequently in the spoken discourse. As compared with the other adverbs just mentioned, youshihou 有時候 ‘sometimes’ implies a relatively lower frequency. The speaker of (175) indicates that he usually takes photos of outpatients’ wounds, but sometimes he is too busy to do it. Youshihou 有時候 ‘sometimes’ expresses the speaker’s less than full commitment to his utterance since he is unable to identify the times that he misses taking photos for his outpatients. Although youshihou 有時候 ‘sometimes’ is the most common adverbs of indefinite frequency employed by the speakers, it is only used once in the written discourse.

4.3.3.4 Adverbs of approximation

Adverbs of approximation are adverbs used to hedge the information which is indefinite, unobtainable, or not necessary to give, such as dagai 大概 ‘approximately’, yue

約 ‘about’, and jihu 幾乎 ‘almost’. Adverbs of approximation convey the notion of imprecision, and are normally attributed to Prince et al.’s (1982) “approximators”. By examining physician-to-physician discourse, Prince et al. conclude that uncertainty is the underlying cause of the application of approximators for medical specialists. Adverbs of approximation enable the speakers/writers to talk about matters or numerical figures they are not certain about, which reduce their commitment to the true value of the propositions.

Adverbs of approximation can be utilized to modify both quality and quantity (Lo 2010).

However, they are mostly employed to hedge the numerical expressions in my corpus. The speakers and the writers use similar number of approximative adverbs, with 26 in the speaking and 33 in the writing. It is observed that the speakers prefer disyllabic adjectives, whereas the writers favor monosyllabic adverbs. Table 17 shows the top 10 frequent adverbs

179 of approximation in both genres.

Table 17. Frequency of adverbs of approximation used in the spoken vs. written genres

Spoken N % Written N % 大概 193 53.02% 約 132 47.48% 幾乎 31 8.52% 至少 30 10.79% 差不多 30 8.24% 介於 15 5.40% 至少 24 6.59% 近 14 5.04% 左右 18 4.95% 大約 12 4.32% 不到 14 3.85% 幾乎 12 4.32% 快 12 3.30% 不等 9 3.24% 將近 7 1.92% 將近 7 2.52% 起碼 4 1.10% 左右 6 2.16% 大約 3 0.82% 整體而言 6 2.16%

Dagai 大概 ‘approximately’ makes up over than half of the adverbs of approximation in spoken discourse, as show in Table 15. The monosyllabic yue 約 ‘about’ is favored in written discourse. Examples containing adverbs of approximation are illustrated below:

(176) 其實針扎的通報是所有的勞安事件最多的一個 hon.每年大概有一百多件的 個案 (S9) Qíshí zhēn zhā de tōngbào shì suǒyǒu de láo ān shìjiàn zuìduō de yīgè hon. Měinián dàgài yǒu yībǎi duō jiàn de gè'àn ‘In fact, needlestick notification is one of the largest work accident events hon. Every year there are approximately more than one hundred cases.’ (177) 我們在..愈往南,價格是--中部..價格是競爭最激烈的,那幾乎..幾乎是對折了. (S6) Wǒmen zài.. Yù wǎng nán, jiàgé shì--zhōngbù.. jiàgé shì jìngzhēng zuì jīliè de, nà jīhū.. Jīhū shì duìzhéle ‘We.. more heading to the south, the price is--in central Taiwan .. the prices are the most competitive, it is almost .. almost 50% off.’ (178) 據統計，約有 6.6%的女孩及 1.8%的男孩在 6 歲以前曾有過至少一次的泌 尿道感染。其發生率在男童約為每千名年 4.4 次而在女童約為每千名年 34.4 次。(W2) Jù tǒngjì, yuē yǒu 6.6% de nǚhái jí 1.8% de nánhái zài 6 suì yǐqián céng yǒuguò

180

zhìshǎo yīcì de mìniào dào gǎnrǎn. Qí fāshēng lǜ zài nán tóng yuē wèi měi qiān míng nián 4.4 cì ér zài nǚtóng yuē wèi měi qiān míng nián 34.4 cì ‘According to statistics, about 6.6 percent of girls and 1.8 percent of boys of 6- year-old had previously had at least one urinary tract infection. The incidence is about 4.4 times per thousand boys and it is about 34.4 times per thousand girls.’ (179) 你如果剛好差不多七十幾,八十幾,那我們就給你吃四顆藥,ㄟ..吃個四顆,六 顆,吃..吃個..吃個 inderol,看能不能..下降一點 (S6) Nǐ rúguǒ gānghǎo chàbùduō qīshí jǐ, bāshí jǐ, nà wǒmen jiù gěi nǐ chī sì kē yào,ei1.. chī gè sì kē, liù kē, chī.. chī gè.. chī gè inderol, kàn néng bùnéng.. xià xiáng yīdiǎn ‘If you just almost seventies, or eighties, then we will let you take four drugs, ei .. take four or six, take inderol, to see if it can ..be dropped a bit.’ (180) 氣溫介於 11-15℃時發生心肌梗塞死亡的相對危險性(relative risk) 是氣溫介 於 22-23℃時的 1.31 倍，(W1) Qìwēn jièyú 11-15℃shí fāshēng xīnjī gěngsè sǐwáng de xiāngduì wéixiǎn xìng (relative risk) shì qìwēn jièyú 22-23℃shí de 1.31 Bèi ‘The relative risk of myocardial infarction mortality occurring at temperature between 11-15 ℃ is 1.31 times higher than at temperature between 22-23 ℃,’

The speakers of (176) and (177) use the adverbs of approximation, dagai 大概

‘approximately’ and jihu 幾乎 ‘almost’ to indicate that the numerical figures are not the

accurate amounts but merely close numbers. It may be owing to the exact number is not

significant as in (176), or the exact percentage of discount is unobtainable as in (177). Yue 約

‘about’ in (178) refers to approximate percentages concerning the occurrence of certain disease. Zhishao 至少 ‘at least’ indicates that the approximate percentages are based on a minimum chance of infection, and the exact numerical figures above this minimum number are unable to obtain. Chabuduo 差不多 ‘almost’ in (179) and jieyu 介於 ‘between’ in (180) are used to subscribe a range of numerical figures, with (179) refers to patients’ age range and

(180) refers to the temperature. Adverbs of approximation enable speakers/writers to convey their uncertainty on numerical figures and allow them to provide information without full commitment.

4.3.2.5 Summary 181

According to the results of my study, adverbs are the most frequently used lexical

hedges in both the spoken and written genres. As is the case of lexical verbs (see Table 6), the

application of adverbs does not show statistical significance between the spoken and written

discourses. Both speakers and writers tend to utilize a great amount of epistemic adverbs to

modify their commitment to the propositions. The great majority of the usage may be due to

the specific syntactic and semantic features of adverbs. Epistemic adverbs can appear in a

number of different positions in a clause without affecting the meaning of the clause, and

they can be associated with diverse concepts. They can be used to express the

speaker’s/writer’s stance towards event, to estimate the probability of situations, or to denote

the degree or frequency of certain events. In this study, epistemic adverbs are subcategorized

into stance adverbs, adverbs of indefinite degree, adverbs of indefinite frequency, and

adverbs of approximation. Among those four subcategories, stance adverbs are applied the

most frequently, with 49.46% in speaking and 40.11% in writing. Stance adverbs allow the

speakers/writers to present their viewpoints and judgments, to indicate potential alternatives,

to refer to degrees of probability situation, and as well as to interact with the hearer/readers.

Adverbs of indefinite degree are employed to refer to various degrees of qualification and

quantification, which help speakers/writers to distance themselves from full commitment to

an absolute accuracy. Adverbs of indefinite frequency enable speakers/writers to make their assertions less categorical, and meanwhile avoid taking the full responsibility for their

statements. Adverbs of approximation convey the notion of imprecision, which are normally

used to hedge the information that are unobtainable, uncertain, or unnecessary to give.

Adverbs of approximation enable speakers/writers to talk about matters or numerical figures

they are not certain about, which reduce their commitment to the true value of the propositions. In general, stance adverbs are employed more in the spoken discourse than the

written discourse. Speakers are found to apply greater variety of adverbs than writers.

182

Furthermore, writers seem to favor monosyllabic adverbs, whereas speakers use more disyllabic adverbs.

4.3.3 Adjectives

In Chen’s (2008) conversational data, the duplicated form xiaoxiaode 小小的 ‘small’ is the only hedging adjectives found in her corpus. Epistemic adjectives are by no means the least common hedging device as observed in my medical corpus. In my data, epistemic adjectives occupy 6.01% in my spoken discourse and 9.90% in my written discourse.

Epistemic adjectives mark the information presented as tentative, indefinite, or imprecise, much the same way as epistemic adverbs discussed above. The meanings of hedging adjectives identified in my corpus are also analogous with their corresponding adverbial counterparts. Owing to the similarities observed between these two grammatical categories, epistemic adjectives are also subcategorized in accordance with the category of epistemic adverbs. Figure 7 below displays the distribution of these four subcategories of hedging adjective.

80.00%

70.00%

60.00%

50.00% S W 40.00%

30.00%

20.00%

10.00%

0.00% ABCD B. Adjectives of C. Adjectives of D. Adjectives of A. Stance adjectives Adjectives indefinite degree indefinite frequency approximation S 10.95%(53) 12.19%(59) 74.79%(362) 2.07%(10) W 25.08%(155) 13.27%(82) 56.96%(352) 4.69%(29)

Figure 7. Distribution of subcategories of epistemic adjectives in the spoken vs. written genres 183

Figure 7 shows that adjectives of frequency are overwhelmingly used as compared with the

other three subcategories, and this tendency applies to both spoken and written genres. In

comparing with Figure 7 and Figure 6, we see that the distribution of epistemic adjectives is

different from their adverbial counterparts, in that stance adverbs are employed the most

frequently. The four subcategories of epistemic adjectives will be discussed successively in

the following sections.

4.3.3.1 Stance adjectives

Stance adjectives are adjectives which serve to reduce the speakers’/writers’ categorical

commitment. Analogous to its corresponding stance adverbs, stances adjectives can be used

to express the speakers’/writers’ subjective assessments or degree of commitment to the propositions in terms of professional knowledge or experimental results. They are used more frequently by the writers than the speakers, with 25.08% in writing and 10.95% in speaking.

Altogether 39 different stance adjectives are identified in the spoken data, and 63 are found in the written corpus. Table 18 illustrates the top 10 stance adjectives found in my corpus.

Table 18. Frequency of stance adjectives used in the spoken vs. written genres

Spoken N % Written N % 目前的 4 7.55% 可能的 20 12.90% OK 的 3 5.66% 適當的 13 8.39% 可能的 3 5.66% 可能 10 6.45% controversial 2 3.77% 目前的 9 5.81% kuaikuai(怪怪的) 2 3.77% 不宜 6 3.87% 一定的 2 3.77% 不穩 5 3.23% 不適當的 2 3.77% 不穩定 5 3.23% 有問題的 2 3.77% 目前 5 3.23% 怪怪的 2 3.77% 理想的 5 3.23% 適當的 2 3.77% 適當 5 3.23%

Table 18 shows that stance adjectives distribute evenly in the spoken discourse, while

184

kenengde 可能的 ‘possible’ is favored in the written data. The stance adjectives observed in

the corpus include adjectives that express the speakers’/writers’ subjective judgments based

on personal assessment or experimental evidence so far, such as muxiande 目前的 ‘current’

and ok-de ok 的 ‘okay’, and adjectives that entail degrees of probability concerning the

certainty or accuracy of what is being said as well as the possibility of future prospect, such

as kenengde 可能的 ‘possible’ in different contexts. The illustrative examples below

demonstrate these communicative purposes:

(181) 我講我們目前的共識,我們糖尿病醫科--醫師,目前的共識, (S10) Wǒ jiǎng wǒmen mùqián de gòngshì, wǒmen tángniàobìng yīkē--yīshī, mùqiánde gòngshì ‘I am talking about our current consensus, we diabetes medicine--physicians, the current consensus,’ (182) 那我們整個的..的設備 hon 是非常 ok 的,我們會給他們一個獨立 的空間 hon,獨立不孕症的ㄧ個空間 hon, (S8) Nà wǒmen zhěnggè clinic de.. de shèbèi hon shì fēicháng ok-de, wǒmen huì gěi tāmen yīgè dúlì de kōngjiān hon, dúlì bù yùn zhèng deyi1 gè kōngjiān hon ‘The equipment in our clinical center hon.. is very okay, and we will give them a separate space hon, an individual space for independent infertility treatment hon,’ (183) 但是從他們這樣的一個通報系統去推估全台灣..目前 hon..可能的針扎或血 液體液暴露 hon,其實一年應該會有三萬三千六百個案件 hon (S9) Dànshì cóng tāmen zhèyàng de yīgè tōngbào xìtǒng qù tuī gū quán táiwān.. Mùqián hon.. kěnéngde zhēnzhā huò xiěyè tǐyè bàolù hon, qíshí yī nián yīnggāi huì yǒu sān wàn sānqiān liùbǎi gè ànjiàn hon ‘However, from such a notification system to estimate the cases in Taiwan..currently hon .. the possible needlestick cases or body fluids exposure hon, actually, there should be thirty-three thousand six hundred cases per year.’ (184) 本文試簡述過去使用 metformin 的歷史，目前臨床應用以及未來可能的展 望。(W1) Běnwén shì jiǎn shù guòqù shǐyòng metformin de lìshǐ, mùqián línchuáng yìngyòng yǐjí wèilái kěnéngde zhǎnwàng ‘This paper briefly states the history of metformin usage, the present application, and possible future prospects.’

185

Example (181) is a response to an audience’s question. The medicine, metformin, is

commonly used for diabetic treatment, and one of the contraindications concerning

metformin treatment is liver cirrhosis. The audience asks whether the speaker has a good

index to define the dysfunction of the liver. The speaker explains that this question has been

argued for many years, and there is not even a clear definition found in textbooks. So he can

only provide the current consensus in the discipline of Endocrinology & Metabolism.

Muxiande 目前的 ‘current’ of (181) is used to refer to the consensus that has been reached

so far among the physicians of Endocrinology & Metabolism. Ok-de ok 的 ‘okay’ is used to

refer to the facilities of infertility center. In the lecture, the speaker introduces the infertility

center, including the success rate of test tube babies, the cozy environment, professional

doctors and staff, and advanced facilities. Example (182) is a later mention while explaining

the procedure of infertility treatment. This time the speaker uses ok-de ok 的 ‘okay’ to

mention casually the high-tech facilities to avoid the sense of over-extoling since modestly is

a virtue in the scientific community. Kenengde 可能的 ‘possible’ in (183) and (184) are

used to express the probabilities of certain issues. Kenengde 可能的 ‘possible’ in (183)

refers to the possibility that can be attributed to needlestick injury, while in (184) it signals

the probability of future prospects. Those adjectives of indefinite degree are employed to tone

down the certainty or accuracy of the statements, which allows the speakers/writers to

prevent themselves from making full commitment to the statements being said.

4.3.3.2 Adjectives of indefinite degree

Adjective of indefinite degree are commonly used to reduce the degree of definiteness of what is said. 28 different adjectives of indefinite degree are found in the spoken data, while

33 are observed in the written data. Table 19 below illustrates the top 10 most frequently used

adjectives of indefinite degree from both genres.

186

Table 19. Frequency of adjectives of indefinite degree used in the spoken vs. written genres

Spoken N % Written N % 一些 12 20.34% 主要 20 24.39% 一定的 6 10.17% 輕微 9 10.98% 小小的 5 8.47% 不明 6 7.32% 主要 5 8.47% 主要的 6 7.32% fuzzy 2 3.39% 不明的 3 3.66% 不一定 2 3.39% 未明 3 3.66% 不大 2 3.39% 輕微的 3 3.66% 不小的 2 3.39% 一定的 2 2.44% 主要的 2 3.39% 些微 2 2.44% 某一個程度的 2 3.39% 尚可 2 2.44%

Table 19 shows that yixie 一些 ‘a little’ is used somewhat more than the other adjectives of indefinite degree in speaking, while zhuyao 主要 ‘primary’ is used slightly more in writing.

Adjectives in this subcategory are employed to express the speakers’/writers’ uncertainty on the degree of conditions, to indicate the obscurity of events, or to show the modesty for their achievements. Some examples below display the various functions:

(185) 其實我們整個趨勢還是有一點點在往下啦 hon.那這幾年其實我們有進行了 一些..一些...ㄟ..一些改進啦 hon (S9) Qíshí wǒmen zhěnggè qūshì háishì yǒu yīdiǎn diǎn zài wǎng xià la hon. Nà zhè jǐ nián qíshí wǒmen yǒu jìnxíngle yīxiē.. yīxiē...ei.. yīxiē gǎijìn la hon ‘In fact, the whole trend is a little bit downwarding hon. In recent years we actually have carried out a little .. a little ... ei .. a little improvement hon.’ (186) 那其實在..美國 CDC hon,他們的安全針具引用到..那個醫療單位的時候,他們 其實需要有一定的..的流程的評估啦 (S9) Nà qíshí zài.. Měiguó CDC hon, tāmen de ānquán zhēn jù yǐnyòng dào.. Nàgè yīliáo dānwèi de shíhòu, tāmen qíshí xūyào yǒu yīdìngde.. de liúchéng de pínggū la ‘In fact ..in the CDC of United States hon, when the safety needles .. applied to medical units, they actually need certain.. procedure for assessment.’ (187) 不同直接抗病毒藥物的組合治療，完全避免干擾素，也是主要研發方向之 一。(W1) 187

Bùtóng zhíjiē kàng bìngdú yàowù de zǔhé zhìliáo, wánquán bìmiǎn gānrǎo sù, yěshì zhǔyào yánfā fāngxiàng zhī yī ‘Combinations of different direct antiviral treatment to completely avoid interferon is also one of the primary research directions.’ (188) 抗生素建議使用期間須以感染症狀改善為依據，而非治療到整個傷口癒 合。一般建議輕微感染治療時間為 1 到 2 周。(W1) Kàngshēngsù jiànyì shǐyòng qíjiān xū yǐ gǎnrǎn zhèngzhuàng gǎishàn wéi yījù, ér fēi zhìliáo dào zhěnggè shāngkǒu yùhé. Yībān jiànyì qīngwéi gǎnrǎn zhìliáo shíjiān wèi 1 dào 2 zhōu ‘Period recommended regarding the use of antibiotics should be based on improvement of infection symptoms rather than the entire wound healing. Mild infection treatment time is generally recommended for 1-2 weeks.’ (189) 此種症候群，實際上是描述一種病因不明、慢性且複雜的臨床病症，泛指 病人長期或慢性的全身筋骨肌肉到處酸痛，(W2) Cǐ zhǒng zhènghòuqún, shíjì shang shì miáoshù yīzhǒng bìngyīn bùmíng, mànxìng qiě fùzá de línchuáng bìngzhèng, fàn zhǐ bìngrén chángqí huò mànxìng de quánshēn jīngǔ jīròu dàochù suāntòng ‘This syndrome is actually a description of a clinical disorder with obscure, chronic, and complex etiology, referring to the patient's long-term or chronic muscle and body aches everywhere,’ (190) 所以我們感謝很多的單位給我們的幫忙 hon,我們才有今天,成就了我們今 天..小小的一些成就 hon.我們謝謝大家的聆聽,謝謝. (S8) Suǒyǐ wǒmen gǎnxiè hěnduō de dānwèi gěi wǒmen de bāngmáng hon, wǒmen cái yǒu jīntiān, chéngjiùle wǒmen jīntiān.. xiǎoxiǎode yīxiē chéngjiù hon. Wǒmen xièxiè dàjiā de língtīng, xièxiè ‘Therefore, we thank for the assistance of many different units hon, which completes us with this tiny achievement.. We thank you for listening, thank you.’

In (185), the speaker points out that the reported cases of needlestick injury are decreased

gradually, and it is credited to the policy of the hospital administration. The policy works for making a little improvement on this issue. Yixie 一些 ‘a little’ is utilized to hedge the degree

of the improvement, and meanwhile allow the speaker to distance himself from a full

commitment to his utterance. Yiding 一定 ‘certain’ in (186) refers to certain procedures

which may be unobtainable or unimportant at the moment of speech. The adjective of

indefinite degree allows the speaker to reduce his commitment to the utterance. The writers of 188

(187) use the adjective zhuyao 主要 ‘primary’ to indicate that what is being stated is merely

one of the primary perspectives for further researches. The hedging noun zhiyi 之一 ‘one of’

located in the sentence-final position further weakens the definiteness of the statement.

Qingwei 輕微 ‘mild’ of (188) is utilized to modify the degree of infection, which refers to a

lower degree of severity. This adjective conveys the sensation of vagueness, which allows the

writers to avoid commitment to precise figures. The adjective buming 不明 ‘obscure’ in

(189) transparently denotes the sense of uncertainty. In medical practice, a lot of causes of

diseases are unidentified so far. Therefore, the writers employed the adjective of indefinite

degree to reduce their commitment to the statements. Xiaoxiaode 小小的 ‘tiny’ in (190) is

utilized to express the speaker’s modesty towards the achievements of his infertility team. In

his ending remarks, the speaker employs the reduplication from, xiaoxiaode 小小的 ‘tiny’, to humbly minimize their accomplishment. As mentioned early in Chapter 3, the duplication is used to imply small amount of time or frequency, and sometimes it can signal the implicature of attempt (Li and Thompson 1997, Liu et al. 2011). In this case, xiaoxiaode 小

小的 ‘tiny’ entails a small amount of achievement, and it manifests the speaker’s intention to show solidarity and modesty to the audience.

4.3.3.3 Adjectives of indefinite frequency

As shown in Figure 7, adjectives of this subcategory account for more than half of the overall epistemic adjective for both genres, with 74.79% in the spoken discourse and 56.96% in the written discourse. The high frequency in the employment of adjectives of indefinite frequency implies that the speakers/writers make great use of these hedging devices to modify their propositions with various degrees of uncertainty or inaccuracy. Adjectives of indefinite frequency are often found “as tentative quantifications where numerical exactitude is not necessary or possible or as indications that what is said is based on the most characteristic features of a given phenomenon” (Varttala 2001: 136). In this subcategory, 45

189

different adjectives of indefinite degree are used by the speakers, while 69 are found to be

employed by the writers. Table 20 illustrates the top 10 most frequently used adjective of

indefinite frequency identified in both genres.

Table 20. Frequency of adjectives of indefinite frequency used in the spoken vs. written genres

Spoken N % Written N % 一些 203 56.08% 一些 32 9.09% 有些 42 11.60% 某些 26 7.39% 大部分的 15 4.14% 常見的 25 7.10% 一般的 9 2.49% 部分 21 5.97% 一些的 6 1.66% 平均 19 5.40% 其他 6 1.66% 有些 18 5.11% 一部分的 5 1.38% 常見 16 4.55% 平均的 5 1.38% 數 16 4.55% ue(有的) 4 1.10% 大部分的 15 4.26% 大部分 4 1.10% 大多數 13 3.69%

In Table 20, we see that yixie 一些 ‘some’ ranks top among the most commonly used

adjectives of indefinite frequency for both genres. In particular, it makes up a great majority

(56.08%) in the spoken discourse. The frequency adjectives implying a vague mid frequency,

such as yixie 一些 ‘some’, youxie 有些 ‘some’, and mouxie 某些 ‘certain’, seem to be employed relatively more often than the ones denoting a higher frequency, such as dabufende

大部分的 ‘most of’ and daduoshu 大多數 ‘most of’ . It is presumably because adjectives

with mid frequency convey a relatively greater range of vagueness and uncertainty. Unless

the speakers/writers are certain about the frequency of an event, which is either higher or

lower, otherwise the employment of adjectives with mid frequency enable speakers/writers to

present their uncertainty and reduce their commitment. In my corpus, frequency adjectives

are mainly employed to quantify their following nouns. The application suggests that the

numerical figures are not significant and that what is said is merely partial of the full picture 190 in terms of the given situations. The following examples demonstrate that frequency adjectives function as quantifiers:

(191) 利用簡單的問卷，讓病人可在幾分鐘內，由護理師解說下，將一些基本資 訊在腫瘤科醫師問診前完成，(W2) Lìyòng jiǎndān de wènjuàn, ràng bìngrén kě zài jǐ fēnzhōng nèi, yóu hùlǐ shī jiěshuō xià, jiāng yīxiē jīběn zīxùn zài zhǒngliú kē yīshī wènzhěn qián wánchéng ‘Using a simple questionnaire, the patient may be able to fill out some basic information within a few minutes, with the assistance of the nurse. The questionnaire then can be completed before seeing the oncologist.’ (192) 那甚至在古..古典的醫療..醫學傳..醫學傳統認為我們是一個權威的,那甚至 現在一些報章雜誌說,我們是非對等的關係, (S2) Nà shènzhì zài gǔ.. Gǔdiǎn de yīliáo.. yīxué chuán.. yīxué chuántǒng rènwéi wǒmen shì yīgè quánwēi de, nà shènzhì xiànzài yīxiē bàozhāng zázhì shuō, wǒmen shìfēi duì děng de guānxì ‘Even in ancient classical medicine ..medical .. medical tradition thought that we were authoritative, and even now, some newspapers and magazines say that our relationship is non-reciprocal,’ (193) 那另外有些 toxin 本身造成之後哩,會曲化,所 以會釋放一些發炎媒介物,讓那個....很厲害 (S7) Nà lìngwài yǒuxiē toxin běnshēn zàochéng leukocytosis, leukocytosis zhīhòu lī, huì qū huà, suǒyǐ huì shìfàng yīxiē fāyán méijiè wù, ràng nàgè..inflammation.. Hěn lìhài ‘There are some other toxin which will cause leukocytosis. After that, leukocytosis will be distorted, and it will release some inflammatory mediators, making that ..inflammation.. very serious.’ (194) 流行病學以及分子病理學研究，皆顯示某些慢性感染與癌症發生有關聯性 (W2) Liúxíng bìng xué yǐjí fēnzǐ bìnglǐ xué yánjiū, jiē xiǎnshì mǒuxiē mànxìng gǎnrǎn yǔ áizhèng fāshēng yǒu guānlián xìng ‘The research of Epidemiology and Molecular Pathology indicates that there is certain chronic infection which is associated with cancer.’ (195) 在臨床治療過程中，所出現清晨空腹高血糖常見的原因有三種 (W2) Zài línchuáng zhìliáo guòchéng zhōng, suǒ chūxiàn qīngchén kōngfù gāo xiětáng chángjiànde yuányīn yǒu sānzhǒng ‘In the clinical course of therapy, there are three common reasons for the emergence of fasting hyperglycemia.’ 191

(196) 因為我們知道大部分的藥,都是從腎臟 er 排洩出來的 (S4) Yīnwèi wǒmen zhīdào dàbùfènde yào, dōu shì cóng shènzàng er páixiè chūláide ‘Because we know that most of the drugs are excreted from the kidneys.’

The writers in (191) explain that the patient’s basic information regarding the tumors can be

elicited by filling out a questionnaire. Yixie 一些 ‘some’ is used to quantify the amount of

the basic information. In (192), the speaker tries to point out alternative viewpoints towards the role the physicians play. Yixie 一些 ‘some’ is employed to refer to some newspapers and magazines. Yixie 一些 ‘some’ in these two examples not only conveys the speaker’s/writers’ uncertainty on the exact amount but also implicitly reveals that the accurate figures are not significant to mention. The speaker in (193) indicates that some but not all toxins can cause leukocytosis, and the leukocytosis will release some sorts of inflammatory mediators. The adjective of indefinite frequency youxie 有些 ‘some’ is used to indicate that only certain kinds of toxins will have effects but the exact number is left out. The speaker may be either uncertain about the exact numbers of those toxins or think it unnecessary to mention. As well as youxie 有些 ‘some’ in (193), mouxie 某些 ‘certain’ in (194) is also employed to reduce the definiteness of the precise figures and simultaneously conveys the writers’ less than full commitment toward their argument. The frequency adjective changjiande 常見的 ‘common’ in (195) is used to indicate that the occurrence of the following reasons is common. This indication appears in the concluding remark, which implies that the writers’ previous arguments are evident. Changjiande 常見的 ‘common’ is utilized to reduce the writers’ commitment to their conclusion since this adjective entails that the writers are aware of other unidentified factors. Dabufende 大部分的 ‘most of’ in (196) denotes a high frequency for the following noun, which signals the speaker’s uncertainty about the accurate amount of the medicine that is excreted in the kidney. With the inherent uncertainty, adjectives of indefinite frequency are employed often in the medial realm to tone down the speakers’/writers’ commitment towards the statements. 192

4.3.3.4 Adjectives of approximation

Adjectives of approximation are adjectives used to modify precision in quantification

(Hyland 1998, Varttala 2001). However, in Chinese, approximative adjectives are mainly

used to hedge quality as also observed by Lo (2010). Approximative adjectives are scarcely

employed in academic written discourse (Varttala 2001, Lo 2010), and this finding is borne

out by my medical corpus. There are only 10 occurrences observed in my spoken discourse and 29 incidences in the written discourse. The adjectives of approximation found in my data are mainly used by the speakers/writers to relate one qualitative incidence to another or to make an approximate evaluation between two situations. The comparative usage help the speakers/writers to draw attention to the approximate nature of the information presented, and in the meantime tone down the speakers’/writers’ commitment. The lexemes used to convey approximative sense are relatively fewer, with 3 in speaking and 7 in writing. Table 21

illustrates all the adjectives of approximation found in both genres.

Table 21. Frequency of adjectives of approximation used in the spoken vs. written genres

Spoken N % Written N % 差不多 8 80.00% 相當 11 37.93% 大約的 1 10.00% 相當的 5 17.24% 前後左右 1 10.00% 類似的 4 13.79% 類似 4 13.79% 相似的 2 6.90% 差不多 2 6.90% 相似 1 3.45%

Table 21 shows that cabuduo 差不多 ‘similar’ is used the most frequently in the spoken

discourse, while xiandang 相當 ‘similar’ is employed relatively more times in the written discourse. Both of the adjectives refer to the approximate closeness between two situations.

Some examples with approximative adjectives are displayed to show the analogy. 193

(197) 減重手術 1 個月內的死亡率約 0.1 至 0.3%，與執行腹腔鏡膽囊切除術相 當；(W1) Jiǎn zhòng shǒushù 1 gè yuè nèi de sǐwáng lǜ yuē 0.1 Zhì 0.3%, yǔ zhíxíng fùqiāng jìng dǎnnáng qiēchú shù xiāngdāng ‘In weight loss surgery, the rate of mortality within a month is about 0.1 to 0.3%, similar to the implementation of laparoscopic cholecystectomy;’ (198) 經鼻內視鏡與傳統內視鏡有相當的感光耦合元件(charge-coupled device) ， 但在亮度、解析度及視野上仍較傳統內視鏡差。(W1) Jīng bí nèi shì jìng yǔ chuántǒng nèi shì jìng yǒu xiāngdāngde gǎnguāng ǒuhé yuánjiàn (charge-coupled device), dàn zài liàngdù, jiěxī dù jí shìyě shàng réng jiào chuántǒng nèi shì jìng chà ‘Transnasal endoscopic and traditional endoscopic have similar photosensitive coupling elements (charge-coupled device), but the brightness, resolution, and vision of transnasal endoscopy are relatively poorer than traditional endoscopy.’ (199) 那個秀傳他們..他們的艙,的確跟我們是差不多,他們沒有呼吸器,他們全程 用..叫小姐進去壓 ambio,壓兩個小時,他們已經有一個小姐因為鼓骨頭壞死, 離職了.(S5) Nàgè xiù chuán tāmen.. tāmen de cāng, díquè gēn wǒmen shì chàbùduō, tāmen méiyǒu hūxī qì, tāmen quánchéng yòng.. Jiào xiǎojiě jìnqù yā ambio, yā liǎng gè xiǎoshí, tāmen yǐjīng yǒu yīgè xiǎojiě yīnwèi gǔ gǔtou huàisǐ, lízhíle ‘The cabin in Xiuchuan Hospital.. is similar to ous, but theirs does not have the respiratorbreathing. They ask the nurse .. to get in to press ambio for two hours. One nurse has quitted because she got bone necrosis.’ (200) 我大概稍微初..初.初..eh 初估過 hon,所以大約的風險可能還是在環衛人員 (S9) Wǒ dàgài shāowéi chū.. Chū. Chū..Eh chū gūguò hon, suǒyǐ dàyuēde fēngxiǎn kěnéng háishì zài huánwèi rényuán ‘I kind of did a ..pre..pre.. eh preliminary estimation hon, so it is suggested that the approximate risk still lies in the sanitation personnel.’

The adjectives of approximation in examples (197) to (199) are used to make analogous

approximation. Relating the current estimation to another similar condition helps the

hearers/readers comprehend better the qualification or quantification being conveyed. It also

serves to evoke the hearers’/readers’ attention, especially when the specified analogous

condition is closely related to the audience, as in (199). The speaker of (199) tries to compare

194 the hyperbaric chamber the hospital currently has with the chamber that another hospital purchases. Since the other hospital is the competitor of the hospital the speaker and the audience work for, undoubtedly the analogous approximation attracts the audiences’ attention. Besides indicating the similarity on the chamber size, the speaker’s main purpose is to specify the differences concerning the operating procedures. Dayuede 大約的

‘approximate’ in (200) is used to express the speaker’s estimation on approximate risk regarding needlestick injury. The approximative adjectives convey the speaker’s feeling of uncertainty, which allows the speaker to distance himself from making a full commitment to his statement.

4.3.3.5 Summary

In my databank, epistemic adjectives are employed more in the written discourse (618 occurrences) than in the spoken discourse (484 occurrences), and the discrepancy is significant statistically, as shown in Table 6. Epistemic adjectives are found to present information as tentative, imprecise, or uncertain, much the same way as their corresponding adverbs. Therefore, they are also classified into stance adjectives, adjectives of indefinite degree, adjectives of indefinite frequency, and adjectives of approximation. Stance adjectives are used to express the speakers’/writers’ subjective assessments according to their personal judgments or experimental evidence obtained so far. They can also be utilized to convey degrees of probability concerning the certainty or accuracy of what is being stated, or to anticipate the possibility of future prospects. Adjective of indefinite degree are mainly used to express the speakers’/writers’ uncertainty on the degree of condition, to indicate the obscurity of events, or to show the modesty of their achievements. Adjectives of indefinite frequency are used the most frequently among those four subcategories, especially in the speaking, which occupy 74.79% in the spoken corpus and 56.96% in the written corpus.

Speakers/writers use these adjectives to modify propositions with various degrees of

195 uncertainty and inaccuracy. It is worth noting that yixie 一些 ‘some’ occur 203 times in the speaking but only 32 times in the writing, which probably imply that in spontaneous talks, speakers tend to employ adjectives with mid frequency adjectives as those adjectives contain a wider range of vagueness and indefiniteness. In my data, frequency adjective are mainly used to quantify their following nouns, which signals that the exact numerical figures are either not significant or unobtainable. Adjectives of approximately are seldom employed in the medical discourse, representing 2.07% in speaking and 4.69% in writing. Approximative adjectives found in my corpus are mainly used to hedge quality instead of quantity. They are used by the speakers/writers to relate on qualitative incident to another, or to make an approximate evaluation between two situations. By applying this type of adjectives, speakers/writers are able to draw attention to the approximate nature of the information presented, and simultaneously tone down their commitment.

4.3.4 Nouns

The results of my study reveal that epistemic nouns are another common type of lexical hedge used in medical discourse, as shown in Table 6 of section 4.1. The number of hedging nouns is significantly higher in writing than in speaking, with the ratio of 8.93% in spoken discourse and 14.80% in written discourse. In my corpus, a great deal of epistemic nouns is the nominal forms of their corresponding verbs and adjectives, which confirm the findings of other studies (Varttala 2001, Chen 2008, Lo 2010). Being similar to their verbal and adjective counterparts, nouns hedges also convey different degrees of tentativeness and uncertainty.

Various types of forms as well as richer communicative purposes conveyed by the nouns are observed in my corpus. The noun hedges found in my data are classified into eight subcategories, including judgmental nouns, evidential nouns, nouns of expectation, nouns of indefinite degree, nouns of definite and indefinite frequency, nouns of approximation, questions words, and indefinite pronouns. The distribution and percentages of all the

196 subcategories are presented in the following figure:

70.00%

A. Judgmental nouns 60.00% B. Evidential nouns C. Nouns of expectation S W D. Nouns of indefinite degree 50.00% E. Nouns of definite and indefinite frequency F. Nouns of approximation 40.00% G. Question words H. Indefinite pronouns

30.00%

20.00%

10.00%

0.00% ABCDEFGH

Nouns A B C D E F G H

S 20.86%(150) 1.81%(13) 0.83%(6) 1.39%(10) 8.48%(61) 28.93%(208) 35.33%(254) 2.36%(17)

W 27.38%(253) 0.87%(8) 0.76%(7) 0.32%(3) 6.49%(60) 58.33%(539) 5.52%(51) 0.32%(3)

Figure 8. Distribution of subcategories of epistemic nouns in the spoken vs. written genres

Figure 8 shows that among those various subcategories, question words (35.53%) are utilized the most frequently by the speakers, and followed by nouns of approximation (28.93%) and judgmental nouns (20.86%), whereas the writers employ overwhelmingly nouns of approximation (58.33%) and then judgmental nouns (27.38%). As nouns of expectation, nouns of indefinite degree, nouns of definite and indefinite frequency, and indefinite pronouns are relatively low in occurrence, the following discussion focuses on judgmental nouns, nouns of approximation, and question words.

4.3.4.1 Judgmental nouns

Similar to judgmental verbs, judgmental nouns are used to convey the speaker’s/writer’s tentativeness and uncertainty towards the truthfulness of a proposition. In

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my corpus, judgmental nouns are typically used to speculate probability of events, to indicate suggestions of other sources, to provide the speakers’/writers’ own suggestions, and to transmit consensus or common notion for certain conditions. The speakers tend to use judgmental nouns to transmit concepts, whereas the writers mainly use them to refer to probability of situations. There are in total 29 different judgmental nouns used in the spoken data, where 42 are used in the written discourse. Table 22 below illustrates the 10 most commonly used judgmental nouns in both genres.

Table 22. Frequency of judgmental nouns used in the spoken vs. written genres

Spoken N % Written N % 機會 45 30.00% 機會 64 25.30% 建議 13 8.67% 機率 30 11.86% 概念 13 8.67% 可能 24 9.49% 想法 11 7.33% 趨勢 22 8.70% 共識 10 6.67% 建議 20 7.91% 可能 9 6.00% 評估 11 4.35% 考量 5 3.33% 可能性 10 3.95% 評估 5 3.33% 概念 8 3.16% 可能性 4 2.67% 參考 7 2.77% 趨勢 4 2.67% 傾向 6 2.37%

Table 22 shows that jihui 機會 ‘probability’ is employed the most frequently in both the

spoken and written discourses, which implies the speakers’/writers’ less than full confidence

to the exact figures. From Table 22, we see that judgmental nouns, such as gainian 概念

‘concept’, xiangfa 想法 ‘thought’, and gonshi 共識 ‘consensus’, are commonly used by the

speakers. Those nouns inherently denote the realization of conception, which are either from

other sources or the speakers themselves. The notions relating to cognition generally entail

certain degrees of vagueness and indefiniteness. The speakers apply those cognitive

judgmental nouns to express their subjective viewpoint or to transmit concepts based on other

resources. The following three examples containing cognitive judgmental nouns are extracted 198

from my spoken data:

(201) 那..他是我們的...er 新的倫理概念認為..病人應該是我們的共同參與者. ( S 2) Nà.. tā shì wǒmen de...er xīn de lúnlǐ gàiniàn rènwéi.. bìngrén yīnggāi shì wǒmen de gòngtóng cānyù zhě ‘Then.. he is our ... er the new ethical concept indicates that .. patients should be our common participants.’ (202) 我們有一些..一些想法,一些觀念 hon,那想跟大家也做一個..溝通這樣子 (S4) Wǒmen yǒu yīxiē.. yīxiē xiǎngfǎ, yīxiē guānniàn hon, nà xiǎng gēn dàjiā yě zuò yīgè.. gōutōng zhèyàng zi ‘We have some .. some thoughts, some ideas hon, that we would like to ommunicate with all of you.’ (203) 那新的,可以.可是要減半使用.hon 這是目前共 識. (S10) Nà xīn de DPP-4 Inhibitor genubia, kěyǐ. Kěshì yào jiǎn bàn shǐyòng.Hon zhè shì mùqián gòngshì ‘You may use the new DPP-4 Inhibitor genubia, but the dose should be cut half, which is the current consensus.’

The speaker of (201) communicates a brand new notion regarding the relationship between the doctor and the patient; the speaker of (202) tries to transmit the correct concept to the

audience about antibacterial prescription; the speaker of (203) provides the current consensus

concerning a new medicine for diabetics. The three judgmental nouns, gainian 概念

‘concept’, xiangfa 想法 ‘thought’, and gonshi 共識 ‘consensus’ are employed by the

speakers to pass on new medical notions. Those cognitive judgmental nouns carry abstract

senses, which imply certain degrees of uncertainty.

Different from the speakers, the writers use more judgmental nouns that denote degrees

of probability, such as jihui 機會 ‘probability’, jilu 機率 ‘probability’, and keneng 可能

‘possibility’. As many numerical figures are unable to be definite, the probable judgmental

nouns allow the writers to avoid the impossible accuracy, and meanwhile reduce their

commitment to what is being stated. The examples from my written data are provided below:

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(204) 在肝硬化的 C 肝患者中，每年有百分之一到四的機會產生肝細胞癌，百分 之四到五的機會發生肝功能代償失調。(W1) Zài gān yìnghuà de C gān huànzhě zhōng, měinián yǒu bǎi fēn zhī yī dào sì de jīhuì chǎnshēng gān xìbāo ái, bǎi fēn zhī sì dào wǔ de jīhuì fāshēng gān gōngnéng dàicháng shītiáo ‘In the hepatitis C patients with liver cirrhosis, there is an annual rates of one to four percent of probability to yield hepatocellular carcinoma, and four to five percent of probability to have liver decompensation.’ (205) 皮膚癌在夏天被診斷的機率較其他季節高。(W1) Pífū ái zài xiàtiān bèi zhěnduàn de jīlǜ jiào qítā jìjié gāo ‘The probability for the diagnoses of skin cancer is relatively higher in summer than in other seasons.’ (206) 當病人出現任何慢性，深部，廣泛的糖尿病足潰瘍及感染時，臨床醫師都 需考慮到骨髓炎的可能。(W1) Dāng bìngrén chūxiàn rènhé mànxìng, shēnbù, guǎngfàn de tángniàobìng zú kuìyáng jí gǎnrǎn shí, línchuáng yīshī dōu xū kǎolǜ dào gǔsuǐ yán de keneng ‘When a patient has any chronic, deep, wide range of diabetic foot ulcers and infection, clinicians are required to take into account the possibility of osteomyelitis.’

In examples (204) to (206), judgmental nouns jihui 機會 ‘probability’, jilu 機率

‘probability’, and keneng 可能 ‘possibility’ are employed to indicate the probabilities of occurrences for various conditions. The ranges (1% to 4%, 4% to 5%) provided in (204), the adverbs of indefinite degree jiao 較 following judgmental nouns in (205), and the hedging speculative verb kaoludao 考慮到 preceding keneng 可能 in (206) further manifest that the probabilities are indefinite and determinate figures are unobtainable. By applying those nouns, the writers are able to distance themselves from full commitment.

The judgmental noun jianyi 建議 ‘suggestion’ is used to make suggestions, and the suggestions may come from the speakers/writers subjective viewpoints or from some convincing sources. It is interesting to note that in speaking jianyi 建議 ‘suggestion’ can be

preceded with the hedging adjective xiao 小 ‘small’ to enhance the speaker’s modesty while

making a suggestion, as shown in example (210) below. The following examples display

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sentences with various judgmental nouns:

(207) 而根據目前 ESGE 的建議是施行內視鏡乳頭切開術是不需要停用，但要停止使用， (W1) Ér gēnjù mùqián ESGE de jiànyì shì shīxíng nèi shì jìng rǔtóu qiēkāi shù shì bù xūyào tíng yòng aspirin, dàn yào tíngzhǐ shǐyòng clopidogrel hé prasugrel ‘According to the current suggestion of ESGE, while operating the implemented endoscopic sphincterotomy, it is not necessary to disable aspirin, but the patients need to stop using clopidogrel and prasugrel,’ (208) 因為其實..美國 ACIP 的建議是這樣,加上說實在的,我..我們就--咳嗽其實說 實在要一開始就診斷你是百日咳還是肺結核其實有困難 (S7) Yīn wéi qíshí.. Měiguó ACIP de jiànyì shì zhèyàng, jiā shàng shuō shízài de, wǒ.. Wǒmen jiù--késòu qíshí shuō shízài yào yī kāishǐ jiù zhěnduàn nǐ shì bǎirìké háishì fèijiéhé qíshí yǒu kùnnán ‘Because in fact .. the suggestion of ACIP is like this, and actually, I .. we--for cough, it is actually difficult to diagnose whether it is the tuberculosis or pertussis at the very early stage.’ (209) 根據目前的結果，我們提出幾點建議，第一、在安排所有內視鏡技術前， 醫師應評估安排之內視鏡技術為高或低出血性風險，並了解病患是否有凝 血功能異常；(W1) Gēnjù mùqián de jiéguǒ, wǒmen tíchū jǐ diǎn jiànyì, dì yī, zài ānpái suǒyǒu nèi shì jìng jìshù qián, yīshī yīng pínggū ānpái zhī nèi shì jìng jìshù wèi gāo huò dī chūxiě xìng fēngxiǎn, bìng liǎojiě bìng huàn shìfǒu yǒu níngxiě gōngnéng yìcháng ‘According to the current results, we make a few suggestions, first, before the arrangement of all endoscopic techniques, the physician should assess whether the endoscopic techniques are in high or low risk of bleeding, and understand whether patients have blood clotting dysfunction;’ (210) hon 今天事實上,slide 做得也非常地精美,啊演講的技巧,相當地好,啊內容相 當地豐富,不過有一個小建議啦 hon, (W10) Hon jīntiān shìshí shàng,slide zuò dé yě fēicháng de jīngměi, a yǎnjiǎng de jìqiǎo, xiāngdāng dì hǎo, a nèiróng xiāngdāng dì fēngfù, bùguò yǒu yīgè xiǎo jiànyì la hon ‘hon today actually, the slides look delicate, ah the presentation skills are very good, ah and the content is quite rich, but I have a small suggestion though,’

In (207), the speaker elicits the suggestion from well-known medical associations to support

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his argument, as well as the jianyi 建議 ‘suggestion’ in (208). To quote suggestions from

other sources brings advantages for the speakers and the writers. On the one hand, the

quotations serve as supports for their arguments or claims, and on the other hand, the

speakers/writers can avoid taking full responsibility for the arguments or claims. Different

from (207) and (208), the suggestions in (209) and (210) are based on the speaker/writers

subjective judgments. In (209), the writers indicate that the suggestions they make are in

accordance with their experimental results. In other words, the suggestions they provide are

based on the experimental consequences they obtain so far rather than accepted facts. jianyi

建議 ‘suggestion’ in (210) performs as a politeness strategy. Example (210) is the comment

for a lecture. The speaker first praises the slides, the speaking skill, and the speech content,

and then brings out his suggestion with a transition term buguo 不過 ‘but’. The transition

signals that there will be a negative comment to follow. Jianyi 建議 ‘suggestion’ is the

hedging noun utilized by the speaker to minimize the potential offensive force of his

following comment. The preceding adjective is allocated purposely to further reduce the

possible force carried by the comment.

4.3.4.2 Nouns of approximation

In my corpus, nouns of approximation are commonly employed in both genres, and

particularly they are the most frequent type of nouns used in the written discourse. There are

208 occurrences (28.93%) of approximative nouns identified in the spoken discourse,

whereas there are 529 occurrences, making up 58.33%, in the written discourse, as shown in

Figure 8. Nouns of approximation denote the concepts of vagueness and indefiniteness. They

are usually employed when the speakers/writers are uncertain about the precision of the

quantity. Approximative nouns can be used to refer to a quantity which is indefinite but more than its preceding amount, such as duo 多 ‘more than’ and yu 餘 ‘more than’, to substitute items that are relatively unimportant, such as deng 等 ‘and for forth’, and dengdeng 等等

202

‘and so forth’, or to signal a range of time, age, or quantity-related items, such as liansan ge

yu 兩三個月 ‘two or three months’, 50-59 sue 50-59 歲 ‘50-59 years old’, or 20-160mg/d.

145 different approximative nouns are observed in the spoken corpus, whereas 310 different

approximative nouns are identified in the written corpus. Most of them are used to present a

range of quantity. Table 23 below illustrates the top 10 commonly used approximative nouns.

Table 23. Frequency of nouns of approximation used in the spoken vs. written genres

Spoken N % Written N % 多 22 10.58% 等 193 35.87% 等等 19 9.13% 多 8 1.49% 兩三個月 5 2.40% 50-59 歲 5 0.93% lisantsapni(二三十年) 3 1.44% 45-60 歲 5 0.93% 一兩年 3 1.44% 近期內 4 0.74% 五六十個 3 1.44% 餘 4 0.74% 等等等 3 1.44% 3-4 週 3 0.56% gua(多) 2 0.96% 3-6 小時 3 0.56% 一兩個 2 0.96% 1-48 小時 2 0.37% 一兩天 2 0.96% 2-3 年 2 0.37%

As shown in Table 23, deng 等 ‘and so forth’ is overwhelmingly used by the writers

(35.87%) to refer to things that is unspecified but relevant to the preceding. The approximative noun deng 等 ‘and so forth’ is utilized to substitute the following unmentioned items which are not as illustrative as their proceeding exemplars. The sentence pattern of Chinese deng 等 ‘and so forth’ is equivalent to Channell’s (1994: 132) tag structure in English, which is the ‘the exemplar + tag’. Tags is one kind of vague expression identified by Channell. The exemplar always precedes the tag, and the tag can follow a number of constituent types, such as nouns phrase, verbs phrases, and embedded sentences.

In the spoken discourse, instead of deng 等, the speakers make use of its reduplications dengdeng 等等 and dengdengdeng 等等等 to substitute the indefinite items. The

approximative noun duo 多 ‘more than’ occur the most in the spoken data, which is used to 203 indicate that the quantity being stated is unable to be identified but it is vaguely more than its preceding amount. Approximative nouns that cover a range of approximate figures occur the most. Those nouns cannot be accumulated like the lexical item deng 等 because most of them are used one time only. Some examples with nouns of approximation are displayed as follows:

(211) 腎上腺機能不全最常見的臨床表徵為疲倦、胃口不佳、體重減輕等症狀 (W1) Shènshàngxiàn jīnéng bùquán zuì chángjiàn de línchuáng biǎozhēng wèi píjuàn, wèikǒu bù jiā, tǐzhòng jiǎnqīng děng zhèngzhuàng ‘The most common clinical manifestations of Adrenal insufficiency are fatigue, loss of appetite, weight loss, and so forth.’ (212) 我們講的 needle 包括我們宿舍用的這些 needle,也包括我們傳遞器械這一方 面等等都是在我們探討的範圍裏面. (S9) Wǒmen jiǎng de needle bāokuò wǒmen sùshè yòng de zhèxiē needle, yě bāokuò wǒmen chuándì qìxiè zhè yī fāngmiàn děngděng dōu shì zài wǒmen tàntǎo de fànwéi lǐmiàn ‘The needles we are talking about include these needles used in our hostel and the circumstances when we need to pass the sharp instruments, and so forth, are covered in our discussion’

The approximative noun deng 等 ‘and so forth’ in (211) and dengdeng 等等 ‘and so forth’ in (212) have the identical semantics, and they are used to imply that there are other exemplars left unmentioned. The substitution may be owing to the speakers’/writers’ uncertainty to the other alternatives or the omitted items are peripheral. deng 等 ‘and so forth’ and its reduplicative forms function as vague identifiers which enable the speakers/writers to avoid providing exact items for the exemplar list.

(213) 2003 年法國因熱浪死了一萬多人，其中高達八成以上是年紀大於 75 歲的 人。(W1) 2003 Nián fàguó yīn rèlàng sǐle yī wàn duō rén, qízhōng gāodá bāchéng yǐshàng shì niánjì dàyú 75 suì de rén ‘In 2003, heat wave in France caused the death of more than one million people, 204

of which greater than 80% are people older than 75 years of age.’ (214) 共有 2 千餘受試者，一半受試者接受術後全乳房放療，另一半於手術當天 接受術中部份乳房放療(IORT) (W2) Gòngyǒu 2 qiān yú shòushìzhě, yībàn shòushìzhě jiēshòu shù hòu quán rǔfáng fàngliáo, lìng yībàn yú shǒushù dàngtiān jiēshòu shùzhōng bù fèn rǔfáng fàngliáo (IORT) ‘A total of more than two thousand participants, half of the subjects received whole breast radiation therapy after surgery, and the other half on the day of surgery accept part of the breast intraoperative radiation therapy (IORT).’

Duo 多 ‘more than’ and yu 餘 ‘more than’ are used to signal that the numerical quantity the speaker or the writer tries to express is a bit more than the preceding amount; however, the exact figure is uncertain. For example, the writers of (213) indicate that in 2003, the heat wave arose in France took more than 10,000 lives away. The amount 10,000 is followed by the approximative noun duo 多 ‘more than’ to imply that more than 10,000 people died, yet the precise number is left unidentified. duo 多 ‘more than’ is observed in both genres, whereas yu 餘 ‘more than’ is exclusively utilized by the writers.

4.3.4.3 Question words

Senme 什麼 ‘what’, ji 幾 ‘how many’, duoshao 多少 ‘how many’, zenmeyang 怎

麼樣 ‘how’ are common question words in Chinese. Question words may function as hedges since they can refer to indefinite entities to denote such as ‘whatever’, ‘anything’, or

‘wherever’ (Biq 1990, Li and Thompson 1997, Liu et al. 2011). In my corpus, question words ji 幾 ‘how many’ and duoshao 多少 ‘how many’ are used to imply indefiniteness in quantity. In addition to present vague quantity, ji 幾 is found to present different communicative purposes. It can be used to signal that something can be or is requested to be accomplished in a short period of time; it can be used to present the speaker’s/writer’s prediction about something can be done within a time span; it can also function as a replacement for any possible date. Ji 幾 can be interpreted as ‘several’, ‘how many’, or

‘more than’ depending on what the language user tries to convey. Sheme 什麼 ‘what’ mainly 205

functions as a referential hedge to show the speaker’s attitude towards the referentiality being

stated (Biq 1990). It yields an indefinite interpretation when the speaker is uncertain or lack

of confidence about what he wants to express. The vague usage of question words enables the

speakers/writers to lower their commitment to the propositions. 23 question words are found

to be utilized by the speakers, whereas there are only 4 used by the writers. Table 24 below

illustrates the top 10 used question words in the spoken discourse and the 4 questions words

found in the written discourse.

Table 24. Frequency of question words used in the spoken vs. written genres

Spoken N % Written N % 幾 125 49.21% 幾 46 90.20% 什麼 61 24.02% 什麼 2 3.92% 多少 21 8.27% 多少 2 3.92% 怎麼樣 11 4.33% 如何 1 1.96% 哪裡 6 2.36% 哪 5 1.97% siami(什麼) 4 1.57% annua(怎樣) 3 1.18% kui(幾) 2 0.79% 多久 2 0.79%

As shown in Table 24, the first three most frequently used question words are identical for

both genres, with ji 幾 ‘how many’ ranks on the top, followed by sheme 什麼 ‘what’ and

then duoshao 多少 ‘how many’. Ji 幾 ‘how many’ occupies nearly half of all the question words (49.21%) in the spoken discourse, while it predominately makes up 90% in the written discourse. Sheme 什麼 ‘what’ is used a lot more in the speaking than writing, which is presumably because the uses of sheme 什麼 as interactional hedges and referential hedges are primarily seen in the spoken language only (Biq 1990). The following examples are extracted to explicate various communicative purposes of question words, and ji 幾, sheme

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什麼, and duoshao 多少 will be discussed successively:

(215) 1929 年,幾種用以降血糖的雙胍類(biguanides) 被合成，其中包括二甲雙胍 (dimethylbiguanide), (W1) 1929 Nián, jǐ zhǒng yòng yǐjiàng xiětáng de shuāngguā lèi (biguanides) bèi héchéng, qízhōng bāokuò èrjiǎshuāngguā (dimethylbiguanide) ‘In 1929, several dynasties of blood glucose with biguanide (biguanides) are synthesized, including metformin (dimethylbiguanide),’ (216) 以前我們實在是..er 神經科的話,以前我們對中風的治療,就..er..< E conservative E>,讓它不會惡化,可是現在的話,需要說在幾分鐘之內,三個小時 內, 就要診斷病人是不是適合打所謂的血栓溶解劑喔. (S6) Yǐqián wǒmen shízài shì..er shénjīng kē dehuà, yǐqián wǒmen duì zhòngfēng de zhìliáo, jiùshì..er..conservative, ràng tā bù huì èhuà, kěshì xiànzài dehuà, xūyào shuō zài jǐ fēnzhōng zhī nèi, sān gè xiǎoshí nèi, jiù yào zhěnduàn bìngrén shì bùshì shìhé dǎ suǒwèi de xuèshuān róngjiě jì ō. ‘Before we really ..er in neurology, before when we treated stroke, that is ..er.. conservative, made it not to deteriorate, but now, the diagnosis is required to be done in several minutes, within three hours, we must diagnose whether the patient fits the so-called thrombolytic agents oh.’

In (215), ji 幾 is used to express the notion of indefiniteness in regard to the quantity, where it is interpreted as ‘several’. Ji 幾 can also be employed to denote concepts beyond its literal meaning. For example, it can be used to signal that something is expected to be accomplished in a short period of time, as in (216). The speaker of (216) asserts that nowadays more aggressive treatments in Neurology is demanded, so the physicians need to make correct diagnosis within a limited time span in order to prevent disease progression. Ji 幾 is used to emphasize the limited time span for decision-making.

The followings are examples containing the question word sheme 什麼:

(217) 所以結果當然都得不到明顯或滿意的療效，以致病人擔心自己是否得了什 麼病或懷疑自己是否得了什麼隱疾或惡性癌症，於是到處看病，經常吃 藥， (W2) Suǒyǐ jiéguǒ dāngrán dōu dé bù dào míngxiǎn huò mǎnyì de liáoxiào, yǐzhì bìngrén dānxīn zìjǐ shìfǒu déliǎo shéme bìng huò huáiyí zìjǐ shìfǒu déliǎo shéme 207

yǐnjí huò èxìng áizhèng, yúshì dàochù kànbìng, jīngcháng chī yào ‘The results of course are not so obvious or satisfactory, so that the patient worry about whether they have whatever disease or suspect if they gain whatever unidentified illness or malignant cancer. Thus, they constantly look for special treatment, and take medicine frequently.’ (218) 過去 CT 看石頭就是一個鈣化點,你也不曉得成分,那..不曉得它的 type,那..如 果你要去..去--一般來講,它的好處就是,直接可以鑑別什麼?尿酸石,跟其他的 草酸鈣石或什麼 (S6) Guòqù CT kàn shítou jiùshì yīgè gàihuà diǎn, nǐ yě bù xiǎodé chéngfèn, nà.. Bù xiǎodé tā de type, nà.. Rúguǒ nǐ yào qù.. Qù--yībān lái jiǎng, tā de hǎochù jiùshì, zhíjiē kěyǐ jiànbié shénme? Niàosuān shí, gēn qítā de cǎosuān gài shí huò sheme ‘In the past, a stone would be represented as a calcification via CT scanner. You would not know what the ingredients it possessed or what type it is. If you go .. go .. -- Generally speaking, its advantage is..what can you define directly? uric acid stones, calcium oxalate stones, or whatever.’

Sheme 什麼 in (217) and (218) function as referential hedges, which is used to disclaim responsibility for the accuracy or truthfulness of what is said. As indicated by Biq (1990),

‘sheme + enumerated items’ and ‘enumerated items + sheme’ are two fixed patterns in

Chinese, meaning ‘A, B, …, and so on and so forth’. The structures of (217) and (218) confirm these two enumerative patterns. The speakers of (217) and (218) employ sheme 什

麼 to avoid responsibility for providing an exhaustive list of items, which allow them to reduce their commitment towards the enumeration.

In addition, sheme 什麼 ‘what’ can be interpreted as things in vain under certain conditions, as in (219) and (220).

(219) 你要先確定你的診斷是對的 hon,診斷不對,下面..其實什麼都不用再談了 (S4) Nǐ yào xiān quèdìng nǐ de zhěnduàn shì duì de hon, zhěnduàn bùduì, xiàmiàn.. qíshí shéme dōu bùyòng zài tánle ‘First of all, you have to make sure your diagnosis is right hon. If the diagnosis is wrong, actually, whatever would be unworthy to talk about afterwards.’ (220) 大家可能會想說,啊,那就是腸道的感染而已 hon,那好像也沒什麼 (S7) Dàjiā kěnéng huì xiǎng shuō, a, nà jiùshì cháng dào de gǎnrǎn éryǐ hon, nà 208

hǎoxiàng yě méi shéme ‘We may say, ah, that is just intestinal infection hon, that seems not to be whatever serious.’

The speaker of (219) argues that if a physician’s diagnosis is incorrect, whatever action follows will be useless. In (220), sheme 什麼 is used to explain that the situation mentioned in the preceding clause is merely trivial and unimportant. It seems that sheme 什麼 in (219) is utilized to reinforce the significance of the situation in the preceding utterance, whereas sheme 什麼 in (220) is employed to downgrade the importance of the situation in the preceding statement.

Duoshao 多少 ‘how many’ in (221) and (222) are employed to refer to indefinite figures in quantity:

(221) 由於目前對黎明現象的診斷尚缺乏一致性的準則，而以夜間血糖正常，但 清晨空腹血糖增高者，考慮為黎明現象，而不是以血糖值絕對升高多少來 定義 (W2) Yóuyú mùqián duì límíng xiànxiàng de zhěnduàn shàng quēfá yīzhì xìng de zhǔnzé, ér yǐ yèjiān xiětáng zhèngcháng, dàn qīngchén kōngfù xiětáng zēnggāo zhě, kǎolǜ wèi límíng xiànxiàng, ér bùshì yǐ xiětáng zhí juéduì shēng gāo duōshǎo lái dìngyì ‘Due to the lack of consistency criteria for the current diagnosis of dawn phenomenon, the patient is diagnosed as having dawn phenomenon if his/her blood sugar is normal at night, but the fasting blood glucose level raises at dawn, it is not defined by how many levels the absolute number of blood glucose elevated.’ (222) 住院的病人到底有多少..血糖高?各位一定會告訴我,啊就看糖尿病病人有多 少就多少.對啦,你答對一半啦. (S10) Zhùyuàn de bìngrén dàodǐ yǒu duōshǎo.. Xiětáng gāo? Gèwèi yīdìng huì gàosù wǒ, a jiù kàn tángniàobìng bìngrén yǒu duōshǎo jiù duōshǎo. Duì la, nǐ dáduì yībàn la ‘Do you know how many hospitalized patients who are with high sugar? You will probably tell me, ah, it depends on how many diabetic patients are hospitalized. Well, the answer is only half correct’

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The writers of (221) indicate that the occurrence of dawn phenomenon in diabetics is not

determined by glucose values. That is, the rising rate of the blood sugar can only be

referential. duoshao 多少 ‘how many’ is used to imply an indefinite rising level. As well as

in (221), duoshao 多少 of (222) conveys a vague notion, and it is not the focus of the

speaker’s utterances. Since the exact numerical figure of the diabetic patients is unimportant,

duoshao 多少 ‘how many’ is used to substitute the exact amount.

4.3.4.4 Summary

Epistemic nouns are another common lexical hedges used by medical professionals. In

my corpus, a great amount of hedging nouns is the nominal forms of their corresponding

verbs and adjectives, and similar to their counterparts, hedging nouns also convey different

degrees of tentativeness and uncertainty. The results of my data show that hedging nouns are

employed more in writing than in speaking (14.80% versus 8.93%), and the discrepancy in hedging application is statistically significant. The main difference may lie in the amount of approximate nouns used in the writing, which contributes to more than half of the total hedging nouns (58.33%, with 539 occurrences). Hedging nouns are classified into eight

subcategories, including judgmental nouns, evidential nouns, nouns of expectation, nouns of

indefinite degree, nouns of definite and indefinite frequency, nouns of approximation,

questions words, and indefinite pronouns. It is observed that the speakers tend to utilize judgmental nouns for transmitting concepts, whereas the writers mainly use them to denote probability of situations. Nouns of approximation are used the most frequently among those various subcategories, especially in the written discourse. They are generally applied when

the speakers/writers are uncertain about the precision of the quantity. Approximative nouns

can be used to refer to a quantity which is indefinite but more than its preceding amount, to

substitute items that are relatively unimportant, or to signal a range of time, age, or quantity-

related items. Most of the approximate nouns are found to be used to circumscribe an interval

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in quantification. Question words are substantially utilized in face-to-face interaction as they

mainly function as interactional hedges and referential hedges to show the speaker’s attitude

toward the referentiality being said (Biq 1990). It is found that question words are mostly

used to imply indefiniteness in quantity than quality in my data.

4.3.5 Summary

Previous studies have shown that lexical hedges are predominately utilized by

speakers/writers to express their less than full commitment to propositions. The results of my

medical corpus also confirm this trend. In this study, lexical hedges are classified in terms of

grammatical categories, which include verbs, adverbs, adjectives, and nouns. Among these

four types of lexical hedges, adverbs are overwhelmingly employed by medical professionals

regardless of genres. This tendency is consistent with Chen’s (2008) conversational data and

Lo’s (2010) academic written texts. In English literature, different grammatical categories have been found to be utilized the most for hedging purpose. In Hyland’s (1998) scientific study, lexical verbs are the most common means used by the writers. In Holmes’ (1988) academic corpus, lexical verbs are also used the most frequently in both speaking and writing genres. However, in Varttala’s (2001) study, the most frequent lexical hedge varies by means of disciplines. In his RA corpus, lexical verbs are employed the most frequently in the disciplines of economics and medicine, whereas in technology it is adverbs which occur the most. In the popular scientific articles, adverbs are the well represented means of hedges across the three disciplines. According to the above review, it seems that so far adverbs are the preferred lexical hedges in Chinese language whether in conversation or in academic writing.

In my corpus, adverbs are predominately used by both the speakers and writers, and the statistic results show that there is not a significant difference in the application of hedging adverbs between these two genres. Among various types of adverbs, stance adverbs are used

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the most, which demonstrate the major divergence in the application of hedging adverbs

between genres. Stance adverbs are employed by the medical professionals to express their

subjective viewpoints and judgments as well as to interact with their audiences. Qishi 其實

‘actually’ and shishishang 事實上 ‘in fact’ occur the most in the spoken data, while huo 或

‘alternatively’ is overwhelmingly employed by the writers. It is observed that qishi 其實

‘actually’ and shishishang 事實上 ‘in fact’ are used to express the speaker’s viewpoints based on his clinical experience, to refocus the audiences’ attention on certain part of the talk, or to serve as a contrastive markers. In a lot of cases, the meanings of these two words are semantically vacant. The speakers unconsciously and repeatedly utter qishi 其實 ‘actually’ and shishishang 事實上 ‘in fact’ during their lectures. Therefore, in the face-to-face encounter, they mainly serve as discourse markers as suggested by Wang et al. (2010). Huo

或 ‘alternatively’, including their syntactic variables, amount to 720 tokens in the written discourse. As well as uncertainty, there are always existing alternatives for causes of disease or medical treatment; therefore, stance adverb huo 或 ‘alternatively’ is the best choice for physicians to express uncertainty and the potential alternatives. As RAs are formal means for knowledge transmission in academia, writers should be cautious while presenting their arguments or findings. In medical RAs, propositions with tentativeness and cautiousness are especially observed as there always exists uncertainty regarding differential diagnosis, the probabilistic nature of disease outcome, therapeutic response, or individualized prognosis.

Huo 或 ‘alternatively’ allow medical writers to present the probabilities for all the medical- related situations, and simultaneously lower their commitments to the propositions being stated.

Verbs are another common hedges employed frequently by the speakers and writers as they are the most transparent hedges used to code the subjectivity of the epistemic source.

Alike English, judgmental verbs and evidential verbs are commonly identified in my corpus,

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with judgmental verbs being used substantially more than evidential verbs. Judgmental verbs are used to express the speaker’s/writer’s subjective evaluation, such as conjecture, estimation, or doubts, to convey the speaker’s/writer’s subjective judgments, beliefs or suggestions, or to tentatively draw possible parallelism of events. Evidential verbs are used to

indicate evidentiary justification based on the speaker’s/writer’s perceptions, hearsay

evidence, or research findings from others. The phenomenon that judgmental verbs are used

predominately over evidential verbs in both genres implies that while making statements, medical professionals are constantly aware of the possible alternatives in causes of disease, diagnosis, medical treatment, and treatment response. Although medical specialists own professional knowledge and clinical experiences, they recognize that there are always layers upon layers of explanation and uncertainty is the most basic problem in medical setting.

Therefore, speakers/writers adopt appropriate hedges to modify the strength of their propositions, which meanwhile represents the degree of their commitment to the propositions. Judgmental verbs are then frequently utilized by speakers/writers to convey their tentativeness and cautiousness while making statements. The supportive evidence carried by evidential verbs are only employed when it is necessary. Based on different origins of source, evidential verbs are classified into quotative verbs and sensory verbs. Quotative verbs are verbs referring to scientific evidence and hearsay evidence, while sensory verbs are those that signal subjective perceptions. It is noteworthy that sensory verbs are overwhelmingly employed by the speakers, whereas quotative verbs are preferred by the writers. The tendency is presumably attributed to genre difference. That is, academic writers rely greatly on hearsay evidence and research findings in literature to support their arguments, while speakers strongly adhere to conversational hedges to express their attitude and feelings toward the propositions being said.

Epistemic adjectives found in my data are analogous with their corresponding adverbs,

213 both in the meanings and function. They are normally employed to modify their following nouns, which mark the information contained in the nouns as tentative, indefinite, or imprecise. Although adjectives are also classified into four subcategories, the same way as hedging adverbs, the distribution is different from that of adverbs. In both genres, frequency adjectives occupy more than half of the overall hedging adjectives, with 74.79% in speaking and 56.96% in writing. The high frequency implies that medical specialists make great use of frequency adjectives to modify the degree of their propositions, especially those with mid frequency (e.g. yixie 一些 ‘some’, youxie 有些 ‘some’). It is probably owing to adjectives of mid frequency denote a wider range of vagueness and indefiniteness.

Various types of nouns are identified in my corpus, and overall they are employed more in the written than spoken discourse. Among those different types of nouns, approximative nouns (58.33%) contribute more than half of the nouns in the written corpus, whereas question words appear significantly more in speaking than in writing (35.33% vs. 5.52%). In medical setting, there are always numerical figures and statistical data involved. In a lot of circumstances, it is difficult or impossible for physicians to provide exact figures. Therefore, nouns of approximation are utilized frequently for medical professionals to express their uncertainty or to offer a possible range for medical-related items. In medical writing, 310 different approximative nouns are identified, and a great deal of them appear once only. RAs are formal means for knowledge transmission, writers utilize a lot of approximate nouns to present numerical figures cautiously. On the contrary, in spontaneous interaction, it is not easy for the speakers to memorize all those numbers or the range of certain figures. That explains why nouns of approximation occur predominately in the written corpus. Question words are used almost 7 times more in the speaking than writing as in speaking they can function as indefinite pronouns to denote any indefinite entity. This function is essentially conversational, which is borne out by Chen’s (2008) conversational data. In my data, question

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words are used to imply indefiniteness in quantity, with ji 幾 ‘how many’ used the most in

both genres. The vague sense those question words contain helps lower speakers’

commitment to the information being presented.

4.4 Non-lexical Hedges

Non-lexical hedges are hedges that extended beyond single words or phrases. As

hedges are viewed as context-dependent and interactional, it is not uncommon to see hedging

devices go across utterances. Non-lexical hedges enable the speakers/writers to include more

information in their statements than lexical hedges do. In the present study, non-lexical

hedges consist of three categories, namely conditionality, rhetorical questions, and limitations

addressing, which are classified by means of their functions. The distribution of these three

categories is provided in Figure 9 below:

100.00% 90.00% S W 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Conditionality Rhetorical questions Addressing limitations

Non-lexical Conditionality Rhetorical questions Addressing limitations S 60.83%(486) 94.61%(877) 32.97%(60) W 39.17%(313) 5.39%(50) 67.03%(122)

Figure 9. Distribution of non-lexical hedges used in the spoken vs. written genres

Figure 9 clearly shows that rhetorical questions (94.61%) are employed the most frequently in the spoken discourse, whereas conditionality (60.83%) are favored in the written discourse. 215

The stratum among those categories in the spoken data is rhetorical questions, followed by conditionality, and then limitations addressing, whereas it ranks as addressing limitations,

conditionality, and rhetorical questions in the written discourse. These three categories will be

discussed in the following sections in proper order.

4.4.1 Conditionality

Conditionals has been viewed as one of the hedging strategies in academic discourse

(Hyland 1998, Varttalla 2001, Chen 2008, Lo 2010). If-conditionals imply uncertainty about

actual circumstances and they are used to qualify the speaker’s/writer’s commitment to the

truth of a proposition (Perkins 1983). The protasis (if-clasue) typically sets up certain

situation that departs in some degree from the actual world and the apodosis denotes the

outcome depending on the protasis (Ferguson 2001). The outcome, laying its value on a

hypothetical condition, is then considered as a speculative state of affairs. Werth (1997: 247)

argues that the epistemic domain conditional “corresponds to at least two communicative

functions, hypothetic deduction and deduction from a known fact to a conclusion”, which

requires world knowledge to complete the reasoning process. The following examples

elicited from Werth’s study display these two types of epistemic conditional:

(223) If he doesn’t answer, then he’s probably at his girlfriend’s house. (224) If it’s Tuesday, this must be Belgium. (Werth 1997: 247)

Example (223) is a hypothetical deductive conditional, given a hypothetical situation, and the

conclusion is drawn from a number of possible outcomes. It is the knowledge about this

person’s habits that helps draw the conclusion. As to (224), the information “It’s Tuesday” is

taken as known information, and on the basis of this existent knowledge, the process of

reasoning is conducted. In this example, the if-clause does not set up a situation but rather

offers a piece of given information, a form of modus ponens, as the initial statement of the

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syllogism. Conditionals functioning as a hedging device are found in both spoken and written

discourses (Mead & Henderson 1983, Ford & Thompson 1986, Hyland 1998, Ferguson 2001,

Varttala 2001, to name just a few). The results from my corpus show that conditionals are not

uncommon in medical communication, which occupies around 5% among all the hedging

devices found in both genres (6.04% in speaking; 5.02% in writing). In my Chinese corpus,

if-conditionals occur more in the spoken than in the written discourse, which confirms Ford

& Thompson’s (1986) academic study and Carter-Thomas & Rowley-Jolivet’s (2008) medical research. However, the occurrences of if-conditionals in my Chinese data (55.85 conditionals per 1000 words in speaking and 44.52 conditionals per 1000 words in writing) is much greater than those in Ford & Thompson’s (1986) English data (7.2 conditionals per

1000 words in speaking and 4.6 conditionals per 1000 words in writing).

Conditioning is classified as one of the non-lexical hedges as it normally takes two clauses to complete its meaning and function. The prototypical pattern of conditionals is if-

clause + consequence clause, which is borne out by my Chinese data. There is only one final-

positioning if-conditional found in my spoken data. Different from English, where if is the

protagonist for conditionals; in Chinese several words and phrases can be used to present

conditioning. 43 syntactic forms including words and phrases are identified in the spoken

discourse, whereas 10 are identified in the written discourse. Table 25 illustrates the top ten

conditional forms found in speaking and all the forms observed in the writing.

Table 25. Frequency of conditionals used in the spoken vs. written genres

Spoken N % Written N % 如果 203 41.77% 若 135 43.13% 如果…的話 68 13.99% 如果 84 26.84% nah(若) 42 8.64% 如 38 12.14% 如果說 34 7.00% 一旦 33 10.54% 假設 25 5.14% 倘若 10 3.19% 如果…的時候 14 2.88% 假如 5 1.60%

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假如 13 2.67% 如果…的話 3 0.96% 如果說…的話 12 2.47% 一旦…時 2 0.64% 假使說 8 1.65% 若…時 2 0.64% 萬一 8 1.65% 如果以…而言 1 0.32%

Table 25 shows that the speakers prefer ruguo 如果 ‘if’ to initiate Chinese if-conditionals,

while the writers favor the monosyllabic ruo 若 ‘if’. In addition to words, the speakers and

writers make good use of phrases to build if-clauses, such as ruoguo…dehua 如果…的話

‘if’, ruguo..deshihou 如果…的時候, and yidan…shi 一旦…時 ‘in case’. The conditionals

found in my corpus serve a variety of functions. They can be utilized to make deductions,

either from hypotheses or known information; they can be used to offer supports, to make

suggestions, or to make predictions; they can be employed to call for attention; they may serve as warnings or invitations; they may be used to announce further actions. Some functions can be observed in both genres, whereas some are used exclusively in either. Table

26 below illustrates different functions identified in the medical discourse.

Table 26. Functions of conditionals observed in the spoken and written genres

Spoken Written

A. hypothetic deduction A. hypothetic deduction B. deduction from known information B. deduction from known information C. supportive examples C. supportive examples D. suggestion D. suggestion E. prediction upon conditions E. prediction upon conditions F. treatments offering upon alternative F. treatments offering upon alternative condition condition G. explanation for successive treatment G. explanation for successive treatment H. warning H. warning I. call for attention I. call for attention J. circumscription of the scope J. cause-effect relationship K. announcement for future actions K. categorization L. invitation L. reference offering

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As shown in Table 26, 12 communicative purposes are found in either genre. Among those

functions, 9 are shared by both genres, and the exclusive functions of either genre are marked

in bold face. Conditionals with shared functions will be discussed first, and the unique

functions exclusively observed in either genre will be explained afterwards. Each function

will be explicated with two examples, one from the spoken data and the other from the

written data:

(225) 如果我們好好地去..照顧這種傷口的話,可以降低那個醫療成本 hon,也會提 高病人的那個滿意度 hon (S5) Rúguǒ wǒmen hǎohǎo de qù.. zhàogù zhè zhǒng shāngkǒu dehuà, kěyǐ jiàngdī nàgè yīliáo chéngběn hon, yě huì tígāo bìngrén dì nàgè mǎnyì dù hon ‘If we can take care of this kind of wounds carefully, it can reduce the cost of medical care hon, and that will also improve patients’ satisfaction hon.’ (226) 如果腫瘤躲避免疫系統監控（tumor evasion）而不表現 MHC，這時 T 細胞 就無法偵測、清除癌細胞了 (W2) Rúguǒ zhǒngliú duǒbì miǎnyì xìtǒng jiānkòng (tumor evasion) ér bù biǎoxiàn MHC, zhèshí T xìbāo jiù wúfǎ zhēn cè, qīngchú ái xìbāole ‘If the tumor escape from the monitoring of the immune system (tumor evasion), without performance MHC, then T cells can not detect or remove the cancer cells of.’ (227) 如果你遇到一個病人有..有.有呼吸道感染,那像細菌感染,可是也以 lymphocytosis 為主,啊你一定要考慮百日咳 (S7) Rúguǒ nǐ yù dào yīgè bìngrén yǒu.. yǒu. yǒu hūxīdào gǎnrǎn, nà xiàng xìjùn gǎnrǎn, kěshì yě yǐ lymphocytosis wéi zhǔ, a nǐ yīdìng yào kǎolǜ bǎirìké ‘If you encounter a patient who has respiratory infections, analogous to bacterial infections, but also has the symptoms of lymphocytosis, then you must consider it as pertussis.’ (228) 如果冠狀動脈是正常，造成 cTn 升高的原因不外乎是第 2 型心肌梗塞，或 者非冠狀動脈因素引發。(W1) Rúguǒ guānzhuàng dòngmài shì zhèngcháng, zàochéng cTn shēng gāo de yuányīn bùwàihū shì dì 2 xíng xīnjī gěngsè, huòzhě fēi guānzhuàng dòngmài yīnsù yǐnfā ‘If the coronary arteries are normal, the reasons for elevated cTn must be type 2 myocardial infarction, or non-coronary factors lead.’

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If-conditionals in examples (225) to (228) are used to make deductions. Examples (225) and

(226) display clearly a dependent relationship between the protasis and the apodosis. That is,

the possible occurrence of the consequence is depending on the if-clause. The hypothetic

conditions proposed in (225) and (226) are indeterminate: it outlines an ideal prospect for the

further in (225), while it hypothesizes a possible condition in (226). The speakers of

examples (227) and (228) make deductions from given information, which is corresponding

with Werth’s (1997) example (2). With the given circumstances, the outcomes are highly

predictable, and therefore, linguistic terms with firm tone are employed to cooperate with

hedges to strength the predictions, as yiding yao kaulu 一定要考慮 ‘must consider’ in (227)

and buwaihu shi 不外乎是 ‘must be’ in (228).

(229) 如果是一個< E streptococcus E>的一個,那不 一定會比來得差 hon,尤其是在的, 可能會比另外來得好 (S4) Rúguǒ shì yīgè tramuro de yīgè infection, nà penicillin bù yīdìng huì bǐ vancomycin láidé chà hon, yóuqí shì zài lung de infection, penicillin kěnéng huì bǐ lìngwài láidé hǎo ‘If the infection is caused by streptococcus, penicillin is not bound to be worse than vancomycin , especially in the lung infection, penicillin may be better than others.’ (230) 而在執行經鼻內視鏡檢查過程中，因內視鏡並非由口進入，病患可以說 話、觀看內視鏡影像，以及和內視鏡醫師溝通。如檢查過程中有任何不適 或需求，也可立即表達與反應。 (W1) Ér zài zhíxíng jīng bí nèi shì jìng jiǎnchá guòchéng zhōng, yīn nèi shì jìng bìngfēi yóu kǒu jìnrù, bìng huàn kěyǐ shuōhuà, guānkàn nèi shì jìng yǐngxiàng, yǐjí hé nèi shì jìng yīshī gōutōng. Rú jiǎnchá guòchéng zhōng yǒu rènhé bùshì huò xūqiú, yě kě lìjí biǎodá yǔ fǎnyìng ‘In the implementation of transnasal endoscopy procedure, the endoscope does not go through the mouth, so the patient can talk, and watch endoscopic images, as well as communication with the endoscopist. If there is any discomfort or demands during the examination, the patient can react immediately.’ (231) 第一個是,其實我們可以盡量--如果這樣的醫療行為,可以不用用到針頭或尖 銳物品 hon,我們其實是--如果不需要使用,就不要使用 hon,是最好 (S9)

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Dì yī gè shì, qíshí wǒmen kěyǐ jìnliàng--rúguǒ zhèyàng de yīliáo xíngwéi, kěyǐ bùyòng yòng dào zhēntóu huò jiānruì wùpǐn hon, wǒmen qíshí shì--rúguǒ bù xūyào shǐyòng, jiù bùyào shǐyòng hon, shì zuì hǎo ‘The first is, in fact, we can try --if in such a medical practice, you may avoid using needles or sharp objects hon, we actually--if we do not need to use them, we’d better skip that hon, it will be the best way.’ (232) 若糖尿病病人以飲食控制及運動仍無法有效的控制血糖時，應早日考慮使 用藥物治療。(W1) Ruò tángniàobìng bìngrén yǐ yǐnshí kòngzhì jí yùndòng réng wúfǎ yǒuxiào de kòngzhì xiětáng shí, yīng zǎorì kǎolǜ shǐyòng yàowù zhìliáo ‘If the diabetic patients with diet and exercise are still unable to effectively control blood sugar, the use of drug therapy should be considered as soon as possible.’

If-conditionals in (229) and (230) function as supportive examples for the speaker’s/writers’ claims. The speaker of example (229) earlier advocates that there is not a good or bad distinction on antibiotics. As long as they can function properly and effectively on patients’ problems, they are all good ones. The so-called good or bad distinction is only a myth held by the majority. Example (229), a conditional utterance, is then offered as a support for the speaker’s advocate. He takes streptococcus infection as an example, asserting that vancomycin is not necessarily to treat the infection better. Especially in the lung infection, penicillin may be a better choice than vancomycin although vancomycin is traditionally regarded as a stronger and better antibiotic. The writers of (230) introduce the Transnasal endoscopy which has become the first line of diagnostic and therapeutic tool of gastrointestinal diseases. The writers entitle this new equipment as savior for patients with endoscopy phobia. Several advantages of this new equipment have been listed in example

(230). The if-conditional displays one of the advantages in the enumeration to support the writers advocate. In (231), the speaker indicates that needlestick injuries may give rise to infection problem for physicians, nurses, and sanitation workers. The injuries may be caused under different situations and occur in various places in the hospital. The speaker then utilizes

221 if-conditional to provide his suggestion by advising the audience to try to keep away needles as much as possible. The writers in (232) suggest that medical treatment should be taken into consideration once the diabetic cannot be properly controlled via diet and exercise. The tentative suggestion is further toned down by applying the hedging auxiliary yin 應 ‘should’ and the speculative verb kalui 考慮 ‘consider’.

(233) 那=如果 ABI 小於零點六到零點八的話,我們高度懷疑它是周邊血管方面的 問題 hon,阻塞了 hon,啊零點五..小於零點五的話,一般都是有那個..截肢的可 能性 hon.啊如果是大於一點二..的話 hon,他可能動脈有硬化的情形 hon. (S5) Nà =rúguǒ ABI xiǎoyú líng diǎn liù dào líng diǎn bā dehuà, wǒmen gāodù huáiyí tā shì zhōubiān xiěguǎn fāngmiàn de wèntí hon, zǔsèle hon, a líng diǎn wǔ.. Xiǎoyú líng diǎn wǔ dehuà, yībān dōu shì yǒu nàgè.. jiézhī de kěnéng xìng hon. A rúguǒ shì dàyú yī diǎn èr.. dehuà hon, tā kěnéng dòngmài yǒu yìnghuà de qíngxíng hon ‘If the patient’s ABI is less than 0.6 to 0.8, we highly susptect that it is the problem of peripheral vascular artilleries.., blocking the hon. If it is ah .. less than 0.5, then 0.5, usually there is a possibility of amputation .. hon. ah .. if the ABI is greater than the 1.2, he may have atherosclerosis hon.’ (234) 如果腎臟科醫師在術前把病人的體液狀態透析得剛剛好，而麻醉科醫師卻 在手術時給了太多靜脈注射液，就會造成病人肺水腫；相反的，若是腎臟 科將病人透析過度，而許多麻藥又會使得病人血管擴張，共同作用下造成 血壓過低的問題。(W2) Rúguǒ shènzàng kē yīshī zài shù qián bǎ bìngrén de tǐyè zhuàngtài tòuxī dé gānggāng hǎo, ér mázuì kē yīshī què zài shǒushù shígěile tài duō jìngmài zhùshè yè, jiù huì zàochéng bìngrén fèi shuǐzhǒng; xiāngfǎn de, ruò shì shènzàng kē jiāng bìngrén tòuxī guòdù, ér xǔduō máyào yòu huì shǐdé bìngrén xiěguǎn kuòzhāng, gòngtóng zuòyòng xià zàochéng xiěyāguò dī de wèntí ‘If in the preoperative status the nephrologist dialyzes the patient's body fluids just right, but the anesthesiologist gives too much intravenous injection during the surgery, which will cause pulmonary edema; Conversely, if the nephrology dialysis is high, and lots of anesthetics will make the patient vasodilation, those joint functions result in low blood pressure problems.’

Conditionals can be used to predict a patient’s possible health problems upon medical examinations. Examples (233) and (234) express the speaker’s/writers’ predictions in terms 222

of the patients’ conditions. The speaker of (233) predicts three possible consequences

depending on three different values of ABI, while the predictions made in (234) are

depending on treatments of physicians from different disciplines. The potential disharmony

of the co-therapy will cause different problems for the patient. In compared with this set of examples, it is easy to note that the tone of (233) is less assertive than that in (234). The

speaker of (233) employs other hedging devices to tone down his argument, such as gaodu

huaiyi 高度懷疑 ‘highly suspect’, kenengxin 可能性 ‘possibility’, and keneng 可能

‘may’. The discrepancy observed may be due to genre difference. The utilization of several

hedges may manifest the speakers’ tentativeness and cautiousness. Since it is a physician to

physician interaction, modesty and concealing tentativeness make statements more acceptable to the audience.

(235) 那..也是 hon,你如果用..有用一些的ㄧ個藥物 hon,那或是..這病人現在正處在一個的狀態的時候,你多去他..抗生素在..腎臟的 一個排除 hon,所以這個你要考慮,要加劑量 hon.可是如果說病人的腎功能變 不好,他已經有在,你可能要考慮減劑量 hon, (S4) Nà..renal clearance yěshì hon, nǐ rúguǒ yòng.. yǒuyòng yīxiē hypo-- hemodynamic active deyi1 gè yàowù hon, nà huò shì.. Zhè bìngrén xiànzài zhèng chù zài yīgè hyper dynamic de zhuàngtài de shíhòu, nǐ duō qù enhance tā.. Kàngshēngsù zài.. Shènzàng deyi1 gè páichú hon, suǒyǐ zhège nǐ yào kǎolǜ, yào jiā jìliàng hon. Kěshì rúguǒ shuō bìngrén de shèn gōngnéng biàn bù hǎo, tā yǐjīng yǒu zài dialysis, nǐ kěnéng yào kǎolǜ jiǎn jìliàng hon ‘Then ..about renal clearance hon. If you use .. use some hypo - hemodynamic active in drug hon, or ..the patient is now in a hyper dynamic status, you enhance antibiotics .. exclude through kidneys hon, so that you have to consider that you may want to raise the dose hon. However, if the patient's kidney function becomes bad, he is in dialysis, you may want to consider reducing the dose hon,’ (236) 左主幹病變若外科手術風險不高，繞道手術仍為首選治療；但若繞道手術 風險較高，的分數< 22 者屬心導管介入治療的 class IIa 適應症。(W2) Zuǒ zhǔgàn bìngbiàn ruò wàikē shǒushù fēngxiǎn bù gāo, ràodào shǒushù réng wéi shǒuxuǎn zhìliáo; dàn ruò ràodào shǒushù fēngxiǎn jiào gāo,Syntax score de 223

fēnshù < 22 zhě shǔ xīn dǎoguǎn jièrù zhìliáo de class IIa shìyìng zhèng ‘If the risk of the surgery is not high for left main stream of cardiac, bypass surgery remains the treatment of choice; but if the risk of bypass surgery is relatively high, Syntax score is less than 22, the patient would fit the indication of class IIa in the heart catheter interventional treatment.’

In (235) and (236), if-conditionals are used to provide alternative treatments for a certain

disease. Two conditionals are employed in each example to express the alternative conditions

the disease may manifest itself. The choice of the treatment is depending on the patient’s

condition. Like example (233), the speaker of (235) employs the speculative verb kaolu 考慮

‘consider’ and the episteme auxiliary keneng 可能 ‘may’ to shows the speaker’s tentativeness and makes his statements sound less assertive for the audience. The application of different hedging devices not only mitigates the arguments but also reduces the speaker’s commitment to what is being said.

(237) 如果說氧氣還可以維持,接下來你可能..你插不進去,你可能是病人的肌肉還 是不--太高,你給他補打一個神經肌肉阻斷劑, ,而且這個劑量要大一點.每公斤兩hon,那再 來插管.成功了,那當然沒問題,如果還是不行 hon,插不進去,那氧氣是不是可 以維持?如果氧氣維持不了就直接進到..hon fail 的流程,那如..如果說氧氣還 可以維持,那你可以再..再繼續插 hon,就是說,如果超過了三次還是不行,那你 就要進入一個流程,那我們看看 fail 流程,事實上這個很重要 hon. (S3) Rúguǒ shuō yǎngqì hái kěyǐ wéichí, jiē xiàlái nǐ kěnéng.. nǐ chā bù jìnqù, nǐ kěnéng shì bìngrén de jīròu háishì muscle tone bù--tài gāo, nǐ gěi tā bǔ dǎ yīgè shénjīng jīròu zǔ duàn jì, acetylcholine, érqiě zhège jìliàng yāo dà yīdiǎn. Měi gōngjīn liǎng milligram hon, nà zài lái chā guǎn. Chénggōngle, nà dāngrán méi wèntí, rúguǒ háishì bùxíng hon, chā bù jìnqù, nà yǎngqì shì bùshì kěyǐ wéichí? Rúguǒ yǎngqì wéichí bùliǎo jiù zhíjiē jìn dào..hon fail de liúchéng, nà rú.. Rúguǒshuō yǎngqì hái kěyǐ wéichí, nà nǐ kěyǐ zài.. zài jìxù chā hon, jiùshì shuō, rúguǒ chāoguòle sāncì háishì bùxíng, nà nǐ jiù yào jìnrù yīgè fail liúchéng, nà wǒmen kàn kàn fail liúchéng, shìshí shàng zhège hěn zhòngyào hon ‘If the oxygen can still be maintained, then you might .. you can not plug in, it could be the patient's muscles or muscle tone is not -- too high, you may give

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him the neuromuscular blocking agent, acetylcholine, Moreover, this dose should be bigger, two milligram per kg hon, then try the intubation. Of course it would not be any problem as long as the process works, if it still does not work hon, you can not insert into, then you have to see whether the oxygen can be maintained? If the oxygen cannot be maintained, you may directly get into the ..hon fail processes, and .. If the oxygen can still be maintained, then you can keep .. keep plugging hon, that is, if you try more than three times, and it still does not work, then you have to enter a fail process, Let us take a look at the fail process, in fact, this is very important hon.’ (238) 若 ACTH 仍然偏高，可以在晚上睡前給予口服 1 毫克 抑制試驗， 若抑制試驗可將 ACTH 抑制，可以再調 整下午劑量或給藥次數，再監測早上 8 點血糖、電 解質、 及 ACTH 濃度。 (W2) Ruò ACTH réngrán piān gāo, kěyǐ zài wǎnshàng shuì qián jǐyǔ kǒufú 1 háokè dexamethasone yìzhì shìyàn, ruò dexamethasone yìzhì shìyàn kě jiāng ACTH yìzhì, kěyǐ zài tiáozhěng xiàwǔ cortisone acetate jìliàng huò gěi yào cìshù, zài jiāncè zǎoshang 8 diǎn xiětáng, diànjiězhì,cortisol jí ACTH nóngdù ‘If the ACTH is still high, 1 mg dexamethasone can be taken before going to bed for suppression test, if dexamethasone suppression test can suppress ACTH, you can then adjust the afternoon cortisone acetate dose or frequency of administration, and then monitor the morning 8:00 blood sugar, electrolytes, cortisol, and ACTH concentrations.’

If-conditionals in example (237) and (238) are used to explain possible solutions in light of

non-ideal conditions. In (237), the speaker employs if-conditionals to demonstrate several

sets of condition-solution successively. He explains that if one condition yields, what would

be the possible solution, and then if the solution does not work, what might be the alternative.

The writers of (238) use if-clause to indicate a potential ill condition, and then offer possible solution in the consequence clause. The second if-conditional suggests what may be the

following treatment if the first situation works out. If-conditionals are utilized to build

hypothetic conditions which may or may not happen in reality, and the possibility of

occurrence varies from case to case. With conditionals, the speakers/writers are able to reduce

their commitment to the situations mentioned.

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(239) 啊^假設你還是不要,那也可以繼續嘛.不過醫院會追蹤, (啊你那又)告告告,啊大概公權力就會介入 (S10) A ^jiǎshè nǐ háishì bùyào, nà yě kěyǐ jìxù care ma. Bùguò yīyuàn huì zhuīzōng,ah li he koo (a nǐ nà yòu) gào gào gào, a dàgài gōng quánlì jiù huì jièrù ‘ah ^ if you still do not want to follow the regulation, you may continue to care them, but the hospital will track, ah if you get involved in the medical legal problem, ah the hospital authority will interfere then.’ (240) XDR-TB 曾在愛滋病盛行率較高的非洲地區造成死亡率極高的群聚感染。 相信如無法更積極有效管理後線抗結核藥物，XDR-TB 絕不是結核病治療 的最後殘局，恐怕有令群醫束手無策的全抗藥性(Panresistant)超級菌株被誘 導出來。(W) XDR-TB céng zài àizībìng shèngxíng lǜ jiào gāo de fēizhōu dìqū zàochéng sǐwáng lǜ jí gāo de qún jù gǎnrǎn. Xiāngxìn rú wúfǎ gèng jījí yǒuxiào guǎnlǐ hòu xiàn kàng jiéhé yàowù,XDR-TB jué bùshì jiéhébìng zhìliáo de zuìhòu cánjú, kǒngpà yǒu lìng qún yī shùshǒuwúcè de quán kàng yàoxìng (Panresistant) chāojí jūnzhū bèi yòudǎo chūlái ‘XDR-TB has caused high mortality with cluster infection in high HIV prevalent Africa. I believe if we can not actively and effectively manage the anti-TB drugs, XDR-TB is by no means the final messn for TB treatment, I am afraid there might be full-resistant (Panresistant) super strain induced out, which may not be dealed with by doctors’

Conditionals serve as a warning in example (239) and (240). The speaker of (239) is one of the Vice Presidents of the hospital, and he is invited to make a comment on the speech about diabetics care. In his comment, he proposes that if the audiences have diabetics among their patients and they are not confident to take good care of those diabetics, maybe the physicians should consider transferring those diabetics to the team specialized for Endocrinology &

Metabolism. Since this is an instant idea bursting out through the talk, it is not yet regulated by the hospital administration. Therefore, to make his well-intended suggestion not sound mandatory, the if-conditional shows that the physicians still have the right to keep their patients as the idea is so far only an impromptu. However, the main point is manifested in the following clause initiating with the transitional conjunction bukuo 不過 ‘but’, which makes

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the conditional statement sounds like a warning. Especially he foretells that if patients lawsuit

any physician for dissatisfactory caring, then the hospital authority will take an action for it.

As well as the speaker’s warning, the writers of (240) also propose a serious warning to the readers by if-conditionals. The writers assert that as long as the condition predicted in the if-

clause is not handled properly, terrible or even helpless consequence may be caused. In these

two cases, conditionals are employed to call attention to the audiences/readers against the

possibilities of potential troubles.

(241) 如果在呢,我們就怎麼樣?我們就一直..一直掃嘛.,我剛才講,再掃,不然就怎麼?濃度加大,加大 (S6) Rúguǒ zài single energy ne, wǒmen jiù zěnme yàng? Wǒmen jiù yīzhí.. Yīzhí sǎo ma.Delay face, wǒ gāngcái jiǎng, zài sǎo, bùrán jiù zěnme? Nóngdù jiā dà,contrast jiā dà (Rhetorical Q/ Interaction) ‘If we operate the single energy CT, how should we do? We would keep.. keep scanning. Delay face, I just said, keep scanning, Or otherwise? Increasing the concentration and the contrast.’ (242) 此外病人生命徵象已越漸不穩定，甚至出現休克問題，倘若再投予 CMV- IVIG ，藥物成效真能發揮？是否造成醫療成本與資源的浪費？相反地， 本案若提前檢驗 CMV，提早給予 ganciclovir ，發現反應不佳，及時能投 注 CMVIVIG，是否能扭轉病勢？值得省思！(W1) Cǐwài bìngrén shēngmìng zhēngxiàng yǐ yuè jiàn bù wěndìng, shènzhì chūxiàn xiūkè wèntí, tǎngruò zài tóu yǔ CMV-IVIG, yàowù chéngxiào zhēnnéng fāhuī? Shìfǒu zàochéng yīliáo chéngběn yǔ zīyuán de làngfèi? Xiāngfǎn dì, běn'àn ruò tíqián jiǎnyàn CMV, tízǎo jǐyǔ ganciclovir, fāxiàn fǎnyìng bù jiā, jíshí néng tóuzhù CMVIVIG, shìfǒu néng niǔzhuǎn bìngshì? Zhídé xǐng sī ‘In addition, when the patient's vital signs are becoming more unstable, and even has shock problems, if I prescribe more CMV-IVIG, does drug effectiveness really work? Or it may result in a waste of health care costs and resources? Conversely, if CMV test could be conducted in advance, and ganciclovir could be given earlier, and once the poor response was found, and then CMVIVIG was given in time, whether illness could be turned around? It worthes our reflection!’

Conditionals may form interrogatives to call for attention. In this type of structure, normally the premise is provided in the if-clause, and the question is set in the consequence-clause. In 227

(241), the speaker produces a rhetorical question via if-conditional during his talk. However, the speakers himself provide the answer right afterwards. The rhetorical question is not proposed to elicit answers but to establish the speaker-hearer relationship in the face-to-face encounter. The writers of (242) discuss a case report in the article. The patient in this case expired eventually even the physicians had tried their best to help. The writers make self- examination on this case and raise the questions. The conditionals are used to express the writers’ uncertainty on their treatments and simultaneously show their expectation to obtain advices from the readers.

So far I have discussed several communicative purposes of if-conditionals shared between the spoken and the written discourses. In the following paragraphs I will expound functions which appear exclusively in either genre. The speakers are found to make use of conditionals to circumscribe the scope of the following topic, to announce future actions, or to present modest invitation; the writers employ conditionals to express the cause-effect relationship between the symptom and the consequence, to make categorization, or to offer referential information. I will first discuss the functions identified in the spoken data, and then the functions observed in the written data:

(243) 碰到評估困難氣道,事實上有四個層次 hon.一個就是說我們的傳統喉頭鏡,到 底有沒有辦法看得到?第二個就是說,我的..那個..有沒有辦 法換氣,給他個,還有第三個就是說,如果真要給他 放 LMA hon, 的時候,放不放得進去?第四個,如果真 的要緊急做環甲膜氣切術的時候,有沒有辦法困難?事實上這四個東西,層次, 任何一個有問題,事實上都要歸到困難氣道 hon. (S3) Pèng dào pínggū kùnnán qìdào, shìshí shàng yǒu sì gè céngcì hon. Yīgè jiùshì shuō wǒmen de chuántǒng hóutóu jìng, dàodǐ yǒu méiyǒu bànfǎ kàn dédào vocal code? Dì èr gè jiùshì shuō, wǒ de.. Nàgè.. Yǒu méiyǒu bànfǎ huàn qì, gěi tā gè bag-mask ventilation, hái yǒu dì sān gè jiùshì shuō, rúguǒ zhēn yào gěi tā fàng LMA hon, extraglottic device de shíhòu, fàng bù fàng dé jìnqù? Dì sì gè, rúguǒ zhēn de yāo jǐnjí zuò huán jiǎ mó qì qiē shù de shíhòu, yǒu méiyǒu bànfǎ kùnnán? Shìshí shàng zhè sì gè dōngxī, céngcì, rènhé yīgè yǒu wèntí, shìshí

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shàng dū yào guī dào kùnnán qìdào hon ‘While facing difficult airway assessment, in fact, there are four levels hon. The first is the traditional laryngoscopy, by this, if we can see the vocal code? The second is that, my..that..if the patient can freely breathe, with the bag-mask ventilation. The third is, if you really give him LMA hon, extraglottic device, can it go through? The fourth, if you really want to do an emergency thyrocricoid tracheostomy surgery, would it work fine? The fact is that if there is any difficulty encountered in any level, actually, it should be attributed to difficult airway hon.’

If-conditional is found to help the speaker circumscribes the scope of his following discussion, as in (243). The speaker claims that there are four stages for a physician to evaluate if the patient should be treated with the Difficult Airway. These four stages are the topics for the speaker’s successive discussion. If-conditionals are employed to bring out two of the stages.

(244) 那=改天如果有..eh..那個..有錢的話,我們這個科內就會再買..申購這個..那個 儀器 hon. (S5) Nà =gǎitiān rúguǒ yǒu..Eh.. Nàgè.. Yǒu qián dehuà, wǒmen zhège kē nèi jiù huì zài mǎi.. Shēngòu zhège.. Nàgè yíqì hon ‘Then.. another day if there ..eh .. if we have the budget, in our department..we will buy .. purchase this .. that instrument hon.’ (245) (啊就很簡單,這樣調而已 hon.改天若有機會,再跟大家講.) (S10) Hon a jiù hěn jiǎndān, zhèyàng diào éryǐ hon. Gǎitiān ruò yǒu jīhuì, zài gēn dàjiā jiǎng ‘Hon it is very simple, just mix it this way hon. I will talk about it some other dsay if there is an opportunity.’

In (224) and (225), the conditionals are used to announce the potential actions in the future.

The possibility of the actions is in line with the realizations of the premises offered in the if- clauses. Although the actions, to buy certain equipment and to offer an advanced lecture, are highly likely, they are not assured guarantees. Thus, if-conditionals allow the speakers to

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express their anticipations and at the same time to avoid making full commitment to the

announcements.

(246) 啊在這裡是先提出來跟大家討論 hon,如果說待會大家在演講過程中有意見 的話,hon 也隨時歡迎大家可以討論 hon (S9) A zài zhèlǐ shì xiān tí chūlái gēn dàjiā tǎolùn hon, rúguǒshuō dài huì dàjiā zài yǎnjiǎng guòchéng zhōng yǒu yìjiàn dehuà,hon yě suíshí huānyíng dàjiā kěyǐ tǎolùn hon ‘Ah herein I would like to discuss about this issue with you. If you have any comments during the presentation, then, hon you are always welcome to raise questions.’ (247) 那我們很有幸,這是我跟我所有團隊在開會的時候,各位可以看到,成員很多, 每一科都會進來.hon 當然,各個--各位醫師假設須要..這樣一個團隊,你隨時 可以跟我們講 (S10) Nà wǒmen hěn yǒuxìng, zhè shì wǒ gēn wǒ suǒyǒu tuánduì zài kāihuì de shíhòu, gèwèi kěyǐ kàn dào, chéngyuán hěnduō, měi yī kē dūhuì jìnlái.Hon dāngrán, gège--gèwèi yīshī jiǎshè xūyào.. Zhèyàng yīgè tuánduì, nǐ suíshí kěyǐ gēn wǒmen jiǎng ‘We are very fortunate. This is the photo taken when me and my team were at a meeting. You can see that there are many members, physicians from different departments come and join… hon, each-- if you need .. such a team to assist you, you can always tell us.’

Conditionals in example (246) and (247) function as humble invitations. In the opening

remarks, the speaker of (246) modestly announces that any interruption is acceptable if any of

the audience wants to express his/her opinions. Besides inviting opinions, the application of if-conditional shows the speaker’s awareness of possible opposition to the issue he is about to

discuss. The speaker of (247), at the end of his lecture, shows a photo of his team members,

and he makes a modest remark. The speaker states that he is lucky and honored to establish a

solid team in the Diabetes Health Management Center, and the team members comprise the

speaker himself and excellent physicians from various disciplines. Then his following

declaration is brought out by if-conditional to convey both the speaker’s modesty for his

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achievements and his uncertainty on whether his team is required by the audience Thus,

conditionals allow the speakers to make modest invitations and mitigate their achievements.

As mentioned earlier, there is one if-conditional which does not fall in the traditional P

(the protasis) + Q (the apodosis) order. This example is identified in the spoken discourse,

and it is illustrated below:

(248) 所以如果我們員工都有抗體,即使是 source 是陽性的,B 肝陽性 hon,他就不需 要追蹤,hon 如果有抗體的話. (S9) Suǒyǐ rúguǒ wǒmen yuángōng dōu yǒu kàngtǐ, jíshǐ shì source shì yángxìng de,B gān yángxìng hon, tā jiù bù xūyào zhuīzōng,hon rúguǒ yǒu kàngtǐ dehua ‘So if our employees have antibodies, even if the source is positive, positive Hepatitis B hon, he would not need to be tracked, hon, if they have antibodies.’

Regarding to the positions of if-conditionals, Ford and Thompson (1986) suggest that there

are two factors for writers to locate an if-clause in final position: when the subject is

interesting and when an if-clause is disproportionately longer than the mail clause.20

However, the post-positioning if-clause from my data seems to fit neither of the factors, and it is a spoken form rather than a written one. There are two if-clauses produced in this utterance,

and the second if-clause is basically a partially duplicate of the first if-clause. It is presumably

that the repetition is perhaps the speaker’s talking style as the parenthetic phrases between the

first if-clause and its consequence clause are also two partially duplicates, source shi yangxin de, source 是陽性的 ‘source is positive’ and B-gan shi yangxin hon B 肝陽性 hon ‘hepatitis

B is positive’.

In the following paragraphs, I will discuss the communicative functions exclusively observed in the written discourse.

(249) 一旦血流阻斷超過 20、30 分鐘以上，就會導致心肌壞死，也就是急性心肌

20 According to Ford and Thompson (1986), in written English, new, heavy, or compared NPs are normally introduced in the main clause while shared, unchallengeable, background for the following proposition are provided in the if-clause. 231

梗塞。(W) Yīdàn xuè liú zǔ duàn chāoguò 20,30 fēnzhōng yǐshàng, jiù huì dǎozhì xīnjī huàisǐ, yě jiùshì jíxìng xīnjī gěngsè ‘In case the blood flow is blocked for more than 20, 30 minutes or more, it will lead to myocardial necrosis, which is acute myocardial infarction.’

The if-conditional yidan 一旦 ‘in case’ in (249) is used to manifest an absolute cause-effect relationship between the if-clause and the consequence clause. The writers utilize if- conditional to claim that the serious condition in if-clause definitely leads to a fetal consequence which is the acute myocardial infarction. Although the two problems respectively stated in the if-clause and the consequence clause display a definite cause-effect relationship, the writers make the claim via if-conditional to reduce the force of the claim.

Meanwhile, it allows the writers to escape from making full commitment to the argument since it only happens under certain condition as stated in the if-clause.

(250) 假如病人在接受治療的二十四週內仍無法將血清中的 C 肝病毒清除時，我 們稱之為「對治療無效者」(non-responder)。(W1) Jiǎrú bìngrén zài jiēshòu zhìliáo de èrshísì zhōu nèi réng wúfǎ jiāng xiěqīng zhōng de C gān bìngdú qīngchú shí, wǒmen chēng zhī wèi `duì zhìliáo wúxiào zhě'(non-responder) ‘If the patient’s hepatitis C virus of serum is still unable to stay clear within 24 weeks treatment, then we call him/her as a "non-reponder to the treatment" (non- responder).’

(251) 假如病人在治療結束時血清中已經檢測不到病毒，治療結束二十四週後的 血清中仍檢測不到 C 肝病毒的核醣核酸時，吾人則稱之為「持續病毒學反 應者」 (sustained virologic responder, SVR)。(W1) Jiǎrú bìngrén zài zhìliáo jiéshù shí xiěqīng zhōng yǐjīng jiǎncè bù dào bìngdú, zhìliáo jiéshù èrshísì zhōu hòu de xiěqīng zhōng réng jiǎncè bù dào C gān bìngdú dí hétáng hésuān shí, wúrén zé chēng zhī wèi `chíxù bìngdú xué fǎnyìng zhě' (sustained virologic responder, SVR) ‘If there is no detectable levels of virus in the patient’s serum at the end of the treatment, and the RNA of hepatitis C virus remains undetectable twenty-four weeks after the treatment, I myself call him/her as "sustained virologic

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responders "(sustained virologic responder, SVR).’

Conditionals can be used to make categorizations as long as certain criteria are achieved, as

shown in (251) and (252). The inclusive women 我們 ‘we’ is employed in (251) as the

subjects who make the categorization, while the personal wuren 吾人 ‘myself’ is used In

(252) to refer to the writer himself. These two examples are actually produced by the same writer. Both of the subjects imply that the categorizations are based on subjective viewpoints rather than public-agreed terminology. The strategy shows the writer’s awareness of the potential objections as it other researchers may prefer their own categorization.

(252) 在日本根據一個多中心的世代研究，操作大腸內視鏡黏膜下切除術的出血 機率為 1.5%，若經驗較少的醫學中心則為 5.9%。(W1) Zài rìběn gēnjù yīgè duō zhōngxīn de shìdài yánjiū, cāozuò dàcháng nèi shì jìng niánmó xià qiēchú shù de chūxiě jīlǜ wèi 1.5%, Ruò jīngyàn jiào shǎo de yīxué zhōngxīn zé wèi 5.9% ‘In Japan, according to a multi-center cohort study, the bleeding rate for the operation of large intestine endoscopic mucosal resection is 1.5%, if the medical center has relatively less experience of it, the bleeding rate would be 5.9%.’ (253) 而偏頭痛病人如合併危險因子(高血壓、糖尿病、高血脂等)，中風的比例 為非偏頭痛的 1.3-9.6 倍 (W2) Ér piān tóutòng bìngrén rú hébìng wéixiǎn yīnzǐ (gāo xiěyā, tángniàobìng, gāo xiě zhī děng), zhòngfēng de bǐlì wéi fēi piān tóutòng de 1.3-9.6 bèi ‘For migraine patients, if it is merged with other risk factors (hypertension, diabetes, high cholesterol, etc.), the probability of getting stoke is about 1.3-9.6 times higher than patients without migraine.’

The conditional formats of (252) and (253) are used to provide statistical reference to the

readers. In (252), the writers first offer a precise rate of bleeding under general operation, and

then the conditional brings out a higher rate when the medical center has relatively less

experience concerning the same health problem. In (253), the writers provide a range of

numerical figures to indicate the risk of stroke for patients who suffer from migraine. The if-

conditional of (252) refers to the abstract notion of ‘relatively less’, while it is used in (253) 233

to refer to indefinite numerical range. Both conditionals allow writers to escape from making

full commitment towards the propositions being states.

In this section, I examine how conditionals serve as hedging strategy in Chinese

medical discourse. The results show that conditionals are common hedging devices utilized

by medical professionals in both spoken and written genres. As indefiniteness and uncertainty

are ubiquitous in medical realm, medical specialists tend to employ if-conditionals to qualify

their commitment to the truthfulness of the propositions. The if-conditionals can be expressed

by various words and phrases, especially in the spoken discourse. The speakers utilize 43

different expressions to manipulate conditionals, while the writers use only 10 different

kinds. Conditionals are utilized to present different communicative purposes, with some

shared by both genres and some exclusively identified in either genre. Conditionals allow the

speakers/writers to make deductions, predictions, and suggestions; they are used to provide

supportive examples and alternative treatments; they also play as warnings for potential

upcoming problems. Conditionals also serve the interactional function to evoke the hearers/readers attention. Certain communicative purposes are only observed in the spoken

discourse. For instance, the speakers employ if-conditionals to circumscribe the scope of the

following talks, to announce potential future actions, to pose modest invitations to the

audience. As well as the spoken discourse, some functions are identified exclusively in the

written discourse. The writers utilize conditionals to demonstrate a strong cause-effect

relationship between the if-clause and its consequence clause. Conditionals can be used to make subjective categorizations and to provide information for the readers’ reference. With the inherent non-assertiveness of conditional clauses, the speakers/writers can hedge, hypothesize, and manage interaction with their audience/readers and simultaneously modify degrees of commitment to their propositions.

4.4.2 Rhetorical questions

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Questions can be used as a hedging strategy to modify a writer’s state of knowledge towards the truth of a proposition (Perkins 1983, Webber 1994, Hyland 1998, Varttala 2001), and they are similarly regarded as ‘addressee-oriented’ epistemic modality by Perkins (1993) and ‘reader-oriented’ hedges by Hyland (1998). West (1983) indicates that a major obstacle between physicians and patients is the failure in communication, so the use of question is a mutually accessible mean to establish intelligibility in the doctor-patient interaction. In medical research articles, questions serve as one of the rhetorical devices for the writers to persuade their readers and fight for their ideas. By investigating the use of questions in medical journals, Webber (1994) finds that the most important goal of using questions in RAs is to get reader involvement. He argues that questions convey several communicative purposes in medical written discourse. They can be used to indicate the main topic of the paper; they can be used to provide a framework for the following discourse; they can be applied to address a complex issue for further debate. It is also concluded that the application of interrogative forms varies with genres, with more questions employed in editorials and letters and less in research articles. In Chinese, questions are found to be used to express the speakers’/writers’ uncertainty towards the truthfulness of the propositions (Chen 2008, Lo

2010). They can also be applied to reduce the force of a statement so as to minimize the potential FTA.

In the present study, I examine both spoken and written discourses produced by medical professionals. The results show that hedging questions are used much more frequently in my spoken data than those of in the written data (94.61% with 877 occurrences vs. 5.39% with 50 occurrences), as shown in Figure 9. The questions functioning as hedging devices are identified as rhetorical questions in my study. Those questions are not necessarily used to elicit specific answers but rather to engage the audience on certain messages or viewpoints. Following Li and Thompson’s classification, four types of interrogative forms are

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observed in my data, which are wh-questions, yes-no questions, tag questions, and disjunctive questions. In the present study, the wh-questions are interrogative forms that contain questions words which are equivalents of English words as what, why, which, and so forth.

The yes-no questions are sometimes signaled by the presence of the question particle ma 嗎 or ne 呢 and sometimes presented without the particle but semantically function to elicit an answer to confirm or deny the proposition of the question. The gag questions are formed as a statement plus a short A-not-A question form attached at its end. This type of question

functions to seek confirmation of the statement proceeding before the tag. Disjunctive

questions are used to present alternatives of two or more options, and the respondent is

expected to make a choice among the options. Two types of disjunctive questions are

identified in the corpus. One type of disjunction questions are formed by two clauses joined

together by the morpheme haishi 還是 ‘or’, and the other type contains the A-not-A

question form, and the respondent is expected to choose between the affirmative sentence and

its negative counterpart, such as the A-not-A question you mei you siao 有沒有效? in the

utterance zhikeyao you mei you siao 止咳藥有沒有效 ‘Does cough medicine work?’ The

following examples extracted from my corpus are provided to demonstrate these four types of

interrogative forms respectively:

(254) 狂犬病是甚麼？為什麼會在台灣出現？又為什麼是鼬獾？身為醫師該如何 面對？ (W2) Kuángquǎnbìng shì shéme? Wèishéme huì zài táiwān chūxiàn? Yòu wèishéme shì yòu huān? Shēn wèi yīshī gāi rúhé miàn duì ‘What is Rabies? Why would it appear in Taiwan? And why is it in ferret badger? How would a physician deal with it?’ (255) 那你看那個商店寫童叟無欺,你會覺得這個商店..是誠實的商店嗎? (S2) Nà nǐ kàn nàgè shāngdiàn xiě tóng sǒu wú qī, nǐ huì juédé zhège shāngdiàn.. Shì chéngshí de shāngdiàn ma ‘When you see the sign on the shop written in ‘fair trade shop’, will you believe that this store .. is really an fair store?’ (256) 我們在..上個禮拜剛剛經過評鑑,評鑑是以病人為中心,可是這是一頂很大的 236

帽子, 對不對? (S2) Wǒmen zài.. Shàng gè lǐbài gānggāng jīngguò píng jiàn, píng jiàn shì yǐ bìngrén wéi zhōngxīn, kěshì zhè shì yī dǐng hěn dà de màozi, duì bù duì ‘we.. just last week we just went through the evaluation, which was based on the notion of patient-centered, but this is a big label, right?’ (257) 那用..用眼,去觀察這個染色的特徵 hon,啊用腦 hon,去想想看,這個病人是社 區型感染呢還是住院型感染? (S7) Nà yòng.. Yòng yǎn, qù guānchá zhège rǎnsè de tèzhēng hon, a yòng nǎo hon, qù xiǎng xiǎng kàn, zhège bìngrén shì shèqū xíng gǎnrǎn ne háishì zhùyuàn xíng gǎnrǎn ‘use .. eye to observe the staining characteristics, ah with brain hon, to think if this patient belong to community-based infection or hospital infection?’ (258) 那一些死掉的..小嬰兒,除了本身百日咳本身,那有沒有可能是有其他細菌 (S7) Nà yīxiē sǐ diào de.. Xiǎo yīng'ér, chúle běnshēn bǎirìké běnshēn, nà yǒu méi yǒu kěnéng shì yǒu qítā xìjùn ‘Some of the dead .. little baby, in addition to their pertussis itself, is there any possiblility that the death is caused by other bacteria?’

Examples (254) to (256) successively represent wh-question, yes-no question, and tag question.

Example (257) is the first type of disjunctive question with haishi 還是 ‘or’ to connect two clauses, while (258) is the second type which contains a A-not-A question form. In order to see whether certain interrogative form is favored by either genre, the percentage and occurrence of each question type are demonstrated in Figure 10.

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70.00%

60.00% S W 50.00%

40.00%

30.00%

20.00%

10.00%

0.00% A. wh-Q B. yes-no Q C. tag Q D. disjunctive Q

Rhetorical questions A. wh-Q B. yes-no Q C. tag Q D. disjunctive Q S 65.34%(573) 10.03%(88) 4.22%(37) 20.41%(179) W 46.00%(23) 42.00%(21) 0.00%(0) 12.00%(6)

Figure 10. Distribution of questions used in the spoken vs. written genres

As shown in Figure 10, wh-questions are employed the most frequently in both genres.

Besides wh-questions, the other types of questions do not display a consistent tendency. The speakers tend to use more disjunctive questions than yes-no questions and tag questions, whereas the writers apply a great amount of yes-no questions and few disjunctive questions but not a tag question at all. The discrepancy may be due to genre difference. As noted earlier, the speakers make great use of interrogatives, whereas in writing, interrogatives is the least employed hedging device among those eight categories. As reader involvement is the most significant objective in writing (Webber 1994), it goes without saying that questions would be employed much more in the face-to-face interaction. Tag questions are mainly utilized to pursue confirmation from the respondents; therefore, they fit better in the spontaneous talk- in-interaction. Hedging questions found in my data are equivalent to rhetorical questions in

English literature. They are employed to represent a statement of opinion rather than a question, to indirectly convey disagreement or speech acts (Brown & Levinson 1987, Webber 238

1994), to hedge the truth of a proposition in line with the writer’s state of knowledge, to signal unresolved issues without making a full commitment (Hyland 1998, Vattala 2001), and to arouse the reader’s interest and create anticipation (Webber 1994). The communicative purposes identified in my corpus are presented in Table 27, with 5 of them shared by both genres. Since there are great differences in frequency and occurrences between these two genres, many of the functions are observed exclusively in the spoken discourse.

Table 27. Functions of questions observed in the spoken and written genres

Spoken Written

A. offering a framework for the following discourse A. offering a framework for the following discourse

B. interacting with the audience B. interacting with the reader

C. posing questions C. posing questions

D. arousing attention with series of questions D. arousing attention with series of questions

E. anticipating possible questions pondered by the E. anticipating possible questions pondered by the

audience audience

F. introducing new medical policy or current heed

G. prophesying a future topic

H. directing the audiences’ attention towards the

slides

I. reporting questions uttered by the speaker himself

or others

J. creating participation and show humor

K. making a polite invitation

L. offering tentative suggestions

M. conveying sarcasm

N. seeking for reconfirmation

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In the following, I will discuss the functions shared by both genres fist and then introduce the functions identified exclusively in the spoken discourse. All the functions will be explicated with illustrative examples:

(259) 那現在醫療關係裡面,我們談到真理是甚麼?那下一個問題,那事實是甚麼?那 這是我今天我要講的. (S2) Nà xiànzài yīliáo guānxì lǐmiàn, wǒmen tán dào zhēnlǐ shì shénme? Nà xià yīgè wèntí, nà shìshí shì shénme? Nà zhè shì wǒ jīntiān wǒ yào jiǎng de ‘Nowadays in the medical relation, we talk about what the truth is? Then the next question, what is the reality? These questions are what I will talk about in my lecture today.’ (260) 在這些的案例中，我們可以說他們的糖尿病已達到緩解(remission) 或治癒 (cure) 了嗎？糖尿病一般認為是一慢性疾病，意即當病人罹患糖尿病後， 會有長期血糖代謝異常狀態。…本篇文獻回顧主要探討現有能成功『緩 解』糖尿病的治療方法。(W1) Zài zhèxiē de ànlì zhōng, wǒmen kěyǐ shuō tāmen de tángniàobìng yǐ dádào huǎnjiě (remission) huò zhìyù (cure) le ma? Tángniàobìng yībān rènwéi shì yī mànxìng jíbìng, yì jí dāng bìngrén líhuàn tángniàobìng hòu, huì yǒu chángqí xiětáng dàixiè yìcháng zhuàngtài.…Běn piān wénxiàn huígù zhǔyào tàntǎo xiànyǒu néng chénggōng “huǎnjiě” tángniàobìng de zhìliáo fāngfǎ ‘In these cases, can we say that their diabetes have reached the level or remission or cure? Generally diabetes is considered as a chronic disease, which means that when a patient suffers from diabetes, he has long-term abnormal glucose metabolism... This paper focuses on existing successful treatment of diabetes "remission."’

Questions in (259) and (260) are used to provide a framework for the following discourse. As explicitly pointed out by the speaker/writers, the questions produced serve as the topics for the successive discussion. The questions of (259) and (260) are applied in the opening remarks; questions produced in this part of a speech or an article not only naturally serve to circumscribe the frame of the whole research but also successfully arouse the audiences’/readers’ attention on certain issues.

(261) 胰島素,十單位,打在我身上,跟打在劉副身上,我們兩個降血糖的幅度有沒有 240

一樣?不一樣啦. (S10) Yídǎosù, shí dānwèi, dǎ zài wǒ shēnshang, gēn dǎ zài liú fù shēnshang, wǒmen liǎng gè jiàng xiětáng de fúdù yǒu méiyǒu yīyàng? Bù yīyàng la ‘Insulin, ten units, injects on me, and on Dr. Liu. Will the magnitude of hypoglycemic be the same between two of us? Of course not.’ (262) 至於體溫需降到什麼溫度才停止呢?由於體溫降得太低，會發生反彈性低體 溫(rebound hypothermia, or after drop) ，一般建議病人體溫降低至 38.5℃ 時，降溫就應停止。(W2) Zhìyú tǐwēn xū jiàng dào shénme wēndù cái tíngzhǐ ne? Yóuyú tǐwēn jiàng dé tài dī, huì fāshēng fǎntán xìng dī tǐwēn (rebound hypothermia, or after drop), yībān jiànyì bìngrén tǐwēn jiàngdī zhì 38.5℃Shí, jiàngwēn jiù yīng tíngzhǐ ‘When should we stop the procedure of dropping the body temperature? If the temperature drops too low, it will cause rebound hypothermia or after drop, it is generally recommended that the procedure should be ceased when the patient’s body temperature reaches to around 38.5 ℃.’

Interrogative forms of examples (261) and (262) are used to create the writer-reader relationship. In these two examples, questions are proposed to get the hearers/readers

involvement rather than elicit answers because the answers are immediately provided by the

speaker/writers. In (261), the speaker deliberately engages the audience to make a

comparison between the speaker himself and one of the co-present audience, which arouse

the audiences’ interest. The writers in (262) also employ a question to evoke the readers’

attention, and then the answer is followed afterwards.

(263) 那..平..平常,我們在臨床..遇到很多的感染症的病人,那,大概都會開抗生素. 那..會開是不是代表..會用得很好? (S4) Nà.. píng.. píngcháng, wǒmen zài línchuáng.. yù dào hěnduō de gǎnrǎn zhèng de bìngrén, nà, dàgài dūhuì kāi kàngshēngsù. Nà.. huì kāi shì bùshì dàibiǎo.. huì yòng dé hěn hǎo ‘then ... usually, we ..clinically meet many patients with infectious disease, and we probably will prescribe antibiotics. Is the ability to prescribe them equal to the ability to use them well?’ (264) 纖維肌痛症候群為一種全身性之臨床病症，沒有單項的檢測可供完全的診 斷，所以何者為必要的診斷標準？有否較客觀的診斷標準？仍有一些爭議 (W2) 241

Xiānwéi jī tòng zhènghòuqún wéi yīzhǒng quánshēn xìng zhī línchuáng bìngzhèng, méiyǒu dānxiàng de jiǎncè kě gōng wánquán de zhěnduàn, suǒyǐ hézhě wéi bìyào de zhěnduàn biāozhǔn? Yǒu fǒu jiào kèguān de zhěnduàn biāozhǔn? Réng yǒu yīxiē zhēngyì ‘Fibromyalgia syndrome is a kind of clinical symptom which occurs in the whole body, and there is no single diagnostic examination available for the detection. So what is the necessary diagnostic criteria? Whether there is a more objective diagnostic criteria? There is still some controversy.’

Unlike questions in (261) and (262), which the answers are provided immediately after the questions, examples (263) and (264) contain questions but without answers afterwards. The answer is either too obvious as in (263) or unterminated as in (264). While proposing the

question, the speaker of (263) undoubtedly has already had the answer in mind, and he

believes the answer he has is identical with the audiences’. Thus, it is not necessary to be superfluously provided. The writers of (264) utilize interrogatives to indicate important issues, and right after the questions the writers claim that the answers have not been

unanimously agreed yet. These types of questions are used to attract the hearers’/readers’

attention on the significant unresolved issues. The application of questions in these two examples allows the speakers/writers to express their opinions since the answer is either apparent or indefinite.

(265) 那我..我常常說 hon,er..嘖,特別是..醫生,醫生很難..^抗拒抗生素的誘惑 hon, 那我..我也常常說,用藥容易,停藥難.用藥..用一個..雙..上去 之後,啊..啊....退掉了,那要用多久?敢不敢降階?是一個問題,那用 了..之後,ㄟ,還在,敢不敢停藥?所以,那..這些都是形成我們臨床上 非常大的壓力, (S4) Nà wǒ.. wǒ chángcháng shuō hon,er.. zé, tèbié shì.. yīshēng, yīshēng hěn nán..^kàngjù kàngshēngsù de yòuhuò hon, nà wǒ.. wǒ yě chángcháng shuō, yòngyào róngyì, tíng yào nán. Yòngyào.. yòng yīgè.. shuāng anti-biotis.. Shàngqù zhīhòu, a.. a..fever.. tuì diàole, nà yào yòng duōjiǔ? Gǎn bù gǎn jiàng jiē? shì yīgè wèntí, nà yòngle.. zhīhòu, ei, fever hái zài, gǎn bù gǎn tíng yào? Suǒyǐ, nà.. zhèxiē dōu shì xíngchéng wǒmen línchuáng shàng fēicháng dà de yāl ‘I .. I often say hon, er .. , especially ..for physicians, it is difficult to resist 242

antibiotics temptation .. ^ hon, I .. I often say that applying medication is easy but stopping it is difficult. With a double anti-biotis ..after using it, ah .. ah ..fever .. drained away, then how long should this antibiotics keep going? Do we dare to reduce it? This is a problem. And after it functions for a while, do we dare to withdrawal? These questions cause .. enormous pressure in our clinical practices’ (266) 評估使用荷爾蒙療法爭議在論點資料是何種研究報告、或是臨床實際？荷 爾蒙療法的益處和風險是什麼？使用目的為何？使用那一種荷爾蒙製劑？ 劑量多少？治療對象是自發性停經或是手術後停經？治療的方式？何時開 始治療？荷爾蒙使用期間多久？有否其他的影響因素？可有其他的替代方 案？以上關鍵點如能確實把握，那荷爾蒙療法幾近成功。(W2) Pínggū shǐyòng hè'ěrméng liáofǎ zhēngyì zài lùndiǎn zīliào shì hé zhǒng yán jiù bàogào, huò shì línchuáng shíjì? Hè'ěrméng liáofǎ de yìchu hé fēngxiǎn shì shénme? Shǐyòng mùdì wèihé? Shǐyòng nà yīzhǒng hè'ěrméng zhìjì? Jìliàng duōshǎo? Zhìliáo duìxiàng shì zìfā xìng tíngjīng huò shì shǒushù hòu tíngjīng? Zhìliáo de fāngshì? Héshí kāishǐ zhìliáo? Hè'ěrméng shǐyòng qíjiān duōjiǔ? Yǒu fǒu qítā de yǐngxiǎng yīnsù? Kě yǒu qítā de tìdài fāng'àn? Yǐshàng guānjiàn diǎn rú néng quèshí bǎwò, nà hè'ěrméng liáofǎ jī jìn chénggōng ‘The arguments concering the assessment of hormone therapy lie on whether the material is research data or clinical practice? What are the benefits and risks of hormone therapy? What is the purpose of usage? Which kind of hormone preparation is used? How many doses? Object is natural menopause treatment or after surgery menopause? Treatment approach? When to start treatment? How long is the hormone treatment? Whether there are other influencing factors? Are there any other alternatives? If the above key points can be really grasped, then the hormone therapy is almost succeeded.’

Each of the above examples contains three or more questions in turn. A series of questions are used to arouse the hearers’/readers’ attention and simultaneously show the significance of the issues. The speaker/writers do not provide the answers right after their questions; however, various purposes are observed. Example (265) is produced by a host in the introduction section of a lecture concerning the usage of antibiotics. The speaker advocates that these questions on the application of antibiotics generate pressure on clinical practices. In addition to challenge the audience to think about the issue, the interrogatives may be utilized as a

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tentative request that the host expects the lecturer to give answers to the audience in his talk.

Similar to (265), writers of (266) also employ a series of questions to involve the readers to

think about the complex issues. In writing, it is uncommon to see several interrogatives appearing successively at a time. In this example, 11 questions are used in a row to create intensive atmosphere. With a series of questions, the speakers/writers are able to pinpoints important aspects which should be paid attention, and meanwhile escape from providing definite answers as medical conditions vary from patient to patient.

(267) 那剛好台灣身處亞洲.那這..這時候大家就會問啊,那台灣糖尿病的狀況怎麼 樣? (S10) Nà gānghǎo táiwān shēn chǔ yàzhōu. Nà zhè.. zhè shíhòu dàjiā jiù huì wèn a, nà táiwān tángniàobìng de zhuàngkuàng zěnme yang ‘Taiwanese happens to locate in in Asia. Under this .. this situation, everyone would ask me, ah, how is the diabetes phenomenon in Taiwan?’ (268) 狂犬病毒是經由感染動物的咬傷中唾液汙染傷口而傳染給人。很多人會覺 得奇怪，為什麼是經由唾液傳染呢？其實狂犬病毒在除了蝙蝠以外所有哺 乳類動物的感染途徑都是一樣的。(W2) Kuángquǎnbìng dú shì jīngyóu gǎnrǎn dòngwù de yǎoshāng zhōng tuòyè wūrǎn shāngkǒu ér chuánrǎn jǐ rén. Hěnduō rén huì juédé qíguài, wèishéme shì jīngyóu tuòyè chuánrǎn ne? Qíshí kuángquǎnbìng dú zài chúle biānfú yǐwài suǒyǒu bǔrǔlèi dòngwù de gǎnrǎn tújìng dōu shì yīyàng de ‘Rabies virus is passed through the bite of an infected animal's saliva contaminating wounds and causing infections to humans. Many people would wonder why it is contagious through saliva? In fact, in addition to the bat, all mammals share the same rabies virus infection route.’

Questions in examples (267) and (268) are used by the speaker/writers to anticipate possible

questions which the audience/readers may ponder. The speaker of (267) applies the deictics,

dajia 大家 ‘everyone’ to be the questioner to conjecture that the audience may have the

doubt. As well as (267), the writers of (268) also utilize interrogatives to make a conjecture

that presupposes the readers’ doubt. By applying the interrogative forms, the speakers/writers

are able to build the speaker-hearer/writer-reader relationship and involve the hearers/readers 244

to be participants.

The shared functions between the spoken and written discourses have been discussed

above. In the following I will discuss the other 9 communicative purposes which are

observed in the spoken data only.

(269) 那這個是二零一一年,去年的七月,就是舊制的,新制是甚麼?就是醫院裏頭,醫 師評 BS 碼,評估人員評 DE 碼,然後再來到社會局,做需求評估,然後整個..衛 生局,社會局,那最後發給證明. 啊直接發給手冊. (S1) Nà zhège shì èr líng yīyī nián, qùnián de qī yuè, jiùshì jiùzhì de, xīnzhì shì shénme? Jiùshì yīyuàn lǐtóu, yīshī píng BS mǎ, pínggū rényuán píng DE mǎ, ránhòu zài lái dào shèhuì jú, zuò xūqiú pínggū, ránhòu zhěnggè.. Wèishēng jú, shèhuì jú, nà zuìhòu fā jǐ zhèngmíng. A zhíjiē fā gěi shǒucè ‘This was established in 2011, last July, is the old system. What about the new system? In hospitals, physicians assess BS code, evaluators assess DE code, and then then move on to the Bureau of Social Affairs for the assessment of need, then the whole .. health Bureau, Bureau of Social Affairs, and then issue the certificate. Ah directly issue the certificate.’

(270) 那最近兩年是越來越多這樣子的 paper,它在討論各種不同的一洗腎的方式, 我們抗生素到底要如何去調? (S4) Nà zuìjìn liǎng nián shì yuè lái yuè duō zhèyàng zi de paper, tā zài tǎolùn gèzhǒng bùtóng deyi1 gè xǐ shèn de fāngshì, wǒmen kàngshēngsù dàodǐ yào rúhé qù diào ‘In the last two years, more and more papers are like this. They discuss various types of dialysis, so how do we adject the application of antibiotics to fit the variety?’

In examples (269) and (270) questions are used to introduce a new medical policy and a current heed, which the speakers are the specialists in the areas of expertise. Instead of giving a direct lecture or instruction of the issues, the speakers utilize interrogatives to show their modesty and their desire to share knowledge and experiences with the audience.

Interrogatives then serve as hedging strategies for speakers to defer to the medical community and implicitly claim in-group membership (Cutting 2007).

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(271) 那有的公司就把這一個也放進去,那怎麼放?還有那個經過臨床試驗,那等一 下會稍微..稍微講一下疫苗 (S7) Nà yǒu de gōngsī jiù bǎ zhè yīgè yě fàng jìnqù, nà zěnme fàng? Hái yǒu nàgè jīngguò línchuáng shìyàn, nà děng yīxià huì shāowéi.. Shāowéi jiǎng yīxià yìmiáo ‘Some companies also put in this one, but how do they do it? And how does it go through clinical trials? I will briefly..briefly talk about it.’

The question of (271) is employed to prophesy a topic that will be discussed later. The speaker gives an advance notice that he will talk about the procedure of pertussis vaccine manufacture and its clinical experiment.

(272) 那..患者他本身,現在的..的那個 perspective 是怎麼樣?譬如說,oh 她是..er..腳 無力啦,膝蓋疼痛等等,啊這裏的話,就醫師呢,就是把他的 body function, body 的那個..function 跟 structure,ㄟ,我們把它列出來,hon,列出來,然後這裏呢?患 者她的..她的..她現在的功能的狀態,可以做到哪些東西.啊她希望怎麼樣.她 是她希望說,她能夠 care 她的 husband,她能夠幫忙照顧她的先生.那..這裏的 話,就是..我們說情境因素,包括環境跟個人因素,ㄟ,我們都幫她寫出來, (S1) Nà.. huànzhě tā běnshēn, xiànzài de.. de nàgè perspective shì zěnme yàng? Pìrú shuō,oh tā shì..Er.. Jiǎo wúlì la, xīgài téngtòng děng děng, a zhèlǐ dehuà, jiù yīshī ne, jiùshì bǎ tā de body function, body dì nàgè..function gēn structure,ei, wǒmen bǎ tā liè chūlái,hon, liè chūlái, ránhòu zhèlǐ ne? Huànzhě tā de.. tā de.. tā xiànzài de gōngnéng de zhuàngtài, kěyǐ zuò dào nǎxiē dōngxī. A tā xīwàng zěnme yàng? Tā shì tā xīwàng shuō, tā nénggòu care tā de husband, tā nénggòu bāngmáng zhàogù tā de xiānshēng. Nà.. zhèlǐ dehuà, jiùshì.. Wǒmen shuō qíngjìng yīnsù, bāokuò huái jìng gēn gèrén yīnsù,ei1, wǒmen dōu bāng tā xiě chūlái ‘The patient .. now .. what is the perspective? For example, oh she is ..er .. weak legs, achy knees, etc., ah here, it is the physician, hon lists her body function, body and that ..function and structure, ei, we list them, hon, list them, and then what about here? The patient her .. her .. the current status of body function, like..those that she is capable to do now. Ah those that she expect. She hopes that she can take care of her husband, she can help take care of her husband. And here, that is .. we call situational factors, including environmental and personal factors, ei, we have helped her write out,’

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Questions can be used to direct the audience to the slides provided by the speaker. By

applying interrogative forms, the speaker can guide the audiences’ attention from one part of

the slide to another depending on the process of his lecture, as in (272). Questions make the

speaker’s guidance sound polite and less impetuous.

(273) 那個手不能垂下來 hon,會,所以,這不能用這個方法,那這只好要 跟..那要跟病人說,ㄟ,那你到底要呢?還是..要..把它用敷料 治療 hon?那病人選擇是..保留這個手 (S5) Nàgè shǒu bùnéng chuí xiàlái hon, huì edema, suǒyǐ, zhè bùnéng yòng zhège fāngfǎ, nà zhè zhǐhǎo yào gēn.. nà yào gēn bìngrén shuō,ei1, nà nǐ dàodǐ yào amputation ne? Háishì.. Yào.. Bǎ tā yòng fūliào zhìliáo hon? Nà bìngrén xuǎnzé shì.. Bǎoliú zhège shǒu ‘The patient’s hand can not hang down hon, will edema, therefore, this way does not fit his situation. Then I had to ask the patient that if eventually he wanted an amputation? Or .. to ..accept the treatment with dressings? The patient chose to keep his hand.’ (274) 這個就當我們在當住院醫師,最討厭禮拜六下午,接到電話就說某一個藥被自 動 DC 了,hon 那個藥到期被 DC 掉,要不要續用? (S4) Zhège jiù dāng wǒmen zài dāng zhùyuàn yīshī, zuì tǎoyàn lǐbài liù xiàwǔ, jiē dào diànhuà jiù shuō mǒu yīgè yào bèi zìdòng DC le,hon nàgè yào dào qí bèi DC diào, yào bùyào xù yòng ‘When we were still in residency, the most annoying moment was Saturday afternoon when we would receive some phone calls. Somone would say that one drug was automatically DC due to the expiration. Did we need to continue the medication or not?’

The speakers sometimes utter reported questions which were previously produced by the

speakers themselves as in (273) or from other people as in (274) under certain circumstances.

The reported question of (273) was originally produced by the speaker himself while asking

his patient what will be his choice for the treatment. The speaker restores the site, and claims

that it is the patient who eventually made the decision. The interrogative form helps the

speaker to get away from the responsibility for making the decision. Example (274) is

produced with a complaining tone. The question was asked by the speaker’s staff to request 247

whether an antibiotic should be suspended or not. From the utterance, we can feel that the speaker thinks it is not a proper question because the antibiotic was prescribed by other

physician in the earlier stage. The question put the speaker in a dilemma since he was unable

to offer an answer at that moment. The reported question seems to intentionally indicate that

this type of questions is not uncommon among medical personnel. While hearing the reported

question, the audience, as medical professionals, may immediately realize that it is not

possible for the speaker to have an answer without other medical information of the patient.

The reported question then helps the speaker expresses his complaint in an indirect way.

(275) 最後幾分鐘,你知道醫生有好幾種嗎?就是..精神--要不--那個內科就是啦.(.2)對不對?那外科呢?外科呢? ? @@精神科呢? . ah..病理跟法醫, . (S2) Zuìhòu jǐ fēnzhōng, nǐ zhīdào yīshēng yǒu hǎo jǐ zhǒng ma? Jiùshì.. Jīngshén-- yào bù--nàgè nèikē jiùshì know everything, do nothing la.(.2) Duì bùduì? Nà wàikē ne? Wàikē ne? Know nothing, do everything, right? @@Jīngshén kē ne? Know nothing, do nothing. Ah.. Bìnglǐ gēn fǎyī, know everything, do everything, too late ‘The last few minutes, do you know that there are several kinds of doctors? The internal medicine is ‘know everything, do nothing’, right? The surgery? What about the surgery? ‘know nothing, do everything’, right? What about psychiatrists? ‘know nothing, do nothing’. Ah..and pathology and forensic? ‘know everything, do everything, too late’.’

In (275), the questions serve to create participation and show the speaker’s sense of humor.

Three types of questions are applied in this utterance, including yes-no question, tag question,

and wh-question. The speaker initiates this utterance by addressing the audience to a

question, which functions as a strategy to create participation. The syntactic structure of the

initial interrogative ni zhidao yisheng you howji zhong ma? 你知道醫生有好幾種嗎? ‘do

you know that there are several kinds of doctors?’ is ‘addressing expression + statement + question particle ma 嗎’. After attracting the audience’s attention, the speaker provides 248

distorted interpretation for the question he addressed earlier. The funny interpretation wins laughter. Thus, interrogatives may be utilized to share jokes, or more specifically to show the speaker’s sense of humor.

(276) 不曉得大家有沒有什麼問題要來問李醫師? (S4) Bù xiǎodé dàjiā yǒu méiyǒu shé me wèntí yào lái wèn lǐ yīshī ‘I am not sure if anyone of you has questions to ask Dr. Lo?’ (277) 那是不是我們先請啊黃文盛教授給我們鼓勵?還有給我們 comment 一下? (S3) Nà shì bù shì wǒmen xiān qǐng a huángwénshèng jiàoshòu gěi wǒmen gǔlì? Hái yǒugěi wǒmen comment yīxià ‘Should we first invite Dr. Weng-Sheng Huang to encourage us? Give us some comments?’

Questions can be used to make invitations to anyone in the audience as in (276) or a

designated person as in (277). The speakers employ interrogatives to make invitations sound

polite and less mandatory. The expression bu siaode 不曉得 ‘not sure’ in (276) and the

question form shi bu shi 是不是 in (277) convey the speakers’ uncertainty, and they also

shape the utterances into a more polite indirect questions. In (277), the speaker intentionally

invites a particular physician to give a comment. Since the invitation is made spontaneously,

the speaker is uncertain whether the invitation will be accepted. The interrogative forms help

avoid the potential FTA for both the speaker and the invitee, and meanwhile make the

invitation less compelling.

(278) 其實我們應該用分生的技術,因為現在分生--像我們現在只要 design 好一個 priment,其實只要一兩天,很快就可以..就可以讓那個--可以很快診斷這個疾 病.所以是不是可以..是不是就是我們醫院自備一個方向這樣子?那提供我各 人的淺見. (S7) Qíshí wǒmen yīnggāi yòng fēn shēng de jìshù, yīnwèi xiànzài fēn shēng--xiàng wǒmen xiànzài zhǐyào design hǎo yīgè priment, qíshí zhǐyào yī liǎng tiān, hěn kuài jiù kěyǐ.. Jiù kěyǐ ràng nàgè--kěyǐ hěn kuài zhěnduàn zhège jíbìng. Suǒyǐ shì bùshì kěyǐ.. shì bù shì jiùshì wǒmen yīyuàn zì bèi yīgè fāngxiàng zhèyàng

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zi? Nà tígōng wǒ gèrén de qiǎnjiàn ‘In fact, we should use the meristem technique, because now meristem - as long as we design a priment, actually, it only takes one or two days, very soon we may…we may let the.. we can diagnose the disease quicky. so whether we can .. whether our hospital can consider having a proposal like this? Herein I offer my humble opinion.’ (279) 那另外一個就是我的建議,當然就是說,剛剛有提到,我們大概困難插管個案 是不是應該把它拉到前面? (S3) Nà lìngwài yīgè jiùshì wǒ de jiànyì, dāngrán jiùshì shuō, gānggāng yǒu tí dào, wǒmen dàgài kùnnán chā guǎn gè'àn shì bù shì yīnggāi bǎ tā lā dào qiánmiàn ‘The other one is my suggestion, of course, that is to say, as just mentioned, whether we should move the cases of difficult intubation to the priority?’

Questions can be utilized to present the speaker’s tentative suggestion, as in (278) and (279).

In these two examples, the interrogatives are used to express the speakers’ opinions rather than questions. Interrogative forms help the speakers tone down their utterances and make the

suggestions more acceptable to the audience. Both of the suggestive utterances are

represented by disjunctive questions initiating with shi bu shi 是不是 ‘whether…or not’

which displays the speakers’ tentative attitude and uncertainty to whether the proposals will

be accepted.

(280) 那其實,我覺得這樣講是會有問題的 hon.你怎麼會你的病人用甚麼藥,你不知 道他的 indication? (S4) Nà qíshí, wǒ juédé zhèyàng jiǎng shì huì yǒu wèntí de hon. Nǐ zěnme huì nǐ de bìngrén yòng shénme yào, nǐ bù zhīdào tā de indication ‘Actually, I think this way of saying might cause problems hon. How can you be possibly not knowing the medication that your patients are using? And you do not know his indication? (281) 很多事實上,你說,那事實上都是一定..一定會的啦,你 說不准它去走,那根本是違背人性,所以那個都是需要,而且那 的也很重要, 所以我在想說,整形外科的醫生 是沒有邀請還是怎麼樣 hon? @@本來這個本來就是非 常重要 (S5) Hěnduō case shìshí shàng, nǐ shuō recur, nà shìshí shàng dū shì yīdìng.. yīdìng huì de la, nǐ shuō bu zhǔn tā qù zǒu, nà gēnběn shì wéibèi rénxìng, suǒyǐ nàgè 250

dōu shì xūyào skin graft, érqiě nà skin graft de technique yě hěn zhòngyào, suǒyǐ wǒ zài xiǎng shuō, zhěngxíng wàikē de yīshēng shì méiyǒu yāoqǐng háishì zěnme yàng hon? Běnlái zhège combine care běnlái jiùshì fēicháng zhòngyào ‘In fact in many cases, referring to recurrency, and actually it certainly ..certainly will happen. If you forbit that, it would be contrary to human nature So all of those need skin graft, and the technique of skin graft is also very important, so I wounder if orthopedic doctors are not invited or what hon? In fact, this kind of combine cases are essentially important.’

The questions in the above two examples are used to express the speakers’ surprises sarcastically. In the lecture, the speaker of (280) points out an issue which he thinks ridiculous. That is, sometimes the patient’s case history is not recorded adequately. The speaker thinks that is unacceptable as it may cause problem for the patient’s subsequent treatments. Without clear case history, the follow-up physicians are unable to define whether the current treatment should be continued or suspended, or what should be better consecutive treatments for the patient. Even sometimes the very physician who prescribed the medicine in the first place cannot recall why the original medicine was chosen. In medical profession, this

kind of negligence may cause significant consequences. Instead of making an aggressive

criticism, questions allow the speaker to soften the force of his comment. The wh-question ni zemehui…?你怎麼會…? ‘how can you…?’ ironically conveys the speaker’s doubt and surprise. The utterance of (281) is elicited from the Q & A section, which is produced by a senior physician from Plastic Surgery department. The speaker expresses his guilt and disappointment at the opening remark as he confesses that the topic of the lecture is associated more with his department; therefore, it should be delivered by physician in the

department of Plastic Surgery. In the following discourse, he expresses his agreement to the notion that team work is a must for taking care of serious wounds. Since the wound caring is strongly related to skin, the physicians from Plastic Surgery who possess special knowledge and technique for skin caring can then contribute a lot. However, there is not any physician

251 from his own department presenting in the conference, so he seems to be upset and ashamed about that. Presumably the speaker may intend to preach those younger physicians for not being attending to the conference. Then he suddenly digresses a little from his talk and form an interrogative sentence which serves as a hedging device to soften the speaker’s imposition on the addressee. The disjunctive question is utilized to sarcastically question the young physicians if their absence is owing to lack of invitation21 or whatever reasons.

(282) 好.剛剛沈教授的主題是不是..萬一是屬於困難插管者,那他能夠..拔管率大概 幾 percent hon?大概這個意思? (S3) Hǎo. Gānggāng chén jiàoshòu de zhǔtí shì bùshì.. Wàn yī shì shǔyú kùnnán chā guǎn zhě, nà tā nénggòu.. Bá guǎn lǜ dàgài jǐ percent hon? Dàgài zhège yìsi ‘OK. If the question that Dr. Shen just raised is….just in case that if it belongs to difficult intubation, and then what will be the percentage of the extubation rate? Is that what you tried to ask?’

This utterance is extracted from the Q & A section. In the earlier conversation, the questioner,

Dr. Sheng, asks the lecturer what is the percentage for discarding the respirator from a recovering patient; however, the lecturer’s answer seems irrelevant to the question. Right after the answer, the host, who is aware of the lecturer’s divergent answer, immediately produces the questions in (282). As we know, to point out someone’s mistake directly is regarded as unsparing and rude, especially in public. Thus, interrogatives enable the speaker to avoid the potential FTA. It is worthwhile to note that the questions in (282) serves two distinct functions to the lecturer and the questioner respectively: on the one hand, the host acts as a mediator to reframe the questions to the lecturer, expecting him to give a better answer; on the other hand, the questions function to reconfirm the questioner’s original intention.

Questions are used prevalently in our daily communication to serve different

21 The conference is a routine meeting held every Friday morning, and no invitation will be sent to the physicians who work in the hospital. 252

communicative purposes, and they are also viewed as one of the hedging devices in the

literature (Webber 1994, Hyland 1998, Varttala 2001, Chen 2008, Lo 2010). They can be

employed to hedge the writer’s state of knowledge towards what is being stated and they can

be deliberately used to present the writer’s opinions rather than elicit answers. Questions play

a significant role in the medical community as they serve as an efficient mean to establish intelligibility between the doctor and the patient (West 1983, Tsai 2000, 2005, 2006). The exploration of questions in the specialist-to-specialist discourse seems to be relatively less, and they mainly focus on the written genre. My study examines interrogatives used in the

interactions among medical professionals, and the data comprise both spoken and written

genres. The results show questions are employed in a much higher frequency in the spoken than in the written discourse, with a total 877 occurrences (94.61%) in the speaking versus 50

occurrences (5.39%) in the writing. Genre difference presumably accounts for the tremendous discrepancy. It is observed that questions are employed by both the speakers and the writers to provide a framework to the following discussion, to create participant involvement, to attract the audiences’/writers’ attention on important issues, and to anticipate the audiences’/writers’ doubts. Since interrogatives are utilized a lot more by the speakers, there would be functions exclusively manifested in the spoken discourse. In addition to the above shared functions, questions are applied by the speakers to demonstrate several other functions: they can be used to introduce new policies and current heeds, to foreshadow later topics, to direct the audiences’ attention to the slides, to quote reported questions, to express the speaker’s sense of humor, to make polite invitations, to offer tentative suggestions, to convey sarcasm, and to seek for confirmation. Apart from communicative purposes, four types of question forms are identified in the corpus, which are wh-questions, yes-no questions, tag questions, and disjunctive questions. The speakers make use of all types of questions, and wh-questions make up the majority (65.34%); the writers use three types and

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exclude tag questions, with wh-questions and yes-no question distributed almost evenly (46%

vs. 42%).

4.4.3 Addressing limitations

In addition to conditionals and questions, the other type of non-lexical hedges found in

my corpus contains statements used to address limitations. According to Hyland (1998: 141),

“by referring to experimental weaknesses, limitations of the model, theory or method used, or

inadequate knowledge, writers can qualify commitment by offering a measure of

propositional certainty.” Addressing limitations applied in the present study not only refer to

the limitations of a study in question but also the potential limitations on other researches

which are quoted in the current study or the speakers’/writers’ cognitive limitations.

Addressing limitations is a prevalent hedging strategy applied by the medical professionals.

With this device, the speakers/writers are able to mitigate their commitment to the claims, express tentativeness and cautiousness to their arguments, and show solidarity to the medical

community. As shown in Figure 15, expressions which address limitations occur much more frequently in the writing than in the speaking (25.15% with 122 occurrences vs. 4.22% with

60 occurrences). The references of addressing limitations are classified into twelve types in each genre, with nine of them shared by both. Table 28 illustrates the numerical figures and percentages of each limitation type.

Table 28. Types of imitations identified in the spoken vs. written genres

Spoken Written

A. source A. source

B. uncertainty B. uncertainty

C. treatments vary depending on situations C. treatments vary depending on situations

D. processing D. processing

E. tentative suggestion E. tentative suggestion 254

F. modesty F. modesty

G. lack of evidence G. lack of evidence

H. complexity H. complexity

I. probably reasoning I. probable reasoning

J. knowledge J. contraindication

K. memory processing K. controversial arguments

L. expectation L. need further evidence

M. personal judgment M. method (introspection)

Table 28 shows that the speakers utilize type C the most frequently. Type C, treatment varies depending on situations, are references associated with clinical judgments, which vary from situation to situation. In the written data, Type L appears the most, which addresses the limitation on the insufficiency of current evidences, and more experimental evidence is expected. In spite of shared functions, there are other types of limitations which appear in only the spoken corpus or in the written corpus, as shown in Table 28. It is worth noting that the exclusive types observed in the spoken discourse seem to be closely associated with subjective reasoning. In other words, those four limitations refer to the speaker’s state of knowledge, memory processing, personal expectation and judgment. Among the limitations exclusively identified in the written discourse, only one of them is relative to subjective reasoning, while the other three address objective factors, such as indicating the possible contraindication, controversial arguments, or the necessity of further evidence. In the following discussion, I will first explicate references of the shared limitations found in both genres, and successively discuss the exclusive types of limitations identified in the spoken data and the written data. Two examples will be provided to explain each type of limitation.

For the shared types, one example will be from the spoken data, while the other will be

255 extracted from the written discourse:

(283) 那事實上,實際上,患者他的 B 肝的hon,因為..er 我.我們.. 我大概沒有辦法逐筆去看啦,因為我們針扎系統裏面沒辦法撈到這個資 料,hon 所以沒辦法看出它實際上. (S9) Nà shìshí shàng, shíjì shang, huànzhě tā de B gān de preference rate hon, yīnwèi..er wǒ. Wǒmen.. wǒ dàgài méiyǒu bànfǎ zhú bǐ qù kàn la, yīnwèi wǒmen zhēn zhā xìtǒng lǐmiàn méi bànfǎ lāo dào zhège zīliào,hon suǒyǐ méi bànfǎ kàn chū tā shíjì shang preference rate ‘In fact, the preference rate of the patient’s Hepatitis B hon, because ..er I ..we..I probably have no way to check case by case, because there is no way available for us to get the information in the groan needle system, hon so we are unable to check the actual preference rate.’ (284) 完全症狀緩解的定義是小於三次腹瀉、無發燒、無腹痛且無白血球增多； 在使用 50 mg 、100 mg 和 200 mg 的病患，其完全症狀緩解分別為 37.5%、50%和 86.7%。在腹瀉緩解的時間上，三組沒有統計上的差別，但 這有可能是樣本數太少的關系。 (W1) Wánquán zhèngzhuàng huǎnjiě de dìngyì shì xiǎoyú sāncì fùxiè, wú fāshāo, wú fùtòng qiě wú báixiěqiú zēngduō; zài shǐyòng 50 mg,100 mg hé 200 mg de bìng huàn, qí wánquán zhèngzhuàng huǎnjiě fēnbié wèi 37.5%,50%Hé 86.7%. Zài fùxiè huǎnjiě de shíjiān shàng, sān zǔ méiyǒu tǒngjì shàng de chābié, dàn zhè yǒu kěnéng shì yàngběn shù tài shǎo de guānxì ‘The complete remission of diarrhea is defined as less than three times, no fever, no abdominal pain, and no leukocytosis; the patients who took 50 mg, 100 mg and 200 mg, the rates of complete remission were 37.5%, 50% and 86.7 % respectively. The duration in the remission of diarrhea does not show statistically significant among these three groups, but that may be due to the small number of samples.’

Examples (283) and (284) are references to limitation of experimental sources. The speaker of example (283) claims that his incapability to provide the exact preference rate of hepatitis

B is due to the deficiencies of source in the hospital. By referring to the insufficiency of medical source, the speaker avoids taking the responsibility to provide the precise numerical figure. The writers of example (284) explain that three distinct doses are applied to relieve the patients’ diarrhea, but the results show that there is no statistically significance regarding the 256 durations for the ease of diarrhea. The writers then distance their commitment to the experimental result by referring to the deficiency in sampling.

(285) 那..所以隨著時間,它的抗藥性可能是逐步產生的 hon,一步一步產生的,那一 步步地累積,那到一個關鍵的點 hon,當然我們目前還不曉得那個點到底是在 甚麼地方 hon,那也許我們的一個..的一個抗藥性就回不來了 hon. (S4) Nà.. Suǒyǐ suízhe shíjiān, tā de kàng yàoxìng kěnéng shì zhúbù chǎnshēng de hon, yībù yībù chǎnshēng de, nà yībù bù de lěijī, nà dào yīgè guānjiàn de diǎn hon, dāngrán wǒmen mùqián hái bù xiǎodé nàgè diǎn dàodǐ shì zài shénme dìfāng hon, nà yěxǔ wǒmen de yīgè.. de yīgè kàng yàoxìng jiù huí bù láile hon ‘So over time, the resistance may be progressively generated and accumulated step by step. When it reaches to a critical point.. hon, of course, we are not sure so far where that point is hon, and maybe the.. the resistance will never be revived hon.’ (286) 以表一之診斷流程圖所示本案例的診斷可能是自體免疫性腎上腺炎 (autoimmune adrenalitis)合併原發性腎上腺機能不全，然而因未測定 21-OH Ab ，因此本案例仍無法確診為自體免疫性腎上腺炎。 (W1) Yǐ biǎo yī zhī zhěnduàn liúchéng tú suǒ shì běn ànlì de zhěnduàn kěnéng shì zì tǐ miǎnyì xìng shènshàngxiàn yán (autoimmune adrenalitis) hébìng yuán fā xìng shènshàngxiàn jīnéng bùquán, rán'ér yīn wèi cèdìng 21-OH Ab, yīncǐ běn ànlì réng wúfǎ quèzhěn wèi zì tǐ miǎnyì xìng shènshàngxiàn yán ‘As shown in the diagnostic flow chart one, the diagnosis in this case may be autoimmune adrenalitis, combined with primary adrenal insufficiency. Since the 21-OH Ab is still unmeasured, this case still cannot be determinately diagnosed as autoimmune adrenalitis.’

Examples (285) and (286) convey the physicians’ uncertainty on the clinical experiments.

The linguistic hedges, women muqian hai bu xiaode 我們目前還不曉得 ‘we are not sure so far’ in (285) and ben anli reng wufa que zheng wei… 本案例仍無法確診為…‘this case still cannot be determinately diagnosed as…’ in (286) are used by the speaker/writers to refer to the indeterminate phenomenon The phrases used in these two references are categorized as shields in Prince et al. (1982) study, and as indicated by Bosk (1980: 72), shields occur most frequently in discussions of diagnoses and planning “to indicate the speaker does not have

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complete confidence in the assertion that he or she is making.” By pointing out the limitation, either from the physician’s lack of confidence or from the insufficiency of modern medical technology, the speakers/writers avoid making any definite conclusion for the clinical problems, and simultaneously leave the indeterminate issues open for further study.

(287) 譬如說你個別的,< E individual E>的,臨床的狀況,還在 你在 al--就是插管人的技術,還有你可獲得的一些..一些設備的資源,事實上 都決定甚麼樣的方式是對病人來說是最好的. (S3) Pìrú shuō nǐ gèbié de,individual de decision-making, línchuáng de zhuàngkuàng, hái zài nǐ zài al--jiùshì chā guǎn rén de jìshù, hái yǒu nǐ kě huòdé de yīxiē.. yīxiē shèbèi de zīyuán, shìshí shàng dū juédìng shénme yàng de fāngshì shì duì bìngrén lái shuō shì zuì hǎo de ‘For example, the individual, individual's decision-making, clinical status, and still you al--the personal cannulation technique, and some..some equipment resources that you can obtain, are in fact help to decide what will be the best for the patient.’ (288) 使用荷爾蒙仍應考慮婦女個人的醫療病史、需求以及各別的喜好. (W2) Shǐyòng hè'ěrméng réng yìng kǎolǜ fùnǚ gèrén de yīliáo bìngshǐ, xūqiú yǐjí gè bié de xǐhào ‘The application of hormone should depends on the patient’s medical history, personal needs, and individual preferences.’

The limitations addressed in (287) and (288) refer to possible variables that should be taken

into consideration in clinical practices. Decision-making is a difficult task in the medical

realm because they are always probability reasoning and conditions associated with clinical

problems. Schwartz (1979) indicates that in some situations, a physician must choose among

several similarly plausible courses of action, and each of them may give rise to potential

serious long-term of short-term consequences; therefore, “a fixed recipe for management, as

defined by a standard protocol, is inappropriate” (p.556). A physician needs to think carefully

and systematically about alternatives. In (287) and (288), the speaker/writers point out that

there are various possible elements which may influence a physician’s decision-making and

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the consequences of medical treatments. Referring to likely variables that a clinical treatment depends on helps the speakers/writers escape from giving a responsible answer.

(289) 那這個原則上是我們已經..eh 簽呈,就是說院方是已經同意這個系統建置,所 以我們目前在積極規畫當中. (S3) Nà zhège yuánzé shàng shì wǒmen yǐjīng..eh qiān chéng, jiùshì shuō yuàn fāng shì yǐjīng tóngyì zhège xìtǒng jiàn zhì, suǒyǐ wǒmen mùqián zài jījí guī huà dāngzhōng ‘Basically, we have ..eh already got the signature, that is, the hospital has agreed to build this system, so we are currenly planning for it.’ (290) 植入基因的將 EPO 製造出之後將依 EPO 產出的速度以 決定日後植入體內的生物幫浦(biopump)中 microdermis 量。此治療法目前 已通過美國專利並進行臨床試驗中。 (W1) Zhí rù jīyīn de microdermis jiāng EPO zhìzào chū zhīhòu jiāng yī EPO chǎn chū de sùdù yǐ juédìng rìhòu zhí rù tǐnèi de shēngwù bāng pǔ (biopump) zhōng microdermis liàng. Cǐ zhìliáo fǎ mùqián yǐ tōngguò měiguó zhuānlì bìng jìnxíng línchuáng shìyàn zhōng ‘The microdermis of implanted gene produces EPO, and the microdermis dose which will be implanted to the biological pump (biopump) is depending on the manufacture of EPO. This therapy has obtained the United States Patent and is currently undergoing clinical trials.’

Referring to a project which is still ongoing or currently under testing helps the

speakers/writers keep distance from assurance, as shown in examples (289) and (290). The

speaker of (289) announces to the audience that the hospital administration has agreed to

purchase difficult airway carts, and the plan is underway. That is, the procurement plan

announced in (289) is under expectation, but the construction is yet to be completed. Example

(290) notes that a new medical treatment is under clinical experiment at this moment, and

people just need to be patient before the treatment is available. An ongoing project does not

equal a guarantee. Referring to unfinished programs reduces the speaker’s/writer’s

conviction, expressing their less than full commitment to the consequences of the ongoing

project or experiment.

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(291) 那看起來,好像各個科室的一個主管,在這邊的好像還是不是很多,或許,這個 是剛剛張醫師來講說,執行面有沒有被推行得很好,一個可能也可以思考的 hon. (S9) Nà kàn qǐlái, hǎoxiàng gège kēshì de yīgè zhǔguǎn, zài zhè biān de hǎoxiàng háishì bùshì hěnduō, huòxǔ, zhège shì gānggāng zhāng yīshī lái jiǎng shuō, zhíxíng miàn yǒu méiyǒu bèi tuīxíng dé hěn hǎo, yīgè kěnéng yě kěyǐ sīkǎo de hon ‘It seems that there are not many heads of various departments sitting here. Not many chiefs attend in this lecture. Perhaps, just like what Dr. Chang mentioned earlier, many aspects have not been done well. This is one aspect that we may think over hon.’ (292) 這相對於以往的報告而言比例偏高(Toursarkissian 及其團隊研究報告為 0.7%, Kearney 及其團隊研究報告為 0.2%) ，原因可能在於本院在執行經 皮氣切術的過程中，因擔心病人疼痛，使用鎮定及麻醉藥物量稍多，這是 未來我們要改進的方向。 (W1) Zhè xiāngduì yú yǐwǎng de bàogào ér yán bǐlì piān gāo (Toursarkissian jí qí tuánduì yán jiù bàogào wèi 0.7%, Kearney jí qí tuánduì yán jiù bàogào wèi 0.2%), Yuányīn kěnéng zàiyú běn yuàn zài zhíxíng jīng pí qì qiē shù de guòchéng zhōng, yīn dānxīn bìngrén téngtòng, shǐyòng zhèndìng jí mázuì yàowù liàng shāo duō, zhè shì wèilái wǒmen yào gǎijìn de fāngxiàng ‘The ratio is relatively higher in compared with previous reports (It is 0.7% for the study of Toursarkissian and his team, and it is 0.2% for the study of Kearney and his team), the reason may lie in the surgery procedure of percutaneous tracheostomy conducted in our hospitcal, for worry of the patient’s pain, we use slightly more amount of tranquilizers and anesthetics, this is what we need to improve in the further.’

The limitations brought out by (291) to (292) refer to the speakers’/writers’ tentative

suggestions. Example (291) is an excerpt from the Q & A section. The speaker of (291), one

of the vice presidents of the hospital, cares much about the problems caused by the

needlestick injury, which is the topic of the lecture. Earlier in the comment, the speaker indirectly indicated that he noticed that many staffs members are absent from the lecture, and he further declares that all the employees need to pay attention to this serious problem, especially the chief of every department. The speaker employs several hedging devices,

260 including hedging verb, adverb, and attribution hedge, to tone down the statement upon his observation regarding the absence of chiefs from various disciplines. Eventually he tentatively suggests that perhaps the implementation of the policy need to be enhanced, and this suggestion is cunningly attributed to another physician. The application of a series of hedges helps mitigate the speaker’s potential FTA, and make the utterance less impulsive to the audience. The limitation of (292) refers to possible reasons which give rise to slightly higher failure rate on the treatment practiced by their medical team, in comparing with other abroad medical reports. The writers tentatively argue that the higher rate may be due to the good intention of their team members. The attribution helps the writers minimize the responsibility of the failure. Then they admit they notice this probability reasoning and suggest it to be an aspect for further improvement.

(293) 到目前,我在講說,我今天..可能會整天都在思考這個問題.@@啊 (這是)到目前我的領悟是只有到這裏而已,很淺的一個東西. (S2) Dào mùqián, wǒ zài jiǎng shuō, wǒ jīntiān.. kěnéng huì zhěng tiān dū zài sīkǎo zhège wèntí. A tansi dào mùqián wǒ de lǐngwù shì zhǐyǒu dào zhèlǐ éryǐ, hěn qiǎn de yīgè dōngxī ‘Up to now, I am saying that, today..I might be thinking all day about this issue. Ah but this is what I have comprehened so far, very shallow realization.’ (294) 腸道營養供給是病人很重要、很基本的一環，希望本文能帶給讀者在臨床 使用或研究上的幫忙。作為一個臨床醫師，應審度病人的狀況及各醫院現 有的配置，選擇一個對病人最有利的方式來放置鼻- 腸管。 (W1) Cháng dào yíngyǎng gōngjǐ shì bìngrén hěn zhòngyào, hěn jīběn de yīhuán, xīwàng běnwén néng dài gěi dúzhě zài línchuáng shǐyòng huò yánjiū shàng de bāngmáng. Zuòwéi yīgè línchuáng yīshī, yīng shěn dù bìngrén de zhuàngkuàng jí gè yīyuàn xiànyǒu de pèizhì, xuǎnzé yīgè duì bìngrén zuì yǒulì de fāngshì lái fàngzhì bí- chángguǎn ‘Intestinal nutrient supply is very important and very basic to patients, I hope that this paper can bring help to the readers in clinical use or research. As clinicians, we should review the patients’ conditions and the existing configuration of individual hospital, selecting the most favorable way for the patients to place the naso-gastric tube.’

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Examples (293) and (294) are modest comments on the limitation of the speaker’s

intelligence and the writers’ research. In my spoken corpus, one physician who is also a priest

gives a lecture entitled Concealing and Informing. After the speech, the speaker of (293) is

invited to make a comment. He states that in medial field, concealing or informing is a

dilemma that challenges a physician’s wisdom. He personally thinks the choice is depending

on individuals, timing, location, and conditions related to the event. Then the speaker humbly

confesses that the above comprehension is very shallow, and that is what he can interpret so

far. Based on the lecture, the speaker’s interpretation definitely resonates most of the

audiences. The comment shows the speaker’s politeness and modesty, which performs a solidarity-giving speech act as a hedging strategy for claiming “in-group membership”

(Cutting 2007). The modest limitation addressing in utterance (294) also conveys the writers’ self-effacing attitude. By modestly concealing the potential contribution of their research to clinical experiments, the writer can show their deference to the community.

(295) 越來越多那個神經內科醫師 hon,去走高壓氧,他的..他們認為那個..那個治療 TRA 的話,就是有..有它的效果 hon.但是我們..這是.這是啦,還沒 有一個啦 hon,我們也不敢太那個..跟神經內科醫師說這個非 常有效啦 hon,畢竟這種病人還是會有他的風險性 hon. (S5) Yuè lái yuè duō nàgè shénjīng nèikē yīshī hon, qù zǒu gāoyā yǎng, tā de.. Tāmen rènwéi nàgè.. Nàgè zhìliáo TRA dehuà, jiùshì yǒu.. yǒu tā de xiàoguǒ hon. Dànshì wǒmen.. zhè shì. Zhè shì paper la, hái méiyǒu yīgè evidence la hon, wǒmen yě bù gǎn tài nàgè.. Gēn shénjīng nèikē yīshī shuō zhège fēicháng yǒuxiào la hon, bìjìng zhè zhǒng bìngrén háishì huì yǒu tā de fēngxiǎn xìng hon ‘More and more neurologists hon, focus their treatment with HBO, his.. they think that.. it is effective to treat TRA. But we ..this is.this is only mentioned in papers, there is not any evident in emperiments yet hon, so we are not too sure ..that if it can effectively assist neurologists. After all, there are still risks for this kind of patients hon.’ (296) 因為 PLA2R 並不表現於老鼠腎臟，所以目前並無動物模式可以證實。 (W1) Yīnwèi PLA2R bìng bù biǎoxiàn yú lǎoshǔ shènzàng, suǒyǐ mùqián bìng wú dòngwù móshì kěyǐ zhèngshí 262

‘Because PLA2R is not shown in mouse kidney, so there is so far no animal model that can be confirmed.’

Addressing limitations to lack of evidence is another shared type of limitation observed in both genres. As well as (295), the writers of (296) straightforwardly point out the defeat of the current research, and which is no evidence to verify the experiment so far. By referring to the shortcomings, the speakers/writers can avoid making any commitment.

(297) 當初第一時間要判斷它是細菌,或是病毒的一個感染的時候, 可能要更..更加 地精確,當然,我知道這個很難 hon,因為包括我們..也覺得這個是會有困難的 一個地方. (S4) Dāngchū dì yī shíjiān yào pànduàn tā shì xìjùn, huò shì bìngdú díyi1 gè gǎnrǎn de shíhòu, kěnéng yào gèng.. gèngjiā de jīngquè, dāngrán, wǒ zhīdào zhège hěn nán hon, yīnwèi bāokuò wǒmen.. yě juédé zhège shì huì yǒu kùnnán deyi1 gè dìfāng ‘It should be more precise at the first stage while you try to determine if it is a bacterial or virus infection. Of course, I know this is very difficult hon, because including us .. also feel that this is very difficult.’ (298) 另外，由於血管缺血性損傷的發生是不可預期的，所以要研究預先給予的好處也是有困難的。 (W2) Lìngwài, yóuyú xiěguǎn quē xiě xìng sǔnshāng de fāshēng shì bùkě yùqí de, suǒyǐ yào yánjiū yùxiān jǐyǔ statins de hǎochù yěshì yǒu kùnnán de ‘In addition, due to the occurrence of vascular ischemic injury is unpredictable, so it is also difficult to explore the benefits of giving statins beforehand.’

Referring to coexistent conditions denotes the difficulty in diagnosis and decision-making for physicians. The utterance in (297) refers to the limitation in determining whether an infection is caused by a bacteria or a virus. The speaker admits that not only himself but also other physicians in the department of Infection acknowledge this predicament. The reference of

(298) refers to the impossibility on foreknowledge to occurrence of certain disease which is ischemic injury in this case. Since the occurrence is unpredictable, it is difficult to prescribe statins beforehand. Referring to the complex conditions of an event enables the

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speakers/writers to avoid taking the full responsibility for providing absolute solutions.

(299) 那所以基本上,就是說咳嗽為什麼會咳很久?會咳那麼久,目前..只知道是..可 能懷疑跟這些 toxin 有關, (S7) Nà suǒyǐ jīběn shàng, jiùshì shuō késòu wèishéme huì hāi hěnjiǔ? Huì hāi nàme jiǔ, mùqián.. zhǐ zhīdào shì.. kěnéng huáiyí gēn zhèxiē toxin yǒuguān ‘So basically, that is to say what causes the patient to cough for a long time? So far we can only suspect that it is probably associated with these toxins,’ (300) 雖然生化標記上升，但對於病人預後目前仍未知，但可藉由數據變化作為 PCI 技術品質的參考。(W1) Suīrán shēnghuà biāojì shàngshēng, dàn duìyú bìngrén yùhòu mùqián réng wèizhī, dàn kě jí yóu shùjù biànhuà zuòwéi PCI jìshù pǐnzhí de cānkǎo ‘Although the biochemical markers increased, the prognosis for patients is so far still unknown, but the data changes can be references for PCI technical quality.’

The last type of limitation shared by both spoken and written genres is the limitation referring

to possible reasoning. The statements of (299) and (300) declare that the reasons for certain

symptom or prognosis are not definite at present; however, some possible conjectures can

still be made. By referring to the indetermination on probable factors, the speakers/writers

can tone down their commitment to the speculations.

In the following discussion, the other types of the limitations observed in either spoken or written genre will be discussed. Admission to lack of knowledge, limitation of memory processing, reference to expectation, reference of personal judgment are exclusively found in spoken data, while reference of contraindication, reference of controversial arguments, requirement of further evidence, and reference of introspection appear only in written discourse. References to limitations in the spoken data are presented first:

(301) 那事實上真正的為什麼會咳那麼久?我..我.我自己是..是.. 是沒有什麼研究. (S7) Nà shìshí shàng zhēnzhèng de mechanism wèishéme huì hāi nàme jiǔ? Wǒ.. wǒ. wǒ zìjǐ shì.. shì.. shì méiyǒu shé me yánjiū ‘Acutally what is the real mechanism that gives rise to the long cough? I .. I .. I

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myself do..do..do not really know.’ (302) hon 那如果她有生殖上的問題,那我們是可以幫忙的.因為那很特殊的治療在 我們這領域裡頭,其實我也是不懂,還是要請沈教授幫忙的. (S8) Hon nà rúguǒ tā yǒu shēngzhí shàng de wèntí, nà wǒmen shì kěyǐ bāngmáng de. Yīnwèi nà hěn tèshū de zhìliáo zài wǒmen zhè lǐngyù lǐtou, qíshí wǒ yěshì bù dǒng, háishì yàoqǐng chén jiàoshòu bāngmáng de ‘hon if she has problems on reproduction, then we can help, because what you mentioned is a very special treatment in your field, I actually do not understand, and still need you, Dr. Shen, to help.’

Examples (301) and (302) refer to the speakers’ limited knowledge on certain medical issues.

Admitting to a lack of knowledge shows a speaker’s honesty which is valued highly in

scientific field. The admission in (301) prevents the speaker from providing an answer to his

previous question. In (302), the speaker responds to the addressee’s question with respect to

the infertility treatment on patients with leukemia. Since the speaker is specialized in the field

of infertility, he then admits that he has no knowledge about patient with leukemia problem

but will be willing to help with the part associated with infertility. As to special treatments

relating to leukemia, the addressee is praised by the speaker to be the top expert in this realm.

The admission to a lack of knowledge enables the speaker to decline the addressee’s

invitation politely.

(303) 那個 B 型肝炎喔,那個血清 hon,啊..我..我假如沒有記錯的話,零點零零零零 零六,那下面六個..六個零,那很少量...的血清,就會感染, (S9) Nàgè B xíng gānyán ō, nàgè xiěqīng hon, a.. wǒ.. wǒ jiǎrú méiyǒu jì cuò dehuà, líng diǎn líng líng líng líng líng liù, nà xiàmiàn liù gè.. liù gè líng, nà hěn shǎo liàng... ee xiěqīng, jiù huì gǎnrǎn ‘The hepatitis B, the serum hon, ah ..I..if I remember correctly, 0.000006, there are six zeros preceding six .. six zeros. It only takes a very small amount.. of serum to get infected,’ (304) 我們曾經有..碰過,治療過兩三個..那個小朋友 hon,一個八歲,一個十..忘記幾 歲了.那個恢復能力很好,從七八分會回到..那個十四十五分 hon. (S5) Wǒmen céngjīng yǒu.. pèngguò, zhìliáoguò liǎng sān gè.. nàgè xiǎopéngyǒu hon, yīgè bā suì, yīgè shí.. wàngjì jǐ suìle. Nàgè huī fù nénglì hěn hǎo, cóng qībā

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fēnhuì huí dào.. nàgè shísìshíwǔ fēn hon ‘We have .. have treated two or three .. kids hon, one was eight years old, another is ten .. I forgot the exact age. Their recovery capabilities were very good, recovering from seven or eight to fourteen or fifteen hon.’

Examples (303) and (304) are references regarding to the difficulty of memory processing.

This type of limitation occurs merely in the face-to-face interaction as naturally occurring

discourse is “locally managed and dynamic, depending on the needs and constraints arising at

the moment of speech in the situated interactional event” (Ono and Thompson 1995: 258).

The utterances of (303) and (304) best demonstrate spontaneous instantiations which are

unplanned and heavily influenced by cognitive limitations. By referring to the limitation of

memory processing, the speaker of (303) reduces his commitment to the following assertion.

In (304), the speaker claims that the younger a patient is, the better a recovery can be

achieved. While mentioning of his experience on treating young children, he faces the

cognitive difficulty in recalling the patient’s age; however, the neglect does not seem to be

affect the flow of the talk because the main point the speaker tries to convey is that younger

children have better recovering ability from brain injury.

(305) 所以希望說,大家有一個概念,一加一,醫療,不是等於二,不是計算題,第二,我 們一定要努力,把醫事人員跟病人,看能不能回歸..我們是一家人.謝謝. (S2) Suǒyǐ xīwàng shuō, dàjiā yǒu yīgè gàiniàn, yījiā yī, yīliáo, bùshì děngyú èr, bùshì jìsuàn tí, dì èr, wǒmen yīdìng yào nǔlì, bǎ yīshì rényuán gēn bìngrén, kàn néng bùnéng huíguī.. Wǒmen shì yī jiā rén. Xièxiè ‘Therefore, I hope that we all have the concept, one plus one is not equal to two in health care. Second, we must strive to see whether medical personnel and the patient can joinly become a family. Thank you.’

Example (305) is a reference of cognition limitation. The speaker of (305) indicates that in

medical realm, things cannot be regarded as simple as math formula. Referring to personal

expectation is seen as a hedging strategy since the expectation represents the speaker’s belief

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and shows that he is looking forward to the achievement in the future although it is not an

assurance.

(306) 那各位可以看到這個他們的發病日期,到他的發病日期,大概相隔十天左右 hon,也就是說這個是它的潛伏期,那臨床上我..我自己在看病人的時候是..依 照這樣子..依照這樣子的情況在判斷 hon. (S7) Nà gèwèi kěyǐ kàn dào zhège tāmen de fābìng rìqí, dào tā de fābìng rìqí, dàgài xiānggé shí tiān zuǒyòu hon, yě jiùshì shuō zhège shì tā de qiánfúqí, nà línchuáng shàng wǒ.. wǒ zìjǐ zài kàn bìngrén de shíhòu shì.. yīzhào zhèyàng zi.. yīzhào zhèyàng zi de qíngkuàng zài pànduàn hon ‘You can see that it is about ten days apart, from the dates of their onsets to his onset hon, that is to say that it is the incubation period, clinically I.. I my..diagnosis is based on…based on those information.’

Example (306) is a limitation referring to the speaker’s subjective judgment. The speaker of

(306) indicates that the incubation period for the pertussis is around 10 days and he clarifies

that the estimated days is based on his personal clinical experience. Attributing the estimation

to the speaker’s own judgment helps the speaker to lower the validity of his statement and

avoid possible opposition from other researchers.

The following examples are types of limitations found exclusively in the written

discourse:

(307) 但對於結構異常、出血及胃癌高風險族群，經鼻上消化道內視鏡的應用仍 需謹慎考慮。(W1) Dàn duìyú jiégòu yìcháng, chūxiě jí wèi'ái gāo fēngxiǎn zúqún, jīng bí shàng xiāohuà dào nèi shì jìng de yìngyòng réng xū jǐnshèn kǎolǜ ‘However, for structural abnormalities, bleeding, and gastric high-risk groups, the application of upper gastrointestinal endoscopy nose still need to be carefully assessed.’

The utterance of (307) appears as the last sentence in the conclusion remarks of an article,

which reminds the readers to be cautious of the application of a new medical instrument. The

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article advocates the advantages of Transnasal Endoscopy which is a new apparatus and has

been widely used in many countries. By referring to the contraindication, the writers

tentatively avoid a full guarantee towards the functions of this instrument.

(308) 目前東西方的醫學會對於抗血小板藥物的使用仍有分歧. (W1) Mùqián dōngxī fāng de yīxué huì duìyú kàng xiě xiǎo bǎn yàowù de shǐyòng réng yǒu fèn qí ‘Currenly, in the eastern and western medicial associations, there are still controversies in the use of antiplatelet drugs.’ (309) 至於氣壓與腦中風的關係目前並無定論，有研究發現若先前 48 小時氣壓低 10 百帕(hPa)，會增加出血性腦中風的機會，不過有研究持相反意見或認為 兩者並無關聯。 (W1) Zhìyú qìyā yǔ nǎo zhòngfēng de guānxì mùqián bìng wú dìnglùn, yǒu yánjiū fāxiàn ruò xiānqián 48 xiǎoshí qi yā dī 10 bǎi pà (hPa), huì zēngjiā chūxiě xìng nǎo zhòngfēng de jīhuì, bùguò yǒu yánjiū chí xiāngfǎn yìjiàn huò rènwéi liǎng zhě bìng wú guānlián ‘Currently, there is still not a final conclusion regarding the relationship between pressure and stroke, a study found that if the air pressure is low as 10 hPa in the previous 48 hours, it will increase the chance of hemorrhagic stroke, but another study holds the opposite view, or considers that there is no correlation between these two.’

Examples (308) and (309) are references of limitations to controversial arguments. In the medical world, it is common to notice alternative views on different issues, such as clinical treatments, medicine prescription, and interpretation of experimental results. Controversial arguments may be derived in accordance with distinct methods, sample sizes, individuals, or theories. Referring to divergent arguments on a certain issue shows the writers’ acknowledgment of alternative possibilities and unobtainable solutions.

(310) 總括來說，對於心血管的臨床預後尚無一致性 的結論，需要更多資料來佐證。 (W1) Zǒngguā lái shuō,a-glucosidase inhibitors duìyú xīn xiěguǎn de línchuáng yùhòu shàng wú yīzhì xìng de jiélùn, xūyào gèng duō zīliào lái zuǒzhèng ‘In conclusion, there is still no consistent conclusion for the outcomes of using α- 268

glucosidase inhibitors for clinical prognosis of cardiovascular, more studies are needed for evidence.’ (311) 此外，有研究針對抗衰老的可能性，甚至是減少糖尿病肝 硬化患者肝性腦病變等較具爭議性的研究發現，則有待更充分，更進一步 的證據支持。 (W1) Cǐwài, yǒu yánjiū zhēnduì metformin kàng shuāilǎo de kěnéng xìng, shènzhì shì jiǎnshǎo tángniàobìng gān yìnghuà huànzhě gān xìng nǎo bìngbiàn děng jiào jù zhēngyì xìng de yánjiū fāxiàn, zé yǒudài gèng chōngfèn, gèng jìnyībù de zhèngjù zhīchí ‘In addition, there are researches focusing on the fuction of metformin, such as the possibility of anti-aging, and even the possibility of reducing the liver encephalopathy of diabetes patients with cirrhosis, etc. For those controversial research findings, we need more fully and further evidence to support.’

Asserting the necessity of further evidence occurs the most frequently among various types of

limitations in the written data. In (310), further evidence is required because there is not any

consistent conclusion coming out; for (311), further evidence is required for supporting some

controversial findings. The requirement of additional supports signifies inadequacy of

assurance on ambiguous issues. As we know, there are always uncertainty, doubts, and

controversy on medical issues, addressing the necessity of further evidence challenges the

readers’ to think about the unsolved problems and it may inspire the readers’ interests in future experiments.

(312) 本病例由 8 月 17 日檢測血液 CMV-PCR 結果為陽性反應，至 8 月 20 日 開始投予< E ganciclovir E>治療。反思距離發病日已過 12 日，才開始抗病 毒藥物治療，是否有延遲治療問題？文獻表示免疫功能不全病人，一旦檢 測 CMV-PCR 結果為陽性，即要及早治療，方能降低死亡率。 (W1) Běn bìnglì yóu 8 yuè 17 rì jiǎncè xiěyè CMV-PCR jiéguǒ wèi yángxìng fǎnyìng, zhì 8 yuè 20 rì kāishǐ tóu yǔ ganciclovir zhìliáo. Fǎnsī jùlí fābìng rì yǐguò 12 rì, cái kāishǐ kàng bìngdú yàowù zhìliáo, shìfǒu yǒu yánchí zhìliáo wèntí? Wénxiàn biǎoshì miǎnyì gōngnéng bùquán bìngrén, yīdàn jiǎncè CMV-PCR jiéguǒ wèi yángxìng, jí yào jízǎo zhìliáo, fāng néng jiàngdī sǐwáng lǜ ‘This case started from August 17, with positive result on the CMV-PCR blood test, till August 20, we began to treat him with ganciclovir. We reflect that when

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the antiviral therapy begain, it had passed 12 days since the patient’s onset, if there is the issure of delay treatment? The literature indicates that for immunocompromised patients, once the CMV-PCR result shows positive, an early treatment is needed in order to reduce mortality.’ (313) 但是當初評估病人胸部 X 光影像，發現雙側肺野出現不明的瀰漫性浸潤， 是否即要警覺病人伺伏 CMV 感染的危機？並及早檢測 CMV-PCR，勿待使 用抗生素與抗結核治療無效時，才思考是否合併有其他病毒感染問題，值 得進一步探討！ (W1) Dànshì dāngchū pínggū bìngrén xiōngbù X guāng yǐngxiàng, fāxiàn shuāng cè fèi yě chūxiàn bùmíng de mímàn xìng jìnrùn, shìfǒu jí yào jǐngjué bìngrén cì fú CMV gǎnrǎn de wéijī? Bìng jízǎo jiǎncè CMV-PCR, wù dài shǐyòng kàngshēngsù yǔ kàng jiéhé zhìliáo wúxiào shí, cái sīkǎo shìfǒu hébìng yǒu qítā bìngdú gǎnrǎn wèntí, zhídé jìnyībù tàntǎo ‘However, at the early stage, while assessing the patient’s chest X-ray image which showed unknown diffuse infiltration on the bilateral lung, should we be immediately alert that the patient may have CMV infection? And we should try to detect CMV-PCR as soon as possible, we should not consider whether there are problems associated with other viral infections till the failure of antibiotics and anti-TB treatment. It is worth further evaluation!’

Examples (312) and (313) are references to limitations of method. These two examples are

extracted from the same article which is a case report of severe Military Tuberculosis co- infected with Cytomegalovirus infection. Due to the scarcity of literature review concerning the co-infection of Military Tuberculosis and CMV infection, the writers were unable to save the patient’s life. In view of this, they publish this article to claim the possibility of co- infection of these two diseases. In scientific writing, “presenting claims as ex-cathedra assertions displays an unacceptable deviant persona since it ignores any involvement by the reader in the ratification of knowledge” (Hyland 1998: 178). In addition, writers need to be aware of possible oppositions from other researchers. In (312) and (313), the interrogatives are then utilized to engage readers in this difficult-to-treat case and make their assertions less categorical. The reader-oriented use of hedges enables the writers to represent their findings with tentativeness and cautiousness and simultaneously show deference to the medical

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community.

By analyzing radiologists’ reactions to uncertainty in mammography interpretation,

Carney et al. (2007) conclude that “No study is without limitations” (p. 240). For example,

the writers indicate that with a representative sample of radiologists practicing in three distinct regions of the United States allow them to generalize to other radiologists in these regions but not to radiologists around the whole country. Referring to limitations of the speakers’/writers’ cognition, shortcomings of other researches quoted in the study, or limitations of the current study, the speakers/writers are able to modify their commitment to what is being stated. This strategy allows the speakers/writers to intentionally mitigate their arguments and claims so as to avoid potential opposition and criticism since there are always alternative viewpoints, probability reasoning, doubts, and uncertainty in clinical practices. As comparing addressing limitations in terms of genre, my results show that the writers utilize this device more frequently than the speakers, with a total 122 occurrences (25.12%) in speaking and 60 occurrences (4.22%) in writing. Nine types of limitation are observed to be shared by both genres including limitation on experimental sources, limitations to the physicians’ uncertainty towards clinical experiments and indeterminate variables, limitation to unverified result, limitations to the speakers’/writers’ tentative suggestions and modesty,

limitations to lack of evidence and probable reasoning. The four types of limitations

identified exclusively in the spoken data are limitations to the speaker’s limited knowledge,

memory processing, future expectation, and subjective judgment. The four exclusive types of

limitations found in the written data are limitations referring to contraindication, controversial

arguments, necessity for further evidence, and limitation of method.

4.4.4 Summary

Non-lexical hedges found in my corpus consists of conditionality, rhetorical questions,

and addressing limitations, and they occupy a certain position in medical communication.

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Non-lexical hedges account for 17.69% in the spoken data and 7.76% in the written

discourse, which indicate that speakers tend to utilize more non-lexical hedging devices to express their less than full commitment towards the propositions than writers. The application of these three non-lexical hedging strategies varies in terms of genres. Conditionality and rhetorical questions are applied more in the speaking, whereas addressing limitations are employed more in the writing. The discrepancies concerning the application of these three different non-lexical hedges between genres are statistically significant. Genre difference is assumed to be the reason that gives rise to this discrepancy. Conditionals (60.83%) make up more than half of the total non-lexical hedges in speaking, and they constitute 39.17% in writing. Part of the reason that conditionality is applied in a certain amount in both genres is presumably analogous to the alternative sense that hedging adverb 或 ‘alternatively’ possesses. As proposed earlier, huo 或 ‘alternatively’ is the most frequently used hedging adverbs in my medical written corpus, which allow writers to convey their uncertainty, estimation, or prediction to the potential probabilities of medical-related situations.

Conditionals seem to hold the similar functions. In conditionals, the consequence (apodosis) is considered as a speculative state of affairs since its value is depending on a hypothetical condition (protasis). The results of my data show that the speakers and writers make use not only single words (e.g. 如果 ruoguo ‘if’, 若 ruo ‘if’) but also phrases to build if-clauses, such as ruoguo…dehua 如果…的話 ‘if’, ruguo..deshihou 如果…的時候, and yidan…shi

一旦…時 ‘in case’. However, the speakers seem to prefer disyllabic ruguo 如果 ‘if’, while the writers favor the monosyllabic ruo 若 ‘if’. It is also observed that in medical setting sometimes the positive result for a hypothetical condition may result in certain outcome, while the negative result of the same condition may lead to another consequence. Also, sometimes there are chain consequences resulting from the fulfillment of several hypothetical conditions. Based on the context, 9 communicative purposes represented by conditionals are

272 shared by both genres, where 4 other functions are identified in either genre respectively. The functions observed in both genres are mainly used for the speakers/writers to hypothesize, to make suggestion, to predict possible outcome, to establish facticity in medical experiment, to detail the precise conditions under which experiments conducted, and to call for audiences’/readers’ attention. The interactional functions, such as making humble invitation and announcing potential future actions only observed in the speaking.

Rhetorical questions are overwhelmingly used in the spoken discourse (94.61%, with

877 occurrences), whereas they only occupy 5.39% (50 occurrences) in the written discourse.

The tremendous discrepancy may be due to genre difference. Evoking audiences’ attention accounts for the main purpose in the face-to-face communication as rhetorical questions are rather employed to engage the audience on certain situations or viewpoints. Four types of question forms are identified in my corpus, namely wh-questions, yes-no questions, tag questions, and disjunctive questions. Wh-questions are the most common question type used in both genres, yet tag questions are not found in the writing. The absence of co-present participants in the written discourse may lead to the absence of tag questions. There are 5 shared communicative purposes identified in both genres. The speakers/writers tend to employ rhetorical questions to provide a framework to the following discussion, to create participant involvement, to attract the audiences’/writers’ attention on important issues, and to anticipate the audiences’/writers’ doubts. Based on different communicative circumstances,

9 other functions are observed exclusively in the face-to-face interaction, which principally serve to create audience involvement, such as directing the audiences’ attention towards the slides, sharing jokes, making polite invitations, and seeking for reconfirmation.

Addressing weaknesses on experimental source, method, or theory used or on the researcher’s inadequate knowledge allow the speakers/writers to distance themselves from full commitment towards the experimental results. The results of my data show that

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addressing limitations is a common hedging strategy used by medical professionals,

especially in RAs. The references of addressing limitations observed in the present study not only refer to the limitations of a study in question but also the limitations on other researches quoted in the current study and the speakers’/writers’ cognitive limitations. Medical specialists make use of this strategy to mitigate their propositions, to express tentativeness and cautiousness, and to show solidarity to the medical community. Expressions for addressing limitations are found to appear a lot more in the writing than speaking (25.15% versus 4.22%). There are 9 types of references of addressing limitations shared by both genres, which mainly employed to indicate uncertainty on clinical judgments and address the limitation on the insufficiency of current evidences, while 4 types of references are identified in each genre. Those exclusive types demonstrate distinct communicative purposes in accordance with genres. They are essentially associated with subjective reasoning in the speaking, including limitations referring to the speaker’s state of knowledge, cognitive limitation at the moment of speech, and personal expectation and judgment. References found in the written discourse are mainly related to objective factors, such as indicating possible contraindication, controversial arguments, or the necessity for further evidence. Addressing the shortcomings of the current study, limitations found in the quoted studies, or speakers’/writers’ cognitive limitations enable speakers/writers to mitigate their arguments and claims as well as to avoid potential criticism from other researches.

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CHAPTER FIVE CONCLUSION

In this study, I investigated hedging phenomena in a Taiwanese medical setting, attempting to see how hedging devices are employed by Taiwanese medical specialists.

Hedges used in two symmetrical genres were examined, with peer lectures as the spoken data

and research articles as the written data. To my knowledge, Chinese hedges in academic

spoken discourse have gained no attention so far, and there is no study comparing the use of

hedges in terms of genres, especially in the specialist-to-specialist communication. In medical

profession, uncertainty is the core issue that physicians have to deal with at all time, and the

linguistic expressions of hedges serve as means for the physicians to express their

uncertainty. In the present study, I explored the questions as to (1) What linguistic devices are

used as hedges in the medical profession in terms of genres? What are their frequencies and distributions? (2) What functions do the hedging devices serve in the spoken and written medical discourse? (3) What are the differences in the use of hedges between the spoken and written medical discourse? (4) Are there any differences in the use of hedges between

Chinese spoken medical discourse and Chinese daily conversation? If yes, what are they? (5)

Are there any differences between Chinese written medical discourse and other written

disciplines? If yes, what are they? Ten speeches, which amount to 12 hours and 13 minutes,

constitute the spoken data, while 40 Chinese research articles from two leading medical journals in Taiwan make up the written data.

The findings in answering to those five research questions are summarized as follows.

1. What linguistic devices are used as hedges in the medical profession in terms of genres?

What are their frequencies and distributions?

The results of my databank show that the medical professionals make use of various hedging strategies to modify their commitment towards the propositions being stated. Those hedging devices are classified into modal auxiliaries, lexical hedges, and non-lexical hedges.

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In my spoken and written corpuses, five different modal auxiliaries, keneng 可能 ‘may’,

keyi 可以 ‘can’, hui 會 ‘will/may’, yinggai 應該 ‘should’, and nenggou 能夠 ‘can’, are identified. Overall, modal auxiliaries are employed more in the speaking than writing, and the difference displays a statistical significance. Among those five auxiliaries, hui 會 ‘will/may’

(44.22%, with 707 occurrences) is used the most frequently by the speakers, whereas keyi 可

以 ‘can’ (29.16%, with 326 occurrences) is the most common auxiliary used by the writers.

Nenggou 能夠 ‘can’ occur the least in both genres. Lexical hedges are composed of verbs,

adverbs, adjectives, and nouns. The results of my data show that lexical hedges are

overwhelmingly employed by medical specialists to hedge their statements, which confirm

the findings in the literature (Lyons 1977, Perkins 1983, Coats 1983, 1987, 1995, Markkanen

1985, Stubbs 1986, Palmer 1986, 1987, 1990, Thompson 1993, Hyland 1998, 2000). Among

those lexical categories, adverbs are used the most frequently in both genres (35.84%, with

2,885 occurrences in speaking and 37.02%, with 2,311 occurrences in writing). The great

majority of adverbs occurrences are presumably due to the specific syntactic and semantic

features that adverbs own (Perkins 1983, Hyland 1998, Varttala 2001, Chen 2008, Lo 2010)

as they can appear in various positions in a clause and they can represent multiple concepts.

In the spoken discourse, nouns are the second most common lexical hedges, and followed by

verbs, whereas these two categories rank the opposite order in writing, with verbs the second

most frequent lexical hedges, followed by nouns. Epistemic verbs are observed to be another

common means for speakers/writers to hedge their commitment, which is presumably

because hedging verbs are seen to the most transparent means to code the subjectivity of the

epistemic source (Hyland 1998). Epistemic nouns is another common lexical hedge used in

the medical discourse, which appear more in the writing than the speaking (14.80% vs.

8.93%). Adjectives are the least used lexical hedges in both genres. While comparing the

application of each lexical hedge between both genres, it is found that the usage of verbs and

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adverbs do not show statistical significance, while there are significant correlations observed

in adjectives and nouns. Non-lexical hedges consist of three categories, namely

conditionality, rhetorical questions, are addressing limitations. Overall, this type of hedges is

utilized more in speaking than writing, with 17.69% versus 7.76%; however, the employment of these three non-lexical hedging strategies varies by means of genres. Conditionality and rhetorical questions are used more in the spoken discourse, while addressing limitations occur more in the written discourse. The statistic results concerning the application of each non- lexical category between both genres are significant.

2. What functions do the hedging devices serve in the spoken and written medical discourse?

The notion of hedging is essentially vague, and the functions conveyed by hedges vary in accordance with genres, disciplines, and communicative circumstances. It is observed that hedges manifest their polypragmatic functions in the present study: one single hedge may serve different communicative purposes and an individual function may be fulfilled by different hedges. Chinese medical professionals frequently employ various types of hedges to deliver different communicative purposes depending on situations. The results of my data show that hedging expressions in each hedging device convey different functions. Some of the functions may be shared by both genres, whereas some are observed exclusively in either one. Modal auxiliaries are mainly used to express epistemic uncertainty or probability, which enable speakers/writers to convey their subjective attitudes or feelings towards the propositions being stated. Auxiliaries are also utilized to make polite and tentative invitations, but these two functions are exclusively observed in the spoken discourse. Hedging verbs are common means employed frequently by medical specialists to hedge their statements, which are mainly classified into judgmental verbs and evidential verbs. Judgmental verbs enable speakers/writers to express subjective evaluations, judgments, or belief, to present their suggestions and recommendations, or to tentatively draw possible parallelism of events or

277 situation. Evidential verbs are used by speakers/writers to elicit the origins of sources for their evidentiary justification. The evidence may derive from the speakers’/writers’ subjective perceptions, hearsay evidence, or findings from research literature. Adverbs are the most frequent lexical hedges utilized by the medical professionals regardless of genres, and they are used to convey a variety of functions. Hedging adverbs can be used to express the speakers’/writers’ subjective viewpoints, judgments, or the degrees of commitment; they can be employed to indicate various degrees of epistemic qualification or quantification or to signal the indefinite frequency of events; they are also found to hedge the information which is uncertain, unobtainable, or unnecessary to give. The functions of hedging adjectives are similar to their corresponding adverbs. Hedging adjectives are used to convey speakers’/writers’ subjective assessments or degree of commitments to the propositions based on professional knowledge or experimental results; they are sometimes employed to reduce the degree of definiteness of what is being; they are also found to hedge quality instead of quantity. In medical discourse, hedging adjectives are predominately utilized to modify their following nouns with various degrees of uncertainty or inaccuracy. Hedging nouns identified in medical communication are mostly the nominal forms of their corresponding verbs and adjectives. They are used to convey the speakers’/writers’ tentativeness and uncertainty towards the truthfulness of propositions. The majority of hedging nouns is applied when the medical specialists are uncertain about the precision of the quantity since medical numerical figures are normally circumscribed within a range. Question words are another commonly used hedging nouns, especially in the face-to-face interaction, which can be used to refer to indefinite entities. The application of if-conditionals is closely related to the notions of indefiniteness and uncertainty in medical setting. Conditionals allow physicians to make deductions, predictions, and suggestions, to provide supportive examples and alternative treatments, to present warnings for potential upcoming problems, or to call for

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audiences’/readers’ attention to certain medical issues. Rhetorical questions are normally

utilized to circumscribe a framework for the following discussion, to create participant involvement, to attract the audiences’/writers’ attention on important issues, or to anticipate the hearers’/writers’ doubts. In short, participant involvement is the main concern for the application of rhetorical questions. The references for addressing limitations are utilized by medical professionals to mitigate their arguments or findings, to express tentativeness and cautiousness to their statements, and to present solidarity to the medical community.

3. What are the differences in the use of hedges between the spoken and written medical

discourse?

In medical communication, there are differences observed in the use of hedges between

genres. According to Table 6, the statistical results show that the significance regarding the

application of hedging devices varies in terms of genres. Speakers tend to use more modal

auxiliaries, conditionality, and rhetorical questions to hedge their propositions than writers,

whereas writers employ more adjectives, nouns, and addressing limitations to mitigate their

commitment than speakers. The results are significant statistically. However, the statistics do

not show significance in the application on verbs and adverbs, which imply that the

frequency for speakers to apply hedging verbs or adverbs does not differ much from that by writers. Some differences are also identified in each hedging category in accordance with

genres. Among the five identified auxiliaries, hui 會 ‘will/may’ is utilized the most

frequently in the spoken discourse, whereas keyi 可以‘can’ is used the most frequently in the written discourse. In addition, the speakers generally apply disyllabic auxiliaries, such as keyi

可以 and yigai 應該, whereas the writers favor the monosyllabic ones, such as ke 可 and yin

應. Keneng 可能 ‘may’ demonstrates two functions, to show politeness and to make

tentative invitations, which only observed in the spoken data; keyi 可以 ‘can’ is exclusively

used by the speakers to make polite invitations; one function conveyed by hui 會 ‘will/may’

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is to announce in advance the upcoming topics for later discussion or actions that will be

accomplished in the future, which occurs only in writing. Yinggai 應該 ‘should’ display two

functions, to make conjectures and to make predictions, which occur solely in the spoken

data. As to nenggou 能夠 ‘can’, it can be used to make suggestions, and this function is exclusively identified in the written discourse. In the category of adverbs, a greater variety of forms are employed in the speaking than writing. Stance adverbs are observed to occur more in the spoken than written data. Also, monosyllabic adverbs seem to be favored by writers. In hedging verbs, the main difference lies in the employment of evidential verbs which include quotative verbs and sensory verbs. Sensory verbs are predominately utilized by speakers, whereas quotative verbs are used overwhelmingly by writers. The difference is presumably due to genre difference as writers rely heavily on hearsay evidence and research findings in literature to support their arguments while speakers inevitably adhere to conversational hedges to convey their attitude or feelings towards the utterances. Although the meanings and functions conveyed by hedging adjectives are analogous with their corresponding adverbs, the distributions of their subcategories differ. Stance adverbs occupy the biggest proportion among various types of adverbs, whereas adjectives of indefinite frequency constitute the great majority in adjectives. The difference implies that speakers/writers make good use of adverbs to express their subjective attitude but employ adjectives to modify their propositions with various degrees of uncertainty. Epistemic nouns are employed more in writing than in speaking (14.80% vs. 8.93%). Various subcategories of nouns are identified in my corpus, and question words are used the most by the speakers, while nouns of approximation are predominately utilized by the writers. Question words are used substantially more in speaking than writing (35.33% vs. 5.52%) since they are essentially conversational, which involving the senses of referentiality and interactivity; approximative nouns are frequently applied by writers to show their uncertainty on numerical figures or to provide a possible range for

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medical-related items. In addition to modal auxiliaries and lexical hedges, differences are also

found in those non-lexical hedges. In conditionality, three communicative purposes are identified exclusively in the spoken discourse, which enable the speakers to circumscribe the scope of the following talks, to announce potential future actions, and to pose polite

invitations to the audience, whereas three other functions are observed exclusively in the

written discourse, which enable the writers to demonstrate a close cause-effect relationship

between the protasis and the protasis, to make subjective categorization, and to provide

information for the readers’ reference. Rhetorical questions are employed a lot more in speaking than in writing (94.61% vs. 5.39%), and genre difference accounts for the discrepancy. Speakers overwhelmingly use more wh-questions (65.34%), while writers utilize more both wh-questions and yes-no questions. There is no tag questions found in the written discourse, which may be owing to the absence of co-present participants in writing. The functions which are not observed in the written discourse include those used to introduce new

policies and current heeds, to foreshadow later topics, to direct the audiences’ attention to the

slides, to quote reported questions, to express sense of humor, to make polite invitations, to

offer tentative suggestions, to express sarcasm, and to seek for confirmation. Addressing

limitations is a prevalent hedging device employed by the medical professionals, and they are

found to appear more in the writing than speaking (25.15% vs. 4.22%). Four types of

limitations are identified exclusively in the spoken data, which are limitations to the speaker’s

limited knowledge, cognitive memory processing, future expectation, and subjective

judgment, while the other four types observed in the written data are limitations referring to

medical contraindication, controversial arguments, necessity for extra evidence, and

limitation of method.

4. Are there any differences in the use of hedges between Chinese spoken medical discourse

and Chinese daily conversation? If yes, what are they?

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For this question, the results found in Chen’s (2008) conversational data will be used to compare with my spoken data. In Chen’s data, the question word sheme 什麼 ‘what’ is employed the most frequently among all the lexical hedges, whereas in my spoken data, the modal auxiliary hui 會 ‘will/may’ occur the most. As sheme 什麼 ‘what’ can be used to denote any indefinite entity, speakers in conversation deliberately utilize it to convey their uncertainty towards utterances. Furthermore, the referential indefiniteness of question words is used to indicate that speakers are unable to find appropriate words for description. Hui 會

‘will/may’ has a subjective reading, and it is usually used to refer to probability or possibility of future events. In the medical spoken discourse, hui 會 ‘will/may’ is typically employed by speakers to express epistemic probability, to make predictions, to anticipate the audiences’ doubts, to convey expectations, or to announce in advance the topics which will be discussed later or actions that may be put into practice in the future. Among various auxiliaries, keneng

可能 is the most common auxiliary used in daily conversation, which is exploited to show the speakers’ predictions or deductions. In medical setting, the most frequent auxiliary is hui

會 ‘will/may’. In Chen’s conversation data, the duplicated form xiaoxiaode 小小的 ‘small’ serve as a hedging adjective to minimize the extent of the effect described by the proposition.

Chen does not establish an individual category for hedging adjectives in her study. In my spoken discourse, adjectives constitute 6.01% (484 occurrences) of all hedging devices, and they are typically to modify the following nouns as tentative, indefinite, and imprecise. As to the category of nouns, in conversation 95% of hedging nouns are found to be question words, and the rest are nominal forms of lexical verbs. In medical discourse, although question words (35.33%) occupy the biggest proportion of lexical nouns, approximative nouns

(28.93%) and judgmental nouns (20.86%) are also widely employed by speakers. According to Chen, the exploitation of hedges is pragmatically motived by subjectivity and intersubjectivity in naturally occurring talk-in-interaction. In medical communication,

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subjectivity and intersubjectivity also play important roles; however, uncertainty, the inherent

feature in medical setting, constantly affects the application of hedges.

5. Are there any differences between Chinese written medical discourse and other written

disciplines? If yes, what are they?

For this question, Lo’s (2010) academic study in Chinese is used to make a comparison

with my written medical discourse. In Lo’s academic written texts, adverbs are used the most

frequently, followed by auxiliaries, and then verbs, and the tendency holds true for all three

disciplines (History & Literature, Business, and Biology). In my written data, adverbs and

auxiliaries are the first and second most frequent hedging devices, but hedging nouns rank the

third place instead of lexical verbs. In academic writing, modal auxiliaries keneng 可能

‘may’, yingai 應該 ‘should’, and keyi 可以 ‘can’ are the most frequently used hedges,

whereas in medical writing, the hedging adverb huo 或 ‘alternatively’ and jiao 較

‘relatively’, and the auxiliary keneg 可能 ‘may’ occur the most. Academic writers tend to

employ a great amount of auxiliaries to express their evaluation of the possibility or

probability of their statements based on their subjective judgments or available information,

while medical writers use not only the auxiliary keneg 可能 ‘may’ but also adverbs to hedge

their statements. The adverb of indefinite degree jiao 較 ‘relatively’ is used by medical

specialists to modify the degrees of qualification and quantification. The hedging adverb huo

或 ‘alternatively’ and its different variables (e.g. huoshi 或是, huozhe 或者, huozheshi 或

者是, haishi 還是) make up the majority of hedging devices, which are used to present potential alternatives commonly seen in medical discourse. Both Lo’s and my studies share the same classification in adverbs, and it is interesting to note that the application of hedging adverbs of my medical writing confirms with history & literature but not biology since both biology and medicine belong to scientific field. Adjectives have the identical classification

with adverbs. In medical writing, adjectives of indefinite frequency occupy the biggest

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proportion of all hedging adjective, which is borne out by Lo’s history & literature. In

business, stance adjectives are used the most, whereas it is the adjectives of indefinite degree

employed the most in biology. The medical writers use 4.69% of approximative adjectives,

while they are totally absent in business and biology. With regard to the subcategory of

nouns, the majority of hedging nouns are realized as judgmental nouns in all three disciplines,

whereas approximative nouns (58.33%) make up more than half of all hedging nouns.

Suggestions for further studies

During the investigation and analysis of my spoken corpus, there were a number of

interesting and noteworthy aspects which I believe deserve further research. First, research on

hedging strategies utilized by female physicians would be worthwhile because it has been

argued that women’s speech differs from men’s in a variety of ways (Lakoff 1975, Tannen

1980, 1986, 1989, 1993, 1994, Holmes 1984, 1988, 1990). All the lecturers in my spoken

corpus are all male physicians; therefore, it may be noteworthy to explore whether the use of

hedges differ in terms of gender. Second, hedging strategies employed by the speakers while

facing their outpatients can be used to compare with hedges identified in their lectures. It may

yield different results when comparing the hedging devices utilized by the same physician in

different settings, such as between specialist-to-specialist interaction and doctor-patient

discourse. Third, as suggested by Dr. Li in the interview, he declares that physicians (內科醫

師) and surgeons (外科醫師) explain things differently under medical setting. Physicians

tend to explicate diagnose or treatments less direct, whereas surgeons comment on patients’

conditions more straightforward. The interviewee argues that there are always possible

indefinite factors leading to certain illness, so physician usually cannot give patients determinate answers. For a surgeon, such as an orthopedist, he is able to tell the patient what

he would do for the broken leg shown on the X-ray film. Therefore, presumably physicians

tend to use more hedging strategies than surgeons.

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In the literature, a great deal of studies have focused exploring hedging phenomena on

medical RAs. Although medical spoken discourse has started to gain certain attention, most

researchers aim at examining the use of hedges in doctor-patients communication. Medicine is strongly associated with the lives of human beings; people sincerely concern about doctors’

diagnoses and their suggestive treatment. The way that medical specialists communicate with

each other seems to be mysterious and out of reach for ordinary people. In this study, I tried

to explore the hedging phenomenon realized in the interaction among medical professionals

in Taiwan. The present study is a starting point for the analysis of physician-to-physician

communication from the aspect of hedging application. It is observed that the hedging

phenomenon is ubiquitous in medical setting, and medical professionals make great use of

hedging strategies to express their uncertainty as uncertainty is clinically common. I hope this

research will contribute to the understanding of hedges in Taiwan’s medical setting, and

meanwhile draw some attention on the above suggestions for further studies.

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