‘Presenting Complaints’

Abstract

This paper examines an aspect of speech and language therapy practice that has not been studied extensively: published exemplars of professional report writing for speech and lan-guage therapists (SLTs), both in training and in practice. The research question addressed in this qualitative study is: ‘How are clients’ speech, language, communication, and feeding eating, drinking and swallowing (FEDS) abilities evaluated in diagnostic report writing exemplars? Specifically, the data consists of sample reports from the speech and language therapy educational literature, that is, texts that aim to demonstrate ‘best practice’ in relation to ‘professional’ report writing. Drawing on Critical Discourse Analysis and Systemic Functional Linguistics, the study uses Appraisal Analysis to examine naturalised representations of clients in eighteen sample diagnostic reports. The findings show that the predominant form of evaluation of clients is negative appreciation, as evidenced by lexical choices including terms such as deficits, disorder, difficulties, and adequate, within normal limits, within functional limits. The emphasis in the report exemplars is primarily on problems or presenting complaints/concerns. Positive appreciation lexical items tend to have weak positive valence built into their semantic features. For instance, the strongest positive appreciation can be found in lexical items such as adequate, within normal limits, within functional limits, etc. An additional form of positive appreciation is expressed in the absence of a problem (e.g. There appeared to be no deficit with comprehension of concrete information). Positive evaluations of client communicative competency were not identified in the reports. Inclusion of affect or emotion was rare in the data set. Occasional instances of judgements were identified in the data. The focus of this paper is on appreciation in particular. This aspect of evaluation in the report exemplars results in reports in which the client’s communicative competence and perspectives on his/her communication are excluded. The implications for the profession are discussed and alternative evaluation options which retain the same underlying meanings are explored. This paper contributes originality to the field by exploring an under-researched aspect of professional speech and language therapy practice which has applications for many healthcare professionals both in clinical practice and in clinical education.