76 Book reviews
Good practice: Communication by nine units that aim to develop language and
skills in English for the medical
practitioner
McCullagh, M., & Wright, R. (2008).
Cambridge: Cambridge University Press.
Reviewed by Rosemary Wette
This very useful addition to the English for
Specific Purposes literature on English for
medical professionals comprises four items: a
student’s book, a teacher’s book, two audio CDs
and a DVD. It is grounded in two commonly
accepted healthcare principles. The first is
the need for effective communication; as the
Director of Clinical Training at the Auckland
District Health Board recently pointed out,
‘85% of doctoring is communication’ (Johnston
2008). The second is that quality care requires
an approach to communication that takes into
account the patient’s perspective and perceptions
of the presenting complaint (Silverman, Kurtz
and Draper 2005). While Good practice shares
the first precept with other recently published
books on communication in medical contexts (eg
Glendinning and Holström 2005; Glendinning
and Howard 2007), the second is more in evidence
in this text than in any of the others. Two groups
of medical professionals are potential users of
Good practice: medical students or recent graduates
who are learning English at the same time as
they are developing their knowledge of medicine,
and qualified, experienced immigrant doctors.
While accessible to both groups, this book caters
specifically to the needs of the latter and assumes a
good knowledge of medicine. It would be suitable
both for self-study and classroom-based teaching.
Good practice is divided into three main sections.
Book reviews
The first provides a brief introduction to the
five basic components of communication in the
medical context: verbal communication, voice
management, non-verbal communication, active
listening and cultural awareness. Like the rest of
the book, it focuses clearly on communication
and brief linguistic explanations are kept free of
specialised terms. The opening section is followed
communication skills for the various stages of
the doctor–patient interview, from initiating
the consultation through the information-
gathering phases (presenting complaint, histories
and examination) to giving and explaining the
diagnosis, planning treatment and closing the
interview. The final two units in this section explain
how to deal with sensitive issues and how to break
bad news to the patient. The third and final section
of the book is again quite short, comprising three
units on communicating with challenging patients,
the elderly, children and adolescents.
The student’s book incorporates a number of
innovative features, including:
• short Think about tasks asking the student to
reflect, activate prior knowledge or self-evaluate
strengths and weaknesses
• Patient speak boxes listing colloquial and lay-
medical terms
• short quotations from experts in medical
communication skills illuminating aspects of
the unit topic
• Cultural awareness boxes explaining Western
cultural norms and asking students to reflect
on and discuss practices in their own cultures
• Communication skills boxes pointing out
appropriate strategies
• Out & about boxes requiring observation and
reflection in healthcare contexts that students
may be working in
• Likert scales at the end of each unit for students
to evaluate their progress.
Some of these features form part of the sequence
of tasks in each chapter, while others appear in
small coloured boxes in broad side margins. The
use of different coloured boxes, prints and fonts
for each type of feature makes each one readily
identifiable: in a book at this advanced level, the
variety of content available on each page seems to
me quite acceptable.
Role play cue cards, answers and tape scripts
2008 Volume 23 No 2
 77 for the two audio CDs are located at the back of
the student’s book. The teacher’s book provides
teaching notes and a task-by-task answer key,
additional language notes and recommended
reading for the teacher on aspects of patient-
centred communication skills, as well as authentic,
photocopiable one-page or two-page articles
from medical journals and textbooks to promote
further discussion on the theme of the unit. The
fourth item in the set of materials is a DVD of
authentic-type consultations showing the five
phases of the medical interview (eg presenting
complaint, planning treatment, breaking bad news).
There are also interviews with two different patient
categories: challenging patients and children.
Compared to other English for medical
professionals texts, Good practice has a number
of valuable strengths, including the inclusion of
information on many aspects of patient-centred
care and the opportunities it provides for students
to learn key communicative skills. While the
spoken dialogues that accompany the book are
briefer, and more bland and straightforward, than
their unscripted equivalents, they are simulated
authentic in that they incorporate:
• different types of requests (eg If you don’t mind,
I’ll take a few notes/We’ll come back and talk about
the arthritis later, if that’s okay with you)
• questions (eg I wonder if you could tell me in your
own words what’s been happening/And your joints –
you’re not suffering from achy joints?)
• phrasal verbs (eg My arthritis has been playing me
up/It flares up every so often)
• lay-medical language commonly used in
healthcare contexts (eg I’ve been having these hot
spells/OK, I’ll give it a go).
A variety of accents including regional British,
Australian, American and some non-native speaker
voices are represented. The five longer DVD
Book reviews
consultations, while still smoothly fluent, are
not so thoroughly scripted and therefore sound
more authentic. The aim in both audio and DVD
texts is clearly to achieve a balance between
authenticity and comprehensibility for teaching
purposes. However, teachers will need to point
out to students that, in these somewhat sanitised
models, elements of actual discourse such as pauses,
hesitations, false starts, grammatical errors and
general imprecision have been minimised. The
often quite distressed, fearful, confused, depressed
and angry emotional states of the patients often
found in real medical interviews have also been
suppressed.
I strongly recommend this book, with the proviso
that there is still something of a gap between the
discourse of Good practice and the sophistication and
subtlety of the language overseas-trained doctors
need to master for the oral component of their
professional exams (Wette and Basturkmen 2006).
It would be suitable for doctors approaching or
already at the level of English language proficiency
(IELTS 7.5 for New Zealand, OET Grade B or
IELTS 7.0 for Australia) required for re-registration.
References
Glendinning, E. H., & Holström, B.A. (2005).
English in medicine (3rd ed.). Cambridge:
Cambridge University Press.
Glendinning, E. H., & Howard, R. (2007).
Professional English in use: Medicine. Cambridge:
Cambridge University Press.
Johnston, M. (2008, May 31). Doctors aim to
translate qualifications. The New Zealand
Herald. Retrieved June 7, 2008 from http://
www.nzherald.co.nz/topic/story.cfm?c_
id=186&objectid=10513568&pnum=0
Silverman, J. D., Kurtz, S. M., & Draper, J. (2005).
Skills for communicating with patients (2nd ed.).
Oxford: Radcliffe Medical Press.
Wette, R., & Basturkmen, H. (2006).
Two perspectives on the language difficulties
of overseas trained doctors: Evidence from role
plays. New Zealand Studies in Applied Linguistics,
12(2), 64–77.
2008 Volume 23 No 2
 78 Communication across cultures:
Mutual understanding in a global
world
Bowe, H., & Martin, K. (2007). Cambridge:
Cambridge University Press.
Reviewed by Denise Gassner
Communication across cultures is an academic
reference for undergraduate and graduate students.
It is also intended for use by interdisciplinary
researchers with no specialised knowledge of
linguistics. The research areas touched on in
this book are pragmatics, discourse analysis,
politeness and intercultural communication.
Materials included in this book have been used as
a resource by one of the authors (Bowe) for the
past ten years in her teaching of these subjects at
Monash University in Melbourne and at Monash
University campuses in Malaysia and South Africa.
The book consists of 11 chapters. Each chapter
covers a key topic of current interest in the field of
intercultural communication. The main critiques
that have been put forward by researchers on some
of the theories explored in the book are presented,
as are recent studies in several areas. The research
presented here covers work done internationally, as
well as studies conducted in Australia. This makes
the book relevant to both the international student
studying in Australia and local students alike. Each
chapter ends with a concise summary of the topics
discussed in the chapter and an extensive review
section. The latter consists of a list of important key
terms used in individual chapters (eg speech acts),
key ideas (what one should know after having read
a chapter), focus questions suggesting hands-on
tasks using the newly acquired knowledge, research
analysis tasks, and a research exercise, and ends with
some suggestions for further reading.
The first chapter introduces the term culture
and traces its development from its earliest uses
Book reviews
to how it is used today. This serves as a good
introduction to the underlying theme of this
book, and the topics discussed in more detail in
the following chapters are presented briefly. In the
second chapter, the authors provide an overview
of the research on speech acts by Austin (1962,
1970), Searle (1969) and Grice (1975). Austin’s
(1962) paper How to do things with words outlines
his work on ‘communicative intent, form and
effects of utterances’ (p 9) and is the basis for
much research. Grice (1975) is well known for his
work on the expectations adult English speakers
have of conversations. He claims that the four
maxims of quantity, quality, relevance and manner
govern expectations on language and resulting
interpretations. These four maxims are tied
together by a general principle, the cooperative
principle. The critique of Grice’s work for its
Anglocentric approach is also discussed in this
chapter, and Sperber and Wilson’s (1986) relevance
theory is suggested as a possible alternative
approach. In relevance theory, the four Gricean
maxims are reduced to one super-maxim, the
maxim of relevance. This theory claims relevance
to be the key in determining how inferences are
drawn in conversations. The work of the Australian
researcher Clyne (1994) is also presented in this
chapter. He proposed a revision of the Gricean
maxims for intercultural communication.
Chapter 3 introduces Brown and Levinson’s
(1978) theory of politeness phenomena. Face,
face-threatening acts and politeness strategies are the
three basic notions of this major approach.
The authors also discuss a key problem that they
see with this model. It is generally thought that the
model was principally concerned with strategies in
the context of face-threatening acts but interaction
does not only consist of such acts. The concept
of face is derived from Goffman’s work (1955,
1967) and the general English perception of ‘being
embarrassed or humiliated’ (p 27). Other approaches
to politeness are discussed; for instance, Wierzbicka
(1972, 1985, 1991, 2003) describes the meaning of
words and illocutionary acts using lexical primitives.
Cultural scripts (Wierzbicka 1994) is the term she
introduced to refer to her technique of describing
cultural norms using natural semantic metalanguage.
Recent approaches in cognitive linguistics explain
how cultural schemas are represented in an
individual’s knowledge. Sharifian’s (2004) work in
cognitive linguistics, on the representation of culture,
is also introduced in this chapter. In his work he
shows how a cultural schema like sharmandegi (being
ashamed) is evident in a number of speech acts in
the Persian language (Farsi).
Chapter 4 focuses on speech acts across cultures.
Research on requests, complaints, apologies and
the acceptance of an apology is presented and the
2008 Volume 23 No 2
 79 work of the Cross-Cultural Speech Act Realisation
Patterns project (Blum-Kulka, House and Kasper
1989) is introduced. This major study looked at
speech act realisations in eight different languages.
Australian research comparing apologies in Australian
English with apologies in Malaysian-Chinese and
apologies in central European languages also feature
in this chapter. Furthermore, recent research on
the gender factor in relation to politeness across
cultures is discussed. Hobbs (2003), for instance,
found that the use of positive politeness did not
appear to be related to status or gender but, rather,
to the role an individual enacts in an interaction.
The authors conclude by quoting Smith’s (1992:
57) research, which claims that it is too simplistic to
say that women are more polite than men, since a
‘multistrategy phenomenon is at work’.
In Chapter 5 the analysis of conversation
introduces the work of Schlegloff (1968) on
conversational openings and the work of Sacks,
Schlegloff and Jefferson (1974) on the turn-taking
system in conversations. Sacks, Schlegloff and
Jefferson (1974) found that most conversations
consist of pairs of utterances, which they call
adjacency pairs. Adjacency pairs are composed of two
parts that have several characteristics. One crucial
feature is that the first part of an adjacency pair
requires the second part of the pair to be uttered.
The different topics explored in this chapter
include greetings and leave-takings, turn-taking
across cultures, repetition as back-channelling in
intercultural communication, functions of laughter,
joking and conversational routines. Research work
on European languages such as Italian and French,
as well as Asian languages, Mexican Spanish,
Australian and American English, is discussed.
Chapter 6 introduces the topics of power
relations in interactions and stereotyping. Hofstede’s
study (1980, 1983, 1991, 1998) on national cultural
differences is introduced and a critique of the
Western bias of this model and the value judgment
in its terminology is presented. However, Hofstede’s
Book reviews
model has been useful in explaining the influence
on power relations of social, cultural, political and
economic factors. The second part of this chapter
explores different studies on stereotyping. Scollon
and Scollon (2001: 87) describe stereotyping as
‘the process by which all members of a group are
asserted to have characteristics attributed to the
whole group’. According to Tajfel (1982), people
tend to categorise themselves positively as the in-
group (at the centre) and others negatively as the
out-group (outside) in order to create pride and
self-esteem.
Naming and addressing is the focus of Chapter
7. Brown and Gilman’s (1960) T–V distinction is
introduced. The symbol T stands for tu (Latin),
the symbol V for vos (Latin). These symbols are
used to differentiate the familiar (T) and the polite
(V) pronouns in a language. Recent changes in
the languages, where this distinction exists, are
also presented. Research by Kretzenbacher (2005),
for instance, shows that the T–V distinction in
German has disappeared in communication on
the Internet, with only T being used. Also, changes
can be observed in the honorific forms in modern
Japanese that are now used less strictly according
to the authors. An interesting topic one might not
have expected to find in a book on intercultural
communication is the discussion of cultural
differences in writing explored in Chapter 8. The
linearity principle, an important feature of English
written discourse, is explained and compared to
the digressive feature of German academic register.
Also, features of written discourse in Arabic and
Japanese are explored, as well as letter writing.
Chapter 9 discusses the difficulty of achieving
pragmatic equivalence in translating or interpreting.
Much of this chapter focuses on the Australian
perspective and advice is given on interpreting
and translating in the business context.Victor
(1992), for instance, suggests using the following
techniques when speaking to business partners for
whom English is a second language: rephrasing
frequently, repeating key ideas in different words
and using written support, since the spoken
knowledge of these L2 speakers might be weaker
than the written knowledge. This chapter also
introduces the topic of advertising, which is a
challenge for intercultural communication because
the values used in advertisements vary between
cultures. For instance, translating an English
advertisement for pet food into Mexican Spanish
would be difficult, since, apart from the difficulty
of achieving pragmatic equivalence in the Spanish
version, the concept of pet food would have to be
introduced into this culture.
Intercultural communication issues in
professional and workplace contexts are presented
in Chapter 10. Different expectations in
2008 Volume 23 No 2
 80 intercultural business encounters and the resulting
miscommunication are described. The norms of
a culture need to be observed in order to avoid
such miscommunication. Béal’s (1990) study on
differences between native speakers of French
and native speakers of Australian English shows
how two sets of sociolinguistic rules can lead to
problems in intercultural communication. Béal
found that ‘different conversational forms to
minimise the threat to the face of the hearer when
making a request’ (p 158) were chosen by French
and Australian speakers. Other workplace contexts
discussed include medical and legal practices.
This chapter also provides a good introduction to
communication issues of Australian Indigenous
clients in the courtroom. Pauwels, D’Argaville
and Eades (1992) found that Aboriginal people
do not use direct questions to find out significant
information, whereas in Western courtrooms using
direct questions is common practice.
The final chapter, Chapter 11, presents research
on successful intercultural communication. It has
been shown that individuals from different cultures
can draw on creative discourse strategies in order
to construct common ground in intercultural
communication. One strategy is, for instance, the use
of repetition for various functions in discourse to
avoid miscommunication. Turn-sharing is another
strategy in intercultural communication used to
construct discourse together. Also, the theory of
accommodation in intercultural communication
is explored. Giles’s (1977) communication
accommodation theory explains social motivations
for speakers to adjust their speech to the language
conventions of the hearer. The notion of
conversational needs, developed by Coupland et al
(1988), has been included in this theory.
In general, this academic reference provides an
excellent and detailed introduction to intercultural
communication and various issues related to such
communication. The key research on the topics
discussed is introduced, critique of the research
Book reviews
is presented and recent studies in some areas are
included. Important tables of original research
have been reprinted and the authors have also
included additional user-friendly tables. However,
in order to fully appreciate these discussions, some
existing linguistic knowledge might be needed.
Therefore, interdisciplinary researchers without
previous knowledge of linguistics might find this
introduction challenging, since the presentation of
the different theories is quite dense.
The languages discussed include European
and Asian languages, as well as different varieties
of English, for instance, Australian English and
Aboriginal English. The Australian research
presented should be helpful for international
students or anybody who wishes to conduct
research in Australia. However, the emphasis on
the Australian context may be too prominent
for use in Europe or the United States. The
organisation of the book is excellent, with further
reading suggested at the end of each chapter for
the interested researcher. The review section for
students also includes exercises that should prove
valuable for group discussions. The presentation
of key terms in the review section will be helpful
for non-native speakers and native speakers alike.
Applying knowledge to solve different exercises
and some suggested small-scale fieldwork for
students are included in this section and make this
book interesting for work in tutorials. However,
when using this reference as a self-study book, it
might be difficult to fully appreciate the review
section, since no answers to the questions are
provided. Often it would be impossible to provide
answers because students are asked to use their own
knowledge of other languages in order to respond.
To conclude, this volume would be most useful
for students attending tutorials or seminars.
Furthermore, researchers who already have some
background knowledge will find that the good
general overview on the topic of intercultural
communication is useful.
References
Austin, J. L. (1962). How to do things with words.
Oxford: Oxford University Press.
Austin, J. L. (1970). Philosophical papers.
Oxford: Clarendon Press.
Béal, C. (1990). It’s all in the asking: A perspective on
problems of cross-cultural communication between
native speakers of French and native speakers of
Australian English in the workplace. Australian
Review of Applied Linguistics, Series S, 7, 16–32.
Blum-Kulka, S., House, J., & Kasper, G. (Eds.).
(1989). Cross-cultural pragmatics: Requests and
apologies. Norwood, NJ: Ablex.
2008 Volume 23 No 2
 81 Brown, R., & Gilman, A. (1960). The pronouns of
power and solidarity. In T. A. Sebeok (Ed.), Style
in language. New York: Technology Press of MIT.
Brown, P., & Levinson, S. (1978). Universals in
language usage: Politeness phenomena. In
E. Goody (Ed.), Questions on politeness (pp. 56–
289). Cambridge: Cambridge University Press.
Clyne, M. (1994). Inter-cultural communication at
work: Cultural values in discourse. Cambridge:
Cambridge University Press.
Coupland, N., Coupland, J., Giles, H., & Henwood,
K. (1988). Accommodating the elderly: Invoking
and extending a theory. Language in Society, 17,
1–41.
Giles, H. (1977). Language, ethnicity and intergroup
relations. London: Academic Press.
Goffman, E. (1955). On facework: An analysis of
ritual elements in social interaction. Psychiatry,
18, 213–231.
Goffman, E. (1967). Interaction ritual: Essays on face to
face behavior. New York: Doubleday.
Grice, H. P. (1975). Logic and conversation. In
P. Cole & J. Morgan (Eds.), Syntax and semantics 3:
Speech acts (pp. 41-58). New York: Academic Press.
Hobbs, P. (2003). The medium is the message:
Politeness strategies in men’s and women’s voice
mail messages. Journal of Pragmatics, 35, 243–262.
Hofstede, G. (1980). Culture’s consequences:
International differences in work-related values.
Beverly Hills, CA: Sage Publications.
Hofstede, G. (1983). Dimensions of national
cultures in fifty countries and three regions. In
J. B. Deregowski & S. Dziurawiec et al. (Eds.),
Explications in cross-cultural psychology (pp. 335–
355). Netherlands: Swets & Zeitlinger.
Hofstede, G. (1991). Cultures and organizations:
Software of the mind. New York: McGraw-Hill.
Hofstede, G. (1998). Think locally, act globally:
Cultural constraints in personnel management.
Book reviews
Pauwels, A., D’Argaville, M., & Eades, D.
(1992). Problems and issues of cross-cultural
communication in legal settings. In A. Pauwels
(Ed.), Cross-cultural communication in legal settings
(pp.77–105). Language and Society Centre,
National Languages and Literacy Institute of
Australia, Melbourne: Monash University.
Sacks, H., Schlegloff, E. A., & Jefferson, G. (1974).
A simplest systematic for the organization of turn-
taking in conversations. Language, 59, 359–387.
Schlegloff, E. A. (1968). Sequencing in
conversational openings. In J. Gumperz &
D. Hymes (Eds.), Directions in sociolinguistics:
The ethnography of communication (pp. 346–380).
New York: Hold, Rinehart & Winston.
Scollon, R., & Scollon, S. W. (2001).
Intercultural communication: A discourse approach
(2nd ed.). Oxford: Blackwell.
Searle, J. R. (1969). Speech acts.
Cambridge: Cambridge University Press.
Sharifian, F. (2004). Cultural schemas in
intercultural communication: A study of Persian.
In J. Leigh & E. Loo (Eds.), Outer limits: A reader
in communication across cultures (pp. 119–30).
Melbourne: Language Australia.
Smith, J. S. (1992). Women in change: Politeness
and directives in the speech of Japanese women.
Language in Society, 18, 527–544.
Sperber, D., & Wilson, D. (1986). Relevance.
London: Routledge & Kegan Paul.
Tajfel, H. (1982). Social identity and intergroup
relations. Cambridge: Cambridge University
Press.
Victor, D. (1992). International business communication.
New York: Harper Collins.
Wierzbicka, A. (1972). Semantic primitives
(Linguistische Forschungen 22). Frankfurt:
Athenäum.
Wierzbicka, A. (1985). Different cultures, different

languages, different speech acts. Journal of

Management International Review, Special issue,
Pragmatics, 9, 145–178.
36(2), 7–26.
Wierzbicka, A. (1991). Cross-cultural pragmatics:
Kretzenbacher, H. L. (2005). Hier im grossen
The semantics of human interaction. Berlin: Mouton
Internetz, wo sich alle duduzen, Internet
de Gruyter.
discourse politeness and German address. Paper
given at the Third International Conference
on Language Variation in Europe (IC1aVE),
Amsterdam, 1–15 June.

2008 Volume 23 No 2
 82 Wierzbicka, A. (1994). Cultural scripts: A semantic
approach to cultural analysis and cross-cultural
communication. In L. Bouton & Y. Kachru
(Eds.), Pragmatics and language learning (pp.1–24).
Urbana-Champaign: University of Illinois.
Wierzbicka, A. (2003). Cross-cultural pragmatics:
The semantics of human interaction (2nd ed.).
Berlin: Mouton de Gruyter.
Book reviews

2008 Volume 23 No 2