Picture credit: Steve Buissinne from Pixabay, ©2015 Steve Buissinne, published on 6 January 2015.
Among my aging peer group within the sisterhood, one truth is universally acknowledged: A retired man’s visit to the doctor proceeds far more effectively when his wife accompanies him. For many of us, this requires adopting a more assertive persona – off to the doctor in full sail, tugboat husband in tow. Poor fellow.
From the doctor’s perspective, however, the scene that enters the consulting room signals an immediate communicative challenge. He may not know it, but what he needs at that moment is a crash course in systemic functional linguistics (SFL). The moment the spouse steps in, the register, configuration of field, tenor and mode begin shifting under his feet (Halliday and Matthiessen 2014; Martin and Rose 2007). SFL scholars remind us that register is the invisible scaffolding that holds everyday interactions together. Field is what is going on, tenor is who is involved and how they relate, and mode is the channel and function of the language being used. These variables shape the meanings that unfold in any situation, including the everyday South African medical consultation.
The field, in theory, is simple: A medical professional gathers information to diagnose and advise a patient. In practice, the field expands the moment the wife arrives, handbag poised, Google printout sheathed in plastic, and husband hovering behind her. The medical interview is about to become a domestic triangulation. The husband offers partial recall: “No, Doctor, I don’t remember falling. I was stepping back to sit down in the chair, but misjudged the distance. I missed the chair and landed on my behind.” The wife immediately corrects him: “He fell, and hard. In fact, he was quite disorientated for a while.” Their shared domestic mythology surfaces when his claim of “occasional chenin blanc” is met with her microscopic headshake, a tiny semiotic flicker. The doctor attempts to maintain clinical accuracy while navigating this turbulence, and his joke about chenin withdrawals softens her. The is disastrous for the doctor. She warms to him, and out comes the plastic sleeve containing the 2:00 am Google research.
At this point, a telling box on the doctor’s desk seems to have grabbed the couple’s attention. A single finger of a blue glove has escaped the closure. The doctor toys with it absent-mindedly as he listens. Husband and wife exchange a look of mock alarm, a moment of perfect solidarity, united in the hope that the gloves will remain untouched – as if anyone really needs introductory drama to the trauma of a medical examination. For the doctor, the field has now become hybrid: part medical interview, part household negotiation and part myth-busting of algorithm-driven misinformation. “No, madam,” he says, “there is no Google article that covers the full implication of what your husband is experiencing. I’ve got this.”
Tenor, officially, is doctor-to-patient. In this situation, it is doctor-to-couple, with shifting alliances and subtle power plays (Martin and White 2005), a sort of three‑way dance around a very elusive solidarity. The husband is the grammatical patient, but only intermittently the informational source. The wife positions herself as historian, clarifier and future implementer of medical instructions. The doctor must maintain authority without alienating either party.
When the examination begins, the earlier tension around the blue gloves dissolves: The doctor does not reach for them. He knows exactly what they were thinking, and a small smirk appears around his mouth. At least he can get through the examination without the mother ship barging in. Reflexes do not lie. The doctor looks the patient in the eye; the wife can only hover and insist, “He’s very stoical, Doctor.”
The mode of the consultation is equally fluid (Martin and Rose 2007). The husband uses spoken mode – vague, elliptical and non-committal: “It comes and goes.” The wife uses spoken-as-written mode – chronological, itemised and almost report-like: “No, it is constant, and worse at night, and any pain-killers are refused. He sweats with the pain, even in the absence of any fever.” The doctor uses spoken-for-record mode, aware that his words must survive the car ride home and the retelling of what happened at the doctor’s rooms to friends and family. “All you need to do is read the package insert of anything I prescribe if you forget any details of our conversation.” He then speaks to Co-Pilot in report mode.
The consultation becomes a layered text: comprehensible to the patient, reassuring to the spouse and accurate enough for documentation. Complicating matters further is the rise of pseudo-shared knowledge, with patients arriving armed with fragments of online research, terminology stripped of context, and anxieties shaped by search algorithms rather than medical training.
In a final shift, just as the consultation seems complete, the tenor must be reconfigured. The doctor turns to the wife and says, “Could I have a private word with your husband?” The handbag snaps open. The Google printout disappears into its depths. The handbag snaps shut. She leaves. The tenor recalibrates into the dyad required for informed consent. The doctor shifts his chair slightly closer to his patient, towards whom he feels unusually empathetic. “If we leave this little hernia alone, then it may stay harmless, but if it traps tissue, it becomes an emergency.” The husband glances at the blue gloves, alarmed, but the doctor continues in the same even tone: “If we repair it early, then you avoid that risk entirely. No gloves today, just your decision.” The husband exhales, relieved.
The solidarity between the two men could not be more palpable. “Sir,” says the doctor, “you need a bit of quick comfort. There’s a pub around the corner. I have an account there. Let her drive and have a double on me.”
References
Halliday, MAK and Matthiessen, C. (2014) Halliday’s introduction to functional grammar. 4th ed. London: Routledge.
Martin, JR and Rose, D. (2007) Working with discourse: Meaning beyond the clause. 2nd ed. London: Continuum.
Martin, JR and White, PRR. (2005) The language of evaluation: Appraisal in English. Basingstoke: Palgrave Macmillan.
Janine. (2026) Consultations with Microsoft Copilot on the SFL‑framed analysis of a married couple medical consultation, 25-27 April 2026.