DIAGNOSTIC REPORTS IN SPEECHLANGUAGE PATHOLOGY:

A SPEECH-LANGUAGE PATHOLOGISTS WRITTEN LIAISON

INTRODUCTION:
Almost all health science professions use some form of a diagnostic report. The general definition of a diagnostic report is a standardized report that summarizes the medical history of a client in a clear and concise way that can be understood by any professional in the field. The reason for having diagnostic reports is that they allow a client to switch health care providers without the risk of there being a miscommunication between professionals or between the professional and the client. Say, for example, that a client is taking a medication that cannot be mixed with a certain chemical. This chemical is not the type of thing he would normally interact with so he doesnt know it is a problem. When he moves, his new doctor asks if hes taking any medications, and he cannot pronounce the long chemical name of the medicine, so he tries to explain what it is with no success. The new doctor doesnt worry about it and in one of the tests, gives him the chemical that is contraindicated by his medication, and it causes severe complications. The point of a diagnostic report in that scenario would be to allow the new doctor to look on his medical records and see that his client takes this medication. Assuming that he is a well-educated doctor, he would then be able to know that the test with the chemical would be contraindicated. In Speech-Language Pathology, there are rarely cases that would have that level of severity if misunderstood, but there are tests that could be readministered for no reason, and ones speech therapy progress could go unknown if there is no diagnostic report. It is self-evident that this is the reason diagnostic reports are written, but why are they written the way they are? What does each section of a diagnostic report say about the doctor that writes it? Because this paper is not explaining what a diagnostic report is, but why it is, it is necessary to look a step deeper. A diagnostic report is a genre that lends itself as an excellent example of what Berkenkotter and Huckin (1993) call situatedness. In their article they define situatedness as the necessity to participate within, the communicative activities of daily and professional life. (482). Each health care profession is in itself, a discourse community, but also, every office has its community as well. The real purpose of a diagnostic report is to be a liaison between the smaller discourse communities to allow for the universal comprehension of the larger discourse community of, in this case, all the speech-language pathologists within a language.

EXAMPLE REPORT:
From page 178 to 181 in Professional Writing in Speech-Language Pathology and Audiology by Drs. Goldfarb and Serpanos, there is an example diagnostic report for a patient named Jane Jones. The report includes many subsections, including the background information, the assessment behavior, and many testing categories, including formal and informal tests, language usage, oral-facial examination, any previous audiological tests, and finally, the personal recommendation the speech-language pathologist gives the client. Each portion of the report has a situated purpose, what Berkenkotter and Huckin call situatedness. One of the very first situated examples in the diagnostic report is the age, which is in the contact information at the beginning. This example has some purposeful errors in it, to allow for a student to read through and find the errors as practice. The age is written purposely incorrectly as 14.6, meaning 14 years and six months.

FORMAT OF AGE AS SITUATED:

The age of the client is written in the form year:month, for example, fourteen years and six months old is written as 14:6, in order to avoid confusion. If fourteen years and six months are written as 14.6 years, a clinician could interpret that as fourteen years and six tenths of the next year, putting the client at about seven months and a week after fourteen years. This is important to the rhetorical purpose of the report. The entire point of having a written report explaining the clients language is so any clinician the client sees can read the report and immediately be on the same page as any clinicians the client have previously seen. Especially in earlier ages, when language acquisition is peaking, and changes are happening quickly, a misinterpretation of age can be crucial. Say a client is five years and five months old and has trouble saying /v/, for example, he pronounces the word vine as fine. The age where the phoneme /v/ is acquired is between four and five-and-ahalf years. The clinician writes the clients age as 5.5, straying from the necessary form of year:month, and marks the child as within the normal limits of language acquisition. When the client moves towns and sees a different speech-language pathologist, he may look at the report and misread the child as five-and-a-half years old. In that circumstance, the child would now be considered late in the acquisition of the phoneme /v/, and be referred to see an SLP regularly for help in the acquisition of the phoneme when it isnt necessary. Within a discourse community that one is situated in, following Berkenkottor and Huckins definition as an active participant in the writing of the genre, one could figure out that in the example, when the clinician wrote the age as 5.5, that he meant five years and five months. One in this case would have the situated cognition, defined by B+H as knowledge that is indexical, inextricably a product of the activity and situations in which it is produced, (485). The point of the diagnostic report, as previously stated, is to be a liaison between discourse communities. One in another office would not have the indexical knowledge of the clinician that wrote the diagnostic report because one is not situated in that culture, but their own office culture. Their clinicians could write five years and five months as 55 (or something else equally obscure), and everyone in the office who was

situated to that office culture would know what it was, but others in other offices would not have a clue. Diagnostic reports are, to an extent, standardized, due to this difference in workplaces.

FORMAL AND INFORMAL TESTING AS DYNAMISM:

In any good diagnostic report, the formal and informal testing are both included. In Jane Joness diagnostic, report, it includes her results to her Goldman-Fristoe 2 test of articulation, a formal test that tests ones articulation in words, in sentences, and after seeing a word correctly articulated. The test shows that Jane has a lisp on the /s/ and /z/ phonemes. Also included in the diagnostic report was Janes informal test, or notes from conversation with the speech-language pathologist. It also claims that she used // (with) for /s/ sounds, and she used // (wither) for /z/ sounds, which is also indicative of a lisp on the /s/ and /z/ sounds, but includes that her intelligibility was not affected. The end recommendations of the clinician that writes the report are for speech therapy once a week for a half-hour to practice the sounds. Because of the purpose of a diagnostic report, the formal and informal tests are necessary. A formal report is an objective report. It can only tell the facts, such as the fact that Jane has a lisp. The informal report is subjective. The absence of the formal test would make the clinician look unprofessional, because it is professional to do some sort of formal test on the initial visit. The absence of the informal test would, it this case, miss information: the fact that even though Jane has a lisp, she is still comprehensible. If a new clinician were to see Jane after this, and Jane were to be completely incomprehensible, the clinician would not know that things became worse. These examples may seem few and far between, but these are the reasons that the diagnostic reports are set up the way they are. This phenomenon is described by Kerry Dirks essay on Navigation Genres. When genres form and change, its because a situation occurs that causes them to form as a response. When that situation happens again, another person uses the first response as a basis for the second, and eventually, everyone whop encounters this situation is basing his/her response on the previous ones, resulting in the creation of a new genre. (Dirk, 252). Someone historically had these problems with their clients moving and knowing what their formal tests say, but not having the subjective view of what the previous speechlanguage pathologist thought of their language production through informal testing, and thus the genre had to include these subjective areas.

CONCLUSION
The reason that the diagnostic report works is through its ability to work between discourse communities as a liaison. The reason it can be a liaison is through the ways genres work. Discourse communities exist and will continue to exist because of human nature. Because they do exist, genres will remain situated within them. Because of the need to have communication between them, these types of genres have to exist and change over time. The dynamism relates to the purpose of the diagnostic report because the report would not effectively get the point across to people from different communities without the fine tuning involved in the changing of genre over time. The report would not be even necessary or worthwhile without situatedness, because if reports were not situated, no one could understand the nuances of what the genre is even explaining. These features of genre are what can allow a speech-language pathology diagnostic report to stand alone as a genre.

Works Cited

Berkenkotter, C., & Huckin, T. N. (1993). Rethinking genre from a sociocognitive perspective. Written Communication, 10(4), 475-509, Dirk, K. (2010). Navigating genres. In Writing Spaces: Readings on Writing, Volume 1, Retrieved from http://writingspaces.org/essays Goldfarb, R., & Serpanos, Y. C. (2009). Professional writing in speech-language pathology and audiology. Abingdon, Oxfordshire, UK: Plural Publishing Inc.