The Pragmatics of Power in Nigerian English Medical Discourse: Doctor Authority, Patient Agency, and Negotiated Health Meaning

Medical discourse is a paradigmatic site of power-mediated language use, and its analysis in the Nigerian English context provides unique insights into how colonial-legacy institutional hierarchies, traditional authority norms, and contemporary patient empowerment pressures interact in the co-construction of health meaning. This dissertation develops a comprehensive pragmatic analysis of power in Nigerian English medical discourse, examining how doctor authority and patient agency are linguistically constituted, contested, and negotiated across multiple levels of medical communication. Theoretical development integrates pragmatic theory with critical discourse analysis, healthcare communication research, and postcolonial institutional linguistics to construct an original analytical framework termed asymmetric pragmatic co-construction that specifies the mechanisms through which power-mediated meaning is produced in Nigerian English medical interaction. The empirical programme is conducted across five sites: a university teaching hospital, a state specialist hospital, a private specialist clinic, a primary healthcare centre, and a traditional medicine clinic, all in Kwara State. Two hundred and forty audio-recorded consultations were collected across the five sites, complemented by patient exit interviews, doctor focus groups, and organizational document analysis. Pragmatic analysis of consultation recordings examines epistemic authority deployment through evidential and modality choices, patient agency expression through resistance strategies and narrative insertion, and the pragmatics of diagnosis delivery across the institutional hierarchy of sites. A key finding is that pragmatic asymmetry is significantly higher in public sector sites than private sector sites, suggesting that market-mediated patient choice partially restructures the pragmatics of power in Nigerian medical interaction. Keywords: medical discourse, pragmatics, power, Nigerian English, healthcare communication.