In Conversation with Peter Joseph Torres

Can you tell me a little bit about your background, your project and where you’re currently with it?

I’m currently finishing my PhD at UC Davis. My background is linguistics and anthropology, which I did at UCLA, and then I moved here for graduate school. I am now doing language work, sociolinguistic work specifically, for doctor-patient interactions. I’m looking at the overall language of the opioid crisis in the United States. That includes looking at policies, and the language that policy-makers or legislators are using to frame or draft policies, and how that affects the conversations that are happening on the ground. I gather doctor-patient data to see how they talk about policies, and how they negotiate opioid policies in their interactions. This is particularly important to me because the opioid crisis in the United States is getting really out of hand. And communication has an important role to play when it comes to prescriptions of opioids, because you don’t have something to show when you are in pain, or when you’re having chronic pain. You’re just telling your doctor through expressing your pain and describing your symptoms, using your voice and using the way you speak and talk about your pain. So, communication has a lot of stake in whether or not you will be prescribed opioids in the United States.

Would you be able to say what specifically are the ways in which you need to talk about your issues in order to get prescribed opioids?

Ever since the opioid crisis got really bad in the United States, doctors are becoming more careful when it comes to prescribing opioids. So, I got curious as to how patients, knowing that they have to express their pain, navigate the stigma of asking for opioids, because they know that they might be misjudged or misrepresented as just trying to seek the drug. And for those who are just trying to seek the drug, I’m trying to figure out how they would express it. So, I became curious about the language of pain, the language of addiction, and whether or not we could structuralize or describe them linguistically, focusing on features such as: voice, pitch, tone, and phrasing. Specifically, I use discourse and conversation-analytic processes to narrow down the features of talk that speakers use to index pain. The difficult part about that is that I’m not a doctor and I can’t declare or judge whether or not patients are addicted or not. I cannot diagnose an opioid disorder. So, the language of addiction became a harder topic as it requires self-identification in part of participants.

What kind of data do you work with?

I record audio of doctor-patient consultations to conduct both discourse and prosodic analysis. It became obvious, as I started listening to these interactions, that patients are really trying to mark their speech when they speak about chronic pain and request opioids. It’s very marked in comparison to other kinds of pain and medication. When they’re talking about opioids, their register would shift drastically in comparison to when they’re talking about, say for example, stomach pain, and all these are happening in the same interaction. Since one interaction would probably take like an hour, and patients discuss around five or six different conditions. So, when they’re talking particularly about the condition that is being prescribed with opioids, my analysis shows pitch lowering and creaky voice as linguistic features used to express pain. There seems to be the need to credibly show pain when patients ask for opioids in comparison to when they ask for something like vitamin D or a hydrocortisone cream. I started isolating these conversations that involve opioids and looking at pitch and that’s when I started seeing this distinction. Aside from just how they are talking about pain, acoustically through their vocal tract, I’m also looking at the discourse side of it, meaning the content of the conversation and the context in which these conversations are happening. I am also looking at the sociolinguistic backgrounds of the patients and whether those affect the prescribing practices of physicians. Are certain speakers more eligible for opioids than others?

What is the current situation in terms of data collection, and where do you see the process going in the next few months?

When the COVID pandemic started last year, I had to stop because the university stopped all the research, aside from it makes sense to stay home. Before the pandemic, I hang out in waiting rooms to recruit participants, sometimes waiting for an entire day for one potential chronic pain patient only to get a “no.” If they agree to participate, I leave the recorder in the room. I am not present. There is some sort of Observer’s Paradox with the presence of the recorder. My recorder is really small though and  it’s not like we can avoid Observer’s Paradox, IRB requires us to explain everything. I must say though, I honestly don’t think the paradox matters for doctor-patient interactions because the patients have so much more they have to focus on, like when a doctor tells a patient ‘we’re gonna cut your opioids today’. Those who resist would make a case to keep their medication, it’s not like they care about the recorder at that point. It actually seems like patients forget, because at the end of appointments, I would come in and thank them for participating and most of them told me that they forgot about the recording. So, I’ve gathered a little bit of data but then COVID happened.

I was trying to figure out ways of gathering data, but the challenge turns into getting approval from IRB during a pandemic. It took me a year to get all my paperwork lined up and good to go. I also didn’t realize how long it would take COVID to end so I kept asking whether it’s worth it to change my plans since the pandemic might be over by the time I finish the required documentation. I guess I was being too optimistic.

You mentioned you wanted to go into telemedicine for future research. What you know about that option, and at what point do you think you’ll be able to do that?

I believe that telemedicine is still growing. Like you said, we haven’t even really figured out what the practices are in telemedicine or whether it follows the same sequence of events that usually takes place in a physical appointment. A lot of psychotherapy appointments have transitioned to online and so patients who use online platforms get to familiarize themselves with the practice by doing it over and over again. I’m guessing in the next ten years telemedicine will be everywhere. It will be the new norm. Instead of ‘do you have to go to the hospital today’, it will be like ‘do you have a telemedicine appointment today?’. And then, when people go to the hospital it will be for something that requires physical attention, perhaps something very serious.

And when do you think you will be able to use the first batch of telemedicine data for your research?

That’s a good question. I feel like every researcher would be like ‘hopefully next year.’ But, the thing is, I still need to finish what I’m working on right now. Realistically, not until I graduate. I was actually on track of graduating but because of COVID and not being able to gather data, it got postponed. So, right now, my main goal personally is to get that done. And then, in the future, hopefully get an opportunity somewhere where I can continue my academic work and my research. If I get lucky, the job market is very steep right now. I really want to work on it. If someone’s reading this and would like to do something about that, let me know. Maybe we can collaborate. I will message you after I finish my dissertation.

What do you think would be the advantages of collecting data in these new ways, or the new things that the pandemic will stimulate?

I think the advantages will be, first, that it will be more acceptable, because there’s a stigma behind gathering data online. I feel like a lot of people who already have jobs now, have been in the business for a while, they had to go out there and gather their own data so of course they would be like ‘why is this allowed now? Before we had to do this or had to do that.’ But again, the world is changing and these computer-mediated interactions warrant to be studied in their own right. There are still people who go out there and seek, that’s important, go out there into the world and seek new information. But not all information is in a physical field site, some, if not most of the understudied communicative behaviours are in the cloud, too, and that ought to be looked at, too. So, I think maybe that will open more opportunities for a different wave of  researchers. I also think the pandemic has really affected data gathering online. Even professionals have started getting used to data gathering done at home. It’s like the pandemic almost opened the idea that communication doesn’t only happen in person, it also happens online. Research is also going by way faster now, as long as you have the right technology and resources. Online data is definitely advancing linguistics and linguistic anthropology.