Management of care or management of face: Indirectness in Nurse Practitioner/patient interactions

• The Nurse Practitioner in this study uses indirectness fairly infrequently.
• Indirectness is used to challenge patient claims of competency and offer advice.
• Indirectness tends to face wants of patients.
• Indirectness helps construct an identity of ‘competent Nurse Practitioner’.

This paper explores the use of indirect speech in medical encounters. Drawing on more recent definitions of indirect speech including discursive indirectness (Walker et al., 2011; Geis, 1995) and indirect addressivity (Lempert, 2010; Kiesling and Gosh Johnson, 2010), I examine indirect speech in medical visits between a Nurse Practitioner (NP) and patients who have been hospitalized with diabetes-related complications. I outline two ways in which indirectness functions in the data: the NP's indirect challenges of patients’ assertions regarding their ability to manage their disease and the NP's use of ventriloquism (Tannen, 2010) to provide advice and medical directives to the patients. Indirectness on the part of the NP may be viewed not only as avoidance of face-threatening acts (i.e. for the benefit of the patients) but also as a second order indexicality, projecting her own identity as a competent Nurse Practitioner who engages in the patient-centered medical approach.