Volume 2 - issue 2 - 2006

Interactive and face-to-face communication:

a perspective from philosophy of mind and language

Based on experiences from an educational programme for medical paramedics which combines physical gatherings with online activities, Halvor Nordby has developed a framework for both interactive and face-to-face communication. Important questions he addresses are similarities and differences between these two types of communication, and he makes use of modern philosophical hermeneutics in his research. With successful communication as the goal, both descriptive and normative approaches are made. Halvor Nordby is professor at Lillehammer University College and at the University of Oslo.


(The video requires Flash)  
 

Halvor Nordby
Professor
Lillehammer University College
Faculty of Health and Social Research
This email address is being protected from spambots. You need JavaScript enabled to view it.

University of Oslo
Faculty of Medicine
Department of Health Management and Health Economy
This email address is being protected from spambots. You need JavaScript enabled to view it.
 
 

Abstract

The aim of this article is to derive fundamental communication conditions from central assumptions in recent philosophy of mind and language, and then use these conditions to clarify essential similarities and differences between face-to-face and interactive communication. The analyses are to a large extent made on the basis of participant observations and dialogues with students in a further education course for medical paramedics, but the conclusions should be of interest to anyone who has a pedagogical interest in understanding the nature of the two forms of communication. The arguments set out in the article have both a descriptive and a normative dimension. They are descriptive in the sense that they aim to give a philosophical analysis of successful communication; they are normative in the sense that they seek to understand how communication can be improved. The article concludes that the philosophical analysis presented constitutes a plausible conceptual framework for analyzing empirical phenomena related to face-to-face and interactive communication.
 

1. Introduction

Lecturers, supervisors and other persons with teaching responsibilities in modern education programs are often involved in two forms of communication: face-to-face communication, in which the participants in a communicative process can observe each other and the wider context of communication, and interactive communication, in which communication happens through some interactive communication channel. Dialogues with students in traditional, physical classrooms are typical examples of the first kind of communication; supervision and discussions via internet-based programs like ‘Classfronter’ are typical examples of the second.
It is obvious that both face-to-face and interactive communication can involve fundamental challenges for communicators, but it is not so clear exactly how these challenges should be understood and related to each other. An important theoretical question is therefore this: To what extent are the communicative challenges involved in the two forms of communication similar, and to what extent are they essentially different?

A thorough analysis of all the potentially relevant aspects of this question would require a very comprehensive discussion. The obvious reason is that the question can be discussed from different perspectives, and that it is unreasonable, at least prima facie, to give one of these perspectives conceptual or epistemic priority (Davies 1998, Peacocke 1998). A better suggestion is that the similarities and differences between face-to-face communication and interactive communication can be elucidated in different ways, and that a variety of analyses can jointly contribute to a better, overall understanding of the nature of the two forms of communication.

My primary motivation for exploring the nature of face-to-face and interactive communication has been the need to understand communicative challenges that confront students in a national further education program for medical paramedics. As the person responsible for one of the courses in this program I have, from a pedagogical and theoretical point of view, attempted to analyze the various forms of interaction paramedics are involved in. I have, in particular, sought to address two questions: What are some of the fundamental problems of understanding paramedics confront when they encounter patients and other health personnel in face-to-face situations? How are these problems similar to, but also different from, the challenges they confront when they communicate interactively via radio or telephone with other health personnel such as nurses in acute medical communication centers? 

The aim of this article is to address some important aspects of these questions on the basis of recent philosophical theories of speech acts and concept possession (Guttenplan 1996; Bechtel & Graham 1998). Within the theoretical framework I develop, I make a fundamental distinction between four communication conditions: firstly, speaker and audience (in a wide sense) need to share a common language that can be used to convey and understand a belief. Secondly, the audience must realize that the speaker has the intention of communicating this belief. Thirdly, speaker and audience must not associate beliefs and thoughts that are literally expressed in language with very different sets of other beliefs and thoughts. And finally, the experiences, motives and values that an audience ascribes to a speaker must not be radically different from the experiences, motives and values that a speaker intends to express. 

I will argue that this philosophical framework is completely general but also particularistic. That is, the four conditions can be used to show how face-to-face and interactive communication involve some of the same fundamental communicative processes, but the conditions can also be used to illuminate crucial differences. This fact, I will argue, constitutes a plausible argument for using the conditions as a conceptual framework for analyzing empirical phenomena related to the two forms of communication. Moreover, the fact that the framework is suitable for understanding and explaining the two forms of communication constitutes an independent justification for the framework itself, as a genuine theory of communication. 
In the last part of the article, I examine the question of how it is possible to avoid various forms of misunderstanding that occur when one or several of the four communication conditions are not met. This discussion is to a large extent based on ideas that have been central within modern philosophical hermeneutics (Bleicher 1980; Mueller-Vollmer 1986; Smith 1997). I focus particularly on Gadamer’s (1975) idea of the aim of understanding as a ‘fusion of horizons’ and argue that in order to avoid poor communication, it is imperative that speakers are aware of various intrinsic aspects of the cognitive and emotional perspectives audiences have. I conclude that this and other implications of the arguments I present should be of interest to anyone who wants to acquire a more philosophical understanding of the nature of face-to-face and interactive communication.
 

2. Background

’Nasjonal Paramedic Utdanning’ (http://paramedic.hil.no/) is a national further education course for health personnel working as paramedics in the national health services in Norway. The program consists of six courses, four of which focus mainly on issues directly related to medicine, one on legal issues and one on communication and ethics.

The need for focusing on communication in the program is obvious. In their daily work as paramedics the students are to a large extent involved in interpersonal relations where empathy, understanding and dialogue are important factors for securing successful interaction. With respect to the especially important relation between paramedics and patients, it is crucial that paramedics are able to understand adequately how patients experience and think about their states of disease, illness or sickness. Their choice of verbal and non-verbal behavior must be based on justified beliefs about the emotional and cognitive perspectives patients have on their condition of disease or illness (Enelow, Forde & Brummel-Smith 1996, Nordby 2004a; Nordby 2006).

A detailed analysis of the diversity of communicative contexts paramedics face in interaction with patients and other health personnel falls outside the scope of this article. The important point I will focus on is that paramedics are involved in two forms of communication that are essentially different from each other. Firstly, they are involved in many direct, face-to-face encounters with patients, relatives of patients and other health personnel - situations in which they are able to observe not only the persons they communicate with but also the wider context of communication. When communicators are able to observe each other in this way, the obvious consequence is that it is possible to use more than uttered words as interpretative clues. Interpretation can also be made on the basis of non-verbal behavior and other observable aspects of the communicative context (Nordby 2004b). The significance of this consequence is obvious. Normally, when we seek to understand other persons we rely on literal interpretation. As Burge (1979, p.88) observes, “literal interpretation is ceteris paribus preferred” in ordinary discourse. For instance, if a speaker says ‘It is raining’, audiences normally assume that the speaker, as long as he means to be sincere, expresses the belief that it is raining involving the concepts it, is and raining that are literally expressed by the words he utters.

The qualification ‘normally’ is important. Sometimes certain aspects of a situation constitute good reason for being skeptical about literal interpretation, as in the case of incongruent communication involving a definite mismatch between verbal and non-verbal behavior. By being sensitive to the potential importance of non-verbal interpretative clues, communicators can avoid incongruent communication and other forms of poor communication that can occur when there is a mismatch between what is strictly speaking said and what is more generally displayed (Eide & Eide 2004). In such cases of experienced inconsistency, attentive audiences use the wider context to form special non-literal and complex interpretations that do not correspond directly to the words that a speaker utters (Davidson 1984). Furthermore, it is a widespread view that there are no observable aspects of face-to-face communicative contexts that are irrelevant in principle for determining the non-literal meaning of verbal speech acts (Bezuidenhout 1997; Cappelen & Lepore 2005). Face-to-face interpretation is essentially holistic; interpreters’ beliefs about the meaning of speakers’ utterances are based on assumptions about of all sorts of observations and all sorts of assumptions about speakers’ social and cultural contexts.  

Face-to-face communication has received most attention in the health care literature focusing on interaction between health personnel and patients, but interactive communication - here defined as communication that does not involve a face-to-face encounter - is often equally important for paramedics (Tjora 1997). When an ambulance is called out, it has received an interactive appeal from an Acute Medical Communication center (AMC - center) where emergency nurses who cooperate with ambulance coordinators have answered an emergency call (‘113’ in Norway). This interactive appeal has several elements, including a precise a description as possible of where the patient is, a categorization of the acuteness of the assignment according to a code, and an indication of the nature of the patient’s state of injury, illness or disease.1   

Furthermore, while patients are being transported there is often extensive interactive dialogue between paramedics and the AMC-center. The paramedics often provide information about the patient’s state of illness or disease, they sometimes ask for medical supervision, and they sometimes require further back-up assistance from other medical units. There are, in fact, a wide range of aspects related to patients’ conditions that are of potential significance in this interactive communication. From the perspectives of all the parties involved, the experienced success of the paramedic-patient interaction will often depend heavily on adequate interactive communication.

It should already now be emphasized that when I distinguish between face-to-face communication and interactive communication in this way, I do not mean to argue that the two types of communication involve communicative processes that are different in principle. On the contrary, I believe that the assumptions I make are consistent with the plausible view that communication is a contextual, interpretative process, and that the difference between face-to-face and interactive communication fundamentally is a difference of degree. The reason this is an important point to make is that some might infer from the above that I rely on unjustified assumptions about some underlying principled distinction, but this is not the case. All I am presupposing is that we have a reasonable clear idea of what the differences between face-to-face and interactive communication are.

More could be said about face-to-face and interactive communication and the particular ways in which paramedics are involved in these forms of communication, but this would fall outside the limits of this article. For my present argumentative purposes, it is sufficient to clarify the basic nature of two forms of communication. I assume, in particular, that I have made it clear that face-to-face communication and interactive communication must involve some different communicative challenges. In the following, I will first develop fundamental communication conditions that are relevant for understanding communication in general, and then use these conditions to shed light on relevant differences.
 

3. Philosophical perspective

In trying to understand some of the fundamental communicative challenges that paramedics confront in their daily work as health personnel, it has been important to make extensive observation studies in ambulances and AMC-centers. These studies have given me valuable knowledge of how the students in the further education course experience and try to solve problems of communication. At the same time it is important to remember that although observations of human behavior and interaction must necessarily provide the basis for deciding whether communication succeeds or fails in a given context, such observations alone cannot establish whether communication succeeds. Conclusions about the status of a communicative process must always be made on the basis of assumptions about the nature of communication. Traditionally, these assumptions have focused on how the ‘external’ - behavior and context – must match the ‘inner’ - the subjective and private (Davidson 1984, Bezuidenhout 1997; Cappelen & Lepore 2005). The traditional idea has been that a speaker has successfully communicated an ‘inner’ mental state S to an audience if, and only if, the audience understands that the speaker intends to use verbal or non-verbal actions to convey state S to him.

Of course, making such communicative assumptions is something we do more or less unconsciously all the time in ordinary discourse, and even if the aim is nothing more than to explicate our common everyday assumptions, we have in effect started to clarify a theory of communication. Indeed, the difference between common sense theories of communication and the philosophical perspective I will apply here is not meant to be one of principle. The aim is rather to locate assumptions that (a) appeal to our ordinary ideas and (b) can be used to understand the fundamental challenges that face-to-face and interactive communication involve.
The theoretical framework I will use in seeking to achieve this twofold aim is grounded in a modern tradition within cognitive science and philosophy of mind and language (Guttenplan 1996; Bechtel & Graham 1998). According to theories that fall within this tradition, verbal and non-verbal actions are conceived of as intentional language acts that express beliefs and thoughts. Beliefs and thoughts are in turn thought of as psychological attitudes to propositions involving mental concepts (Burge 1979; Peacocke 1992). For instance, the sentence ‘Water quenches thirst’ is normally used to express the belief that water quenches thirst involving the three concepts water, quenches and thirst. When a speaker associates these concepts with the sentence, communication of the concepts has succeeded if, and only if, the audience understands that the speaker intends to communicate a belief involving these concepts.
It should be emphasized that this does not mean that an audience must necessarily think that is it correct to understand a language act in the same way as a speaker. For communicative purposes, all that is required is that the belief that an audience thinks that a speaker intends to communicate really is the belief the speaker intends to communicate. Questions about the objective and normative status of the meaning of language acts are therefore not directly relevant for questions of communication; whether communication happens must be determined on the basis of considerations of how speaker and audience understand each other, not on the basis of considerations of how it is correct to understand a given language (Nordby 2006). 2

This point is of particular importance in discourse involving disputed concepts with unclear application conditions, like the basic health concepts disease, illness and sickness (Mechanic 1968; Nettleton 1995; Worhall & Worhall 2003). Health professionals sometimes encounter patients who do not understand these concepts in ways that correspond to influential conceptions within the health services, but if a paramedic tries to adopt a patient’s understanding for communicative purposes, exchange of concepts can happen even if the patient’s understanding is regarded as controversial or even incorrect.
A second and more philosophical point that should be made about the framework of communication that I will use, is that I do not mean to argue that it constitutes the only possible way of analyzing communication. Basically, what I am relying on is that the framework represents a fundamental and influential way of understanding human interaction. I presuppose, in particular, that the assumption that successful communication involves successful exchange of subjective states has an intuitive, immediate appeal that is grounded in our ordinary communicative practices. Of course, in everyday communication it is not common to think of exchange of thoughts and other subjective states as communicative processes, but the reason why the assumption is plausible is not that it aims to capture a process that we are consciously aware of in ordinary discourse. The reason is rather that as long as we conceive of communication as a rational activity, then we have to think of understanding and communication in cognitive terms: our understanding of the language we use, and the way we try to communicate our concepts to others, cannot be reduced to observable behaviour. As McDowell notes,

...to learn the meaning of a word is to acquire an understanding that obliges us subsequently – if we have occasion to deploy the concept in question – to judge and speak in certain determinate ways, on pain of failure to obey the dictates of the meaning we have grasped” (McDowell 1994, p. 160).

McDowell’s claim is illuminating, not only because it is reasonable in itself, but also because McDowell ascribes it to the later Wittgenstein. In contrast to the tradition that McDowell’s interpretation of Wittgenstein is framed within, Wittgenstein is sometimes described as a modified behaviorist. According to this behaviorist interpretation, communication is essentially an observable activity within ‘language-games’, an activity that can be fully explained by referring to how we conform to language rules in different contexts (Kripke 1982).

Whether or not it is (contrary to what McDowell thinks) correct to ascribe some kind of behaviorist ‘third person’ perspective to Wittgenstein, is an important question of exegesis, but it would fall outside the scope of this article to address it. For the purposes here it is more important to think of behaviorism as a genuine source of challenge to cognitive analyses of communication. Independently of what Wittgenstein writes, some might argue that all versions of behaviorism are not obviously false, and that I have not showed why the cognitive framework of communication I have adopted here is more plausible than all these versions.  

Is important to say something briefly about this objection, first and foremost because the choice of framework has substantial different practical consequences. Consider as an example a patient who utters the sentence ‘I am in pain’ and a paramedic who comes to assistance. A behaviorist will typically think of this as a complete communicative process and claim that further explanations that refer to ‘underlying’ subjective states and audiences’ mental interpretations of these states are irrelevant, superfluous or ‘quasi’ explanations that fall outside the realm of proper psychological explanations. 3

There are in my opinion two main problems with this view. Firstly, and as indicated above, if McDowell is correct, then it is possible to think that the way we understand words and communicate meaning is derived from our use of language, and at the same time think that explanations of underlying mental phenomena are important. According to McDowell, what Wittgenstein is opposed to is not mental explanations per se, but a certain way of conceiving of the relation between ‘private’ subjective states and observable actions. It is only if one starts out with a classical Cartesian first-person perspective that one is easily led to think that this dualism involves overwhelmingly difficult epistemic and metaphysical obstacles (Burge 1979; Nordby 2004c). The problem with behaviorism as a response to the Cartesian tradition is that the position inherits the same dualistic way of thinking. The only difference is that behaviorism starts from the other end - from the ‘outside’ - and then claims that it is only this perspective that we have ‘real’ epistemic access to. Behaviorism is a general doctrine that is grounded in a positivistic idea of what counts as elements in scientific explanations of communication.

Secondly, objections to the scientific status of cognitive analyses of communication often seem to rest on the idea that there is only one ‘proper’ level of psychological explanation. However, there is no good reason for holding that this is so. It is true that it is possible, on one level, to explain communication from a third-person perspective. And from this perspective it is correct to say that communication has succeeded if an audience manifests appropriate behavior as a response to actions performed by a speaker. But accepting that this is correct is compatible with holding that there is more to say about underlying mental processes from other perspectives. 

Consider again the above example of a patient who utters ‘I am in pain’ and a paramedic who comes to assistance. How are we to understand this as a communicative process? We find it overwhelmingly natural to assume that the patient really is in pain (as long as he is sincere), that his utterance expresses his experience of being in pain, and that he intends the paramedic to understand that he is in pain (as long as his utterance is not merely an expression of pain) and so on. It is equally natural to assume that the reason the paramedic comes to assistance is that he thinks that the patient is in pain. This idea about the patient’s state of illness is derived from the fact that the patient used the sentence he used, and probably other interpretative clues like signs of pain. In short, the paramedic forms a belief about the patient’s state of mind on the basis of observable properties of the context. Again, this does not depend on a special Cartesian picture of the mental, or on the idea that interpretation is a conscious process. It is simply a natural way of widening a more narrow third-person explanation of what communication involves.

Hopefully, this defense of the plausibility of the cognitive framework has indicated why it has a strong appeal, and why proponents of other approaches therefore face formidable challenges. Obviously, much more could be said about communication as a fundamental philosophical concept, but that would fall outside the aim here as long as my main focus is the application of the framework within health care. In the next section I will argue that theories of speech acts and concept possession can potentially shed theoretically interesting light on face-to-face and interactive communication, and that they can be used to analyze crucial differences within a completely general framework. I have explained how the framework focuses in a comprehensive way on verbal and non-verbal speech acts, but I have also indicated how it implies that an observable context can play a crucial role in interpretation. In the following I will first focus on the issue of general significance and then discuss the idea of an observable context in more detail.
 

4. Communication conditions

Clarifying how communication can succeed or fail is equivalent to clarifying communication conditions – conditions that must be met in order for successful communication to happen. In order to understand communicative challenges within the framework I have outlined, I will make a fundamental distinction between four conditions. The first is that communication requires a common language:
 
(i) In order for an audience to understand a speaker, it is necessary that they share a platform of shared concepts.
 
Here I use the expression ‘speaker’ in a wide sense to mean someone who has a belief, thought or other concept-involving psychological attitude that he wishes to communicate to an audience (one or several persons). Since audiences are unable to grasp speakers’ thoughts and beliefs directly, these subjective states have to be expressed in language acts that can be seen, heard or observed and interpreted in other ways. As emphasized above, this can be all sorts of intentional behavior, but for the sake of clarity I will in the following primarily focus on verbal speech acts. Thus, in order for an audience to be able to understand that a speaker expresses a given belief, it is necessary that the speaker and the audience understand the sentence that the speaker uses in a sufficiently similar way, so that they associate the same concepts with the words that the speaker uses (Cappelen & Lepore 2005).
The qualification ‘sufficiently similar’ is important. When I claim that speaker and audience must have a common language, I do not mean that they have to understand this language in the same way in the sense that they use it in exactly the same ‘language games’ (Wittgenstein 1953). It is sufficient that their understanding is so similar that that they associate the words that are used with the same concepts (Burge 1979; Peacocke 1992; Guttenplan 1996).
This, in effect, presupposes that the conditions for the sharing of concepts are weaker than the conditions for sameness of understanding. It is obvious that communicators must have some similar understanding of a word in order to associate the same concept with it – the understanding that the audience has must to some extent approximate the speaker’s understanding.4 But this leaves open what a sufficiently similar understanding is, and exactly what the threshold condition for shared concepts is has been a disputed issue (for a discussion of this, see Nordby 2004c).

I will not presuppose any specific view on this issue here, but I will rely on the widespread idea that it is unnecessary that communicators use a word in exactly the same way in order to associate the same concept with it. The main reason why this idea is reasonable is this: We very seldom use language in exactly the same ways; there are normally differences due to our respective social and cultural contexts. So if we needed an identical understanding in order to share concepts, we would, in fact, seldom be able to exchange beliefs and thoughts involving the same concepts. Furthermore, laypersons should not need complete expert competence regarding the application conditions of a term in order to express the same concept as persons who have expert competence (Putnam 1981; Pessin & Goldberg 1996). If that were the case, laypersons within a given area of discourse would be unable to communicate with experts (consider again the area of health care and the relation between patients and medical doctors). This is a counterintuitive consequence, and it constitutes a good reason for being skeptical about the view that a platform of shared concepts requires an identical understanding.
 
The second communication condition I wish to focus on is more straightforward:
 
(ii) In order for a speaker to be able to communicate a belief, he needs to have the attention of the audience.
 
The idea is as follows: A speaker might express a belief, used a language that the speaker and the audience have a sufficiently similar understanding of and think it has reached the consciousness of the audience. It can nevertheless happen that the audience fails to realize that the speaker intends to communicate this belief. The reason for this may be lack of attention, problems of interpretation due to a chaotic situation, or an impaired capacity for rational reasoning (a patient might be in a state of shock or under the influence of drugs). But the problem may also be of a more technological nature, e.g. computers that do not work so that audiences are unable to use them as interactive communication tools.

It is important to bear in mind that in order for a misunderstanding of this kind to occur, the speaker must be unaware of the communicative problems. The speaker must genuinely believe that he has the attention of the audience, that there is no significant communicative ‘noise’ or disruption; otherwise he would not be sincerely attempting to communicate a belief. An example can be used to illustrate the point:

Paramedics encounter a patient who has taken a large amount of paracetamol. Relatives have called 113, and the patient himself, in a confused and agitated state, makes it clear that he does not want to be taken to hospital. In order to persuade the patient that treatment in hospital is necessary, the paramedics try to inform the patient about the physiological effects of paracetamol and they tell him that large doses of paracetamol can lead to serious irreversible damage to the liver. They hope that this information will lead the patient to change his mind, but this does not happen. Consequently, the paramedics decide that there is little use in trying to persuade the patient, and they begin to consider more complicated strategies for securing necessary transport and treatment. 
 
In this situation it was evident that the paramedics assumed that the information about the negative health effects of large doses of paracetamol had reached the consciousness of the patient. However, it soon became evident that this had not happened. When the patient calmed down and his relatives told him what the paramedics had said, the patient realized the gravity of the situation and made it clear that he wanted to go to the hospital after all. In the first place, because of his confused state and the stressful encounter with the paramedics, the patient did not form the belief that the paramedics intended to communicate and thought that it was important to communicate.
 
If we manage to avoid the two forms of misunderstands that occur when conditions (i) or (ii) are not met, does this mean that communication has succeeded? Not necessarily. Even if speaker and audience have a platform of shared concepts, and even if the speaker has the attention of the audience so that the message that he intends to communicate actually reaches the consciousness of the audience, it might still happen that the audience associates this message with beliefs and thoughts that are very different from the set of beliefs and thoughts that the speaker associates with the message. This third form of misunderstanding corresponds to a third communication condition:
 
(iii) The wider set of beliefs and thoughts that an audience associates with a belief that is directly expressed in language must not be radically different from the wider set of beliefs and thoughts that the speaker associates with this belief.

As Davidson (1987, p.449) notes, interpretation always “rests on vague assumptions about what is and what is not shared” by speaker and audience, and problems typically arise when assumptions about what is shared beliefs turn out to be incorrect. Of course, if communicators’ perspectives are so radically different that they influence the semantic interpretation of the language that a speaker uses, then the misunderstanding that arises is a misunderstanding of the first kind (i). In such cases speaker and audience do not even have a common language. A misunderstanding of the third kind requires that the message that is literally expressed by language is understood, that the communicators have a sufficiently similar understanding of the words that are used in the sense explained above. The problem that can still arise is that the beliefs that surround this message are radically different. An example can illustrate the point:

An AMC-nurse tells a patient who has called 113 that ‘The ambulance is on its way’. The patient forms the belief that the ambulance is on its way, but he then forms a further belief - the belief that the ambulance will arrive very soon within the next few minutes. The patient expresses disappointment when the ambulance arrives after 30 minutes.

In this case communication of the belief that the ambulance is on its way has succeeded. The AMC-nurse has the attention of the patient, and they both associate the concepts the, ambulance, is, on, its and way with the sentence ‘The ambulance is on its way’. The problem is that communication has failed in the wider sense that the AMC-nurse does not associate the belief that the ambulance is on its way with the belief that the ambulance will arrive within a few minutes.5 The patient, however, forms this association. He grasps the content of the message that the nurse expresses literally in words, but he then forms further associations that are radically different from the way the nurse intends this message to be understood.

The qualification ‘radically different’ is important here. Two persons never associate the beliefs and thoughts they form with other beliefs and thoughts in exactly the same way; there will always be some different associations as long as interpretation is shaped by social and cultural context (Burge 1979; Davidson 1984; Smith 1997). The important point is that there are many cases in which the associations that are formed are so different that poor communication occurs. From the perspectives of speakers, it is the beliefs that it is most important to communicate that are ordinarily expressed literally in words; that is why communication of these beliefs is normally straightforward. It is when speaker and audience understand what is not strictly speaking said in significantly different ways, that a misunderstanding of the third kind (iii) occurs.

Is communication ensured if we manage to avoid the three forms of misunderstanding that correspond to communication conditions (i)-(iii)? We might think so, but this is because we sometimes tend to forget that communication is not always a rational activity. In addition to beliefs and thoughts that are true or false, there are many other subjective states that are important in human interaction. The fourth and final communication condition is meant to capture the fact that we sometimes communicate psychological states that are essentially different from beliefs and thought that are true or false:
 
(iv) The values, emotions and other non-conceptual subjective states that an audience ascribes to a speaker must not be different from the values, emotions and other non-conceptual states that the speaker intends to communicate. 
 By ‘values, emotions and other non-conceptual subjective states’ I mean states that cannot be ascribed as beliefs or thoughts that involve concepts. When we think about communication we often tend to focus on such states, on attitudes we ascribe by saying things like ‘S believes that p’ or ‘S thinks that p’ where ‘p’ is a concept-involving proposition. For instance, when I say ‘S believes that snow is white’, I ascribe to S the attitude of believing in a proposition involving the three concepts snow, is and white (which is true if snow is white and otherwise false). It is easy to forget that we sometimes intend to communicate psychological states that are not attitudes to propositions. Personal values are not attitudes to propositions, it makes no grammatical sense to say ‘S values that p’ and replace for ‘p’ propositions that are true or false depending on how the world is. Personal values are rather attitudes to ‘forms of living’ (Wittgenstein 1953; Johnston 1989); to the ways we wish to live our lives and the activities we like to participate in (Dancy 1996). The same applies to emotions and other personal experiences. The way I feel a certain pain, or the way I have a visual impression of a computer in front of me, cannot be directly experienced by another person. I can attempt to report and communicate my experience by using a sentence that I think is true or false (‘I am in pain’, ‘I have the impression of seeing a computer in front of me’), but this sentence is not identical to the state I talk about and have privileged first-person access to. The state is a pure subjective experience, not a belief or thought about something (Rosenthal 1991).
Understood in this way, the significance of (iv) becomes similar to that of (iii). We often try to communicate our personal values and experiences to other persons, but sometimes our audiences ascribe to us states that are different from those we intend to communicate. For instance, a patient who uses emotional vocabulary like ‘I am in pain’ will normally be interpreted as expressing a state with a certain qualitative ‘pain’ content. If this interpretation is wrong - if the pain that the paramedic thinks that the patient feels is very different from the qualitative nature of the pain the patient feels – then a misunderstanding of the fourth kind has occurred.

Values that are attitudes to forms of life or activities are subject to the same problems of interpretation. In discourse between persons from different social or cultural contexts the values that are ascribed may be different from the values that the communicators have. It is reasonable to assume that this sometimes occurs in paramedic-patient interaction. A patient who is perceived as a person who appreciates that the paramedics are acting in a certain way might in fact be a patient who endorses an alternative course of action. Typical cases include interaction between elderly people and younger paramedics who have a more ‘modern’ way of life. In one case observed by the author of this paper, a paramedic consequently addressed an elderly patient by his first name, even though it was fairly evident that the patient would have appreciated an alternative course of action (e.g. he introduced himself using his surname).

This last communication condition (iv) might seem to inflate the philosophical framework of speech acts and concepts, but this is not the case. On the contrary, since the first three conditions focus entirely on concept-involving beliefs and thoughts, it is possible to formulate a fourth condition that captures the remaining ‘subjective’ and qualitative dimension of human communication. The philosophical framework I have outlined leaves room for this further condition precisely because it makes a sharp distinction between concept-involving and non-concept-involving subjective states.
 

5. Implications: interactive and face-to-face communication

I am not going to argue that the four conditions I have presented represent the only possible way of analyzing communication. Holding that they are reasonable is consistent with holding that there are other conditions that are important as well. In fact, I do not even mean to provide a direct argument for the view that the conditions offer a plausible analysis of how poor communication can occur. What I primarily wish to focus on is their explanatory power, particularly the way they can be used to shed light on the similarities and differences between face-to-face and interactive communication.
If we start with the first condition (i), i.e. having a common language, how is this condition relevant for understanding the nature of the two forms of communication? The basic distinction to be made in connection with (i) is that between what a word means and what a speaker means. An utterance heard on the phone or a sentence read on a computer screen means something – it has a semantic content. But when an audience is confronted with a speaker the immediate question for the audience is as follows: What is the mental state – belief, thought or value - that the speaker has and intends to communicate?
This difference of focus corresponds to two different ways of conceiving of a speech act. The activity that is performed interactively is a pure language act; the social context of the act is not part of the meaning of the act. From the perspective of an audience, the aim is to understand the proposition expressed by the language shared by the speaker and the audience. The focus must be explicitly or implicitly on meaning, and the relevant interpretative activities correspond to the scope of philosophy of language – to philosophical questions about the meaning of language.

Face-to-face communication, on the other hand, is a social activity that essentially belongs within pragmatics and philosophy of mind. The question that confronts face-to-face communicators is this: What is the belief that the speaker in this context uses language to express? This is not a semantic question about the meaning of the words per se, but a question about the psychological nature of the relevant mental states of the speaker. 
Even though the interpretative activities involved in the two forms of communication in this way correspond to different philosophical disciplines, it is important to recognize that the activities are similar in the sense that they both involve literal interpretation. That is, we normally assume that words that are used literally express the concepts communicated. We assume, for instance, that the word ‘dog’ in interactive communication means dog, just as we assume that a speaker who uses the word ‘dog’ expresses a belief involving the concept dog. In this sense there is an important similarity between face-to-face and interactive communication, and the requirement that communicators need to have a common language can be used to understand challenges related to concept communication within both forms of communication.

At the same time it is important to bear in mind that there are sometimes good reasons for not accepting literal interpretations, and in such cases the differences between face-to-face and interaction communication become more significant. In order to show why this is so it is important to distinguish three kinds of expressions. The first is what might be considered words with vague or unclear application conditions. Many words that are used in everyday discourse do not have precise definitions, and the meaning explanations speakers give often differ even though they are members of the same linguistic community (Burge 1979; 1986).6  Three of the most disputed words in the area of health care are ‘disease’, ‘illness’ and ‘sickness’ (Lupton 1994; Radley 1994; Worhall and Worhall 2001), but the point is of course general. There are countless vague or abstract words that communicators tend to understand in significantly different ways.

The fact that we commonly use vague words has an important consequence: different conceptions of what words mean are normally easier to detect face-to-face than interactively. There are at least three reasons why this is the case. Firstly, face-to-face communication more often than interactive communication involves substantial dialogue over time in which communicators realize that they do not have a similar understanding. Furthermore, when differences emerge and receive attention, audiences who are interested in communicating tend to adjust their conceptions of what speakers mean. Secondly, it is sometimes evident from the body language or verbal behavior of a person that he does not share the understanding of another person. If a doctor tells a patient who is feeling ill that it has not been establish that he has a disease, and if the patient thinks that the doctor has a very narrow, rigid understanding of ‘disease’, the patient’s body language may manifest incongruent communication: even though the patient says that he accepts the doctor’s opinion, the patient’s body language or other aspects of the communicative context indicate that he disagree. Thirdly, in face-to-face communication speakers have time, and it is often natural, to explicate in some detail how they understand words they conceive of as controversial. In particular, speakers often provide direct or indirect meaning explanations of words they think the audience has an incomplete understanding of.

Again, these points must be understood as prima facie principles that do not cover all cases. For instance, speakers regularly provide meaning explanations in interactive communication, consider an explanation of what an ‘essay’ is that a teacher distributes to his students via the internet. And face-to-face communication does not always involve extensive rational dialogue and proper explanations of theoretical or technical terms that are conceived to be important, as the above ‘paracetamol case’ clearly illustrates. However, it is surely the rule and not the exception that it is easier to detect and influence different conceptions of what a word means in face-to-face communication than in interactive communication.

This also applies to a second kind of words that can be termed ‘qualitative words’. Qualitative words are words that refer to private, individual experiences, or subjective states that have a significant personal element. Typical examples are words that denote states like pain, nausea or dizziness, but the category, as I understand it here, also includes emotional vocabulary like ‘love’, ‘compassion’ and ‘empathy’ that are used to communicate states that do not so clearly refer to determinate conscious experiences. The important point is that these words also have a subjective, private dimension that it can be difficult to detect in communication.  

Communicative challenges related to the use of qualitative words are to a large extent similar to the challenges related to unclear words, but qualitative words have an additional dimension: an audience has by definition only indirect access to a speaker’s first-person experiences, but it is these experiences that constitute the reference and thereby the individual meaning of qualitative words. Qualitative words report these experiences, but they can only function as interpretative clues to the underlying nature of the experiences. This does not necessarily mean that the experiences are completely hidden from an audience; there are few modern traditions in philosophy of mind that hold that emotional states are fully independent from behavior (Rosenthal 1991; Davies 1995; Guttenplan 1996). The important point is that there must be some independence; there are not many theorists today who accept the extreme and classical behaviorist doctrine that experiences are identical to behavior (Ryle 1949). And if we accept the modern, more modest view that experiences are partly displayed in behavior, then it is reasonable to assume that communication of qualitative words more often succeeds in face-to face communication than in interactive communication. Normally, facial expressions or other forms of observable body language constitute part of the content of the experiences that a speaker intends to communicate.
The third category of words that deserve attention is technical or theoretical words. In face-to-face encounters it is sometimes sufficient to watch a person’s eyes in order to discern whether theoretical vocabulary represents meaningless sounds or not. Furthermore, in face-to-face interaction it is possible to use various forms of body language as specialized communicative tools. A good example is the non-verbal dialogue in AMC centers between nurses and ambulance coordinators. While talking to patients on the phone, they are able to observe each other and use body language – language that patients do not observe  – as part of the basis for deciding what to do. An ambulance coordinator might for instance hold up two fingers to suggest to the nurse that the ambulance should be called out under ‘code 2’. If the nurse nods while the patient is on the line, the ambulance coordinator normally proceeds to call up an ambulance under ‘code 2’.

There is also a further aspect of the communication of technical words that is essentially different from the communication of unclear words and experiences. The fact that technical words have a standard, normative meaning means that it is possible to make a principled distinction between experts who have a complete, correct understanding and laypeople who have an incomplete understanding. Within recent philosophy of mind, it has been a widespread view that if a layperson is willing to defer to an expert’s correct understanding of a word, then he possesses the same concept as the expert even though he does not have a complete understanding. Burge expresses this view in an illuminating way when he writes that 
 
…wherever the subject has attained a certain competence in large relevant parts of his language and has assumed a certain general commitment or responsibility to the communal conventions governing the language’s symbols, the expressions the subject uses take on a certain inertia in determining attributions of mental content to him. (Burge 1979, p. 114)
 
It is only when a person with an incomplete understanding is unwilling to defer to the normative meaning of a word that he should be understood as someone who has chosen to associate the word with his own individual concept that does not correspond to the correct, normative understanding. Deference-willingness is in this sense a precommunicative attitude: laypeople need to have this attitude in the first place in order to be able to possess the same concepts as experts who possess and fully understand the correct, standard concept.
 
The fact that this point is valid only when the expert-layperson distinction applies has an important implication: from the perspective of a speaker who has a competent understanding, it is often easier to secure a platform of shared concepts by using words with precise application conditions than by using unclear, everyday words that do not have standard, normative definitions. The reason is that audiences normally think they are entitled to understand the latter words in special, idiosyncratic ways if there is no profession that knows what the correct understanding is (Helman 1984; Lupton 1994). More generally, communicators tend to think that they are justified in understanding and using unclear or vague expressions in accordance with how they have learned them in their particular social and cultural contexts, even though they know that other speakers sometimes use them in other ways in other contexts. In such cases the idea of deference-willingness does not apply: Communicators from different contexts will stand face to face and be unwilling to revise their understanding.7 But when one of the parties is perceived as being an expert on the application of a word within a given area – e.g. the way students often think of their teachers - the non-expert will normally defer and thereby possess the same concept as the expert.

If one seeks to apply this theory of deference-willingness, the strategy will obviously work only if it is possible to give the audience a sufficient understanding and if the audience is really willing to defer. The latter condition is particularly important. Even if there are standard application conditions for a term, this does not help if the audience thinks of the speaker as a strict authority and consequently does not defer to his explanations. From the perspective of a speaker with a competent understanding who faces an audience who does not have a complete understanding, it is therefore necessary to create a situation where the audience feels comfortable deferring to the normative meaning in order to secure a platform of shared concepts. Furthermore, it is reasonable to assume that this aim is easier to achieve face-to-face than interactively. Often a simple smile, a friendly gesture or other form of body language is sufficient for creating an atmosphere in which audiences think of speakers not only as experts, but as sympathetic experts. In this deep philosophical sense, it is easier to secure communication of concepts in face-to-face relations than in interactive relations.
 

6. Further implications

So far I have focused on implications of the first communication condition (i), but as emphasized above, meeting (i) can only be a necessary condition for meeting the three further conditions (ii)-(iv). When I claim that two persons must understand a language in the same way, what I mean is that they must understand it in the same way in general. Obviously, when a speaker does not have the attention of an audience, speaker and audience do not understand the language act that is performed in the same way there and then. What the second communication condition (ii) was meant to capture is the idea that in order for the communication of a belief to succeed, the attention of the audience is needed in addition to a shared platform of concepts. 
Is (ii) a condition that is relevant in both face-to-face and interactive communication in the way (i) is? It is since speakers always need the attention of their audience in order to be able to communicate beliefs and thoughts. The differences between the two forms of communication do not matter; (ii) represents a fundamental communicative aim both in face-to-face and in interactive communication.

At the same time there is an obvious difference between face-to-face and interactive communication: it is much easier to secure the attention of an audience in the former than in the latter. After all, speakers are normally able to see whether they have the attention of their audience, and it is also easier for them to understand how to proceed in order to secure attention. Again, this does not apply without exception. Audiences might ostensibly understand and internalize what a speaker says but nevertheless make it clear later that they have not formed the beliefs that speakers intend to communicate. Causes can be states of shock or stress but also, less dramatically, lack of genuine attention or problems of concentration.

It is equally evident that the third communication condition that focused on associate misunderstandings applies in both face-to-face and interactive communication. Both forms of communication can involve audiences who associate a message with beliefs and thoughts that are radically different from the beliefs and thoughts that a speaker has. Whether or not the communicators observe each other is not crucial for this. An audience who hears a speaker over the phone might ascribe to the speaker beliefs that the speaker does not have, even though the audience understands what is literally expressed by the sentence in question, as the above ‘The ambulance is on its way’ case clearly illustrated. But this case could also be redescribed to show how a similar misunderstanding could occur face-to-face.  Imagine for instance a doctor who tells a patient who has been hospitalized for some time that ‘Your condition has really improved’. The patient takes this to mean that the doctor thinks that he will be able to leave the hospital within a few days, he becomes frustrated when this turn out to not happen, and we might even imagine that he tells relatives that the doctor gave him false expectations. The problem, we may assume, is that doctor does not associate the belief that the patient’s condition has improved with the belief that the patient should be sent home within a few days. He does not mean to commit himself to this or any other specific interpretation of ‘improved condition’.8

Even though these two cases clearly show that associate misunderstandings can occur both in face-to-face and interactive interaction, they also suggest an argument for the view that they more often occur in the former than the latter. When doctors in situations like the above utter sentences like ‘Your condition has really improved’, it is not unusual for patients to ask ‘Does this mean that I will be able to go home soon?’ if they are concerned about this. There is typically more of an atmosphere of dialogue and conversation in face-to-face communication, and this often causes audiences to clarify their own perspectives and make inquires about the speaker’s beliefs. In fact, communicators’ overall communicative aim is often to clarify their own perspectives and the perspectives of the persons they are talking to. Associate misunderstandings typically occur when the situation is hectic, or when there is for some other reason poor dialogue about different aspects of the issue of discourse. In interactive communication, the problem is often that it takes a lot of time to clarify one’s own perspective extensively.

The same point applies in connection with the last communication condition (iv), which focused on incorrect ascriptions of experiences and values, but now communicators face an additional challenge that makes observation even more significant. On the phone or via radio a person’s subjective states can only be presented as descriptions or single words that express these states. Everything depends on the interpretation that the audience makes; the language that is heard on the phone or seen on the screen is the only interpretative clue. An observable communicative context, on the other hand, will often provide vital clues to the nature of an underlying experience. An adequate understanding of a pain state will normally be easier to achieve in face-to-face encounters because a person’s body language tends to reveal intrinsic aspects of the state.

As long as a person’s immediate surroundings provide important clues to his social and cultural background a similar point applies when values are communicated. Our personal values, the activities we like to participate in and the complex ways we wish to live our lives, are first and foremost accessible by observations of how we actually choose to live our lives in the contexts we are in. In this sense similarities and differences in values are often easier to detect face-to-face than interactively, and incorrect attributions of values do not occur so easily.

There is a further even more fundamental difference between the fourth and the first three communication conditions. The first three focus on conditions for communication of concept-involving prepositional attitudes like beliefs and thoughts. This means that they are subject to the aim of understanding as a ‘fusion of horizon’, the idea that fundamental understanding is a matter of speaker and audience sharing subjective states involving the same concepts. (Gadamer 1975, 1994; Mueller-Vollmer 1986; Green 2000). A speaker and an audience who share many of the same beliefs have cognitive horizons that are much more similar than communicators who do not have many of the same beliefs. From the perspective of a speaker, the practical implications of this idea that a fusion of horizons should be regarded as an aim of understanding can be formulated as three action-guiding questions: corresponding to the first communication condition (i), does the audience have an understanding of the language I use that is sufficiently similar to my own understanding? Corresponding to the second condition (ii), do I have the genuine attention of the audience? And corresponding to the third (iii), is it reasonable to think that the audience will associate the belief that I express literally in language with other beliefs that are radically different from the beliefs I have?

It is important to recognize that since the fourth condition does not focus on conceptual states a similar question related to the idea of a shared horizon cannot be formulated. An experiential state like pain does not involve concepts that can be shared with another person. Of course, if a person reports ‘I am in pain’, and if an interpreter takes this to mean that the person is in pain, then they share the concept pain. But as emphasized above, this is not the same as sharing the state of pain. Similarly with values; a speaker might appreciate living his life in a certain way and attempt to communicate this value to an audience by using a particular sentence. The audience might associate this sentence with the same concepts as the speaker, but this does not mean that they share the same value. In order to understand what the underlying value is, the audience needs to take a further step and identify the value state that lies beneath the surface of language. A misunderstanding of the fourth kind occurs when this attempt fails. The question a speaker needs to ask in order to prevent misunderstandings of this kind is therefore this: Have I correctly understood the values of my audience, and is there a chance that I will be ascribed values that I do not have? 

This question about values should be sharply distinguished from the question of whether a person expresses a true or false subjective state. A belief is subject to rational discussion about truth and falsity; if someone thinks that a person has a false belief, he can rationally try to show the person that the proposition he believes in is false. Since values are attitudes to activities and not propositions, they are not subject to similar questions about objectivity. If someone wants to influence or change another person’s values, the only rational way of doing so is to go beneath them, to locate possible beliefs and thoughts they are grounded in. For instance, I appreciate drinking a lot of coffee. This is an everyday personal value I have, but I would not have it if I formed the belief that drinking a lot of coffee is very unhealthy. So, if a person I consider to be a medical expert explained to me that me my activity is very unhealthy, then I would probably form this belief, and I would no longer have my value.

It is therefore sometimes possible to change a person’s values by identifying unjustified beliefs that support them. The problem arises only if we think that a person’s values are equivalent to beliefs and thoughts and consequently attempts to show the person that his values are not ‘objectively correct’. A person who is subject to such a criticism will typically feel that we are encroaching on a private sphere that we are not entitled to enter; the person has already an implicit grasp of the nature of personal values as subjective states that we have an individual right to form.

A further discussion of this issue would fall outside the scope of this article, but I think it has been important to make it clear exactly why successful communication presupposes that communicators, implicitly or explicitly, are able to distinguish beliefs and thoughts from personal values. A fundamental identification of a person’s values is often crucial for successful communication, regardless whether or not we want to change these values.
 

7. Conclusion

By using examples from paramedic-patient interaction within a theoretical framework from philosophy of mind and language, I have tried to explain how the idea of communication conditions can be used to analyze communication. In doing so I have made a distinction between four fundamental conditions. The first focuses on the idea of a shared language, the second on communicative attention, the third on the way we associate beliefs with other beliefs, and the fourth on subjective states like experiences and values that do not have a conceptual, propositional content.

I have argued that these four conditions constitute fundamental communicative aims both face-to-face and in interactive communication. At the same time they suggest different strategies for how these aims should be achieved within the two realms of communication. The fact that the four conditions cover both forms of communication constitutes a fundamental justification for adopting these strategies in face-to-face and interactive interaction. This does not mean that the conditions imply that it is easier to secure successful face-to-face communication than it is to secure interactive communication. Obviously, it is natural to assume that it is often easier to achieve the former than the latter (but there are some obvious exceptions), but the question of whether this really is so remains a further question. My aim has been to develop a plausible framework for addressing this and other normative questions related to face-to-face and interactive communication.

In addition to this instrumental justification for applying the communication conditions, .I think it is important to recognize a further argument. It is sometimes held that an instrumental justification of a theory must be essentially incomplete, since it is possible for an instrumental theory to be false (Dennett 1978). But in this context I do not think this is a genuine possibility. Philosophical theories of communication are after all meant to capture ordinary discourse - it is standardly assumed that whether they do or not is what makes them true or false  - so in this case the fact that the conditions match our communicative practices constitutes a good reason for holding that they are true. Too often philosophical theories of communication are developed in isolation from areas of application, even though it is claimed that they are grounded in common sense. What I have tried to show is that the four communication conditions are really grounded in ordinary communicative practices.

Finally, I would like to make it clear that it has not been possible to discuss in detail the practical consequences of the analyses I have made within the limits of this article. The aim has been to develop and clarify some fundamental philosophical distinctions and to point out some reasonable implications of these distinctions. However, more empirical research is necessary to explore these implications further. What I have offered is a framework for doing such research, but this is a framework that in itself should be modified and developed further on the basis of such research.
 

References

Bechtel W. & Graham G. (eds) (1998). A Companion to Cognitive Science. Oxford: Blackwell publishing.
 
Bezuidenhout A. (1997). ‘The Communication of De Re Thoughts’. NOUS, 31, pp.197-225.
 
Burge T. (1979). ‘Individualism and the Mental’. Midwest Studies in Philosophy, 4, pp.73-120.
 
Burge T. (1989). ‘Wherein is Language Social?’, in Reflections on Chomsky, A. George (ed). Oxford: Blackwell.
 
Cappelen H. & Lepore E. (2005). Insensitive Semantics. Oxford: Blackwell publishing.
 
Dancy J. (1996) Moral Reasons. Oxford: Blackwell publishing.
 
Davies M. (1995). ‘Philosophy of Mind’, in Philosophy: A Guide Through the Subject, A.C Grayling (ed). Oxford: Oxford University Press.
 
Davies M. (1998). ‘Externalism, Architecturalism, and Epistemic Warrant’, in Knowing Our Own Minds, C. Wright, B. Smith and C. Macdonald (eds). Oxford: Oxford University Press.
 
Davidson D. (1984). Inquires into Truth and Interpretation. Oxford: Clarendon Press.
 
Davidson D. (1987). ’Knowing One’s Own Mind’, Proceedings of the American Philosophical Association, 61, pp.430-70.
 
Dennett D. (1978). Consciousness Explained. Middlesex: Penguin Books.
 
Eide T. & Eide H. (2004). Kommunikasjon i praksis. Oslo: Gyldendal akademisk.
 
Enelow A., Forde D. & Brummel-Smith K. (1996). Interviewing and Patient Care. Oxford: Oxford University Press.
 
Gadamer H. G. (1975). Truth and Method. New York: Seabury Press.
 
Gadamer H. G. (1994). Literature and Philosophy in Dialogue. Albany NY: State University of New York Press. 
 
Green G. (2000). Theology, Hermeneutics, and Imagination: the Crisis of Interpretation at the End of Modernity. Cambridge UK: Cambridge University Press.
 
Guttenplan S. (ed.) (1996). A Companion to Philosophy of Mind. Oxford: Blackwell publishing.
 
Johnston P. (1989). Wittgenstein and Moral Philosophy. Oxford: Routledge.
 
Kripke S. (1982). Wittgenstein on rules and private language. Oxford: Blackwell publishing.
 
Mechanic D. (1968). Medical Sociology. New York/London: The Free Press.
 
Mueller-Vollmer K. (ed.) (1986). The Hermeneutics Reader: Texts of the German Tradition from the Enlightenment to the Present. Oxford: Blackwell publishing.
 
Nettleton S. (1995). The Sociology of Health and Illness. Cambridge UK: Polity Press.
 
Nordby H. (2004a). ‘The Importance of Knowing How to talk about illness without applying the concept of illness’, Nursing Philosophy, 5, pp.30-40.
 
Nordby H. (2004b). ‘Communicative Challenges for Paramedics’. Scand J Trauma Resusc Emerg Med,12, pp.178-182.
 
Nordby H. (2004c). ‘Incorrect Understanding and Concept Possession’, Philosophical Explorations, 7, pp.51-75.
 
Nordby H. (2006). ‘Nurse-patient-interaction: Language Mastery and Concept Possession’. Nursing Inquiry, 13, pp.64-72.
 
Peacocke C. (1992). A Study of Concepts Cambridge MA: MIT Press.
 
Peacocke C. (1998). Being Known. Oxford: Clarendon Press.
 
Pessin A. & Goldberg S. (eds) (1996). The Twin Earth Chronicles. New York/London: M.E. Sharpe.
 
Putnam H. (1981). Reason, Truth and History. Cambridge, UK: Cambridge University Press.
 
Radley A. (1994). Making Sense of Illness. London: Sage publications.
 
Rosenthal D. (1991). The Nature of Mind. Oxford: Oxford University Press.
 
Ryle G. (1949). The Concept of Mind. London: Huchinson.
 
Smith N. (1997). Strong Hermeneutics: Contingency and Moral Identity London: Routledge.
 
Tjora A. (1997). Caring Machines. Dr. Polit Thesis in Sociology. Trondheim: NTNU.
 
Travelbee J. (1971). Interpersonal Aspects of Nursing Philadelphia: Davis.
 
Warnke G. (1987). Gadamer: Hermeneutics, Tradition, and Reason. Stanford CA: Stanford University Press.
 
Wittgenstein, L. (1953). Philosophical Investigations Oxford: Blackwell publishing.
 
Worhall J. & Worhall J. (2003). ‘Defining Disease: Much Ado about Nothing?’ Analecta Husserliana, 72, pp.33-55.


1 An important motivation for providing information about the patient’s condition is that the paramedics can prepare themselves mentally and in practical terms for the situation that awaits them.
 
2 It is in general a sound methodological principle that issues of understanding and communication are not subject to questions about normativity in the way questions of truth and knowledge are.
 
3 I am grateful to an anonymous referee for this journal for pointing out that this objection needs to be addressed.
 
4 As emphasized above, this can be an understanding that the audience thinks is correct in general but also an understanding that is employed for communicative purposes. The important point is that the understanding that the audience employs must approximate the speaker’s understanding.
 
5 When the condition of a patient is perceived as not being acute the ambulance is not required to adopt ‘code one’ which is the code for acute situations, and it might take some time before it arrives (but outside central areas it might take some time even if the code is ‘code one’).
 
6 A meaning explanation is here understood as the explanation a speaker would give if he was asked to explain what a word applies to. Meaning explanations are very seldom conceived of as complete descriptions of what a word means; we do not consider them as sentences that capture the whole meaning of the term we are asked to explain.  They are rather statements that capture central aspects of a word’s meaning. Compare, for instance, the explanation ‘The word ‘dog’ applies to a group of mammals with four legs’ with the explanation ‘ The word ‘dog’ applies to an animal my grandmother has’. Only the first statement is normally conceived of as a meaning explanation.
 
7 Consider again a doctor who tells a patient that he has not been able to locate any underlying disease. The patient, we might suppose, thinks that he must have a disease, and thinks that the doctor has a very narrow understanding of ‘disease’. An important part of the reason why such an attitude is widespread is that the patient thinks that he is entitled to use ‘disease’ in the way he has learned the word in his special social and cultural context. This point generalizes to countless words with non-standard application conditions.
 
8 This kind of misunderstanding is sometimes displayed in newspapers, under headlines like
‘The doctor gave me six months to live’. One should be skeptical about the idea that doctors very often state predictions in such a bold way.  In fact, what has often been stated is something much weaker (‘There is a significant possibility that…’), but patients often associate these statements with stronger claims. This is a general phenomenon that most professionals involved in interaction with various forms of clients or patients should be aware of: we tend to forget qualifications like ‘significant possibility’ after a while, and we think of claims that have been made as much stronger than what they in reality were.

 
 

Search

Monitor 2011 - The digital state of the Norwegian school

Lillian Gran

Department of Education and Social Work
Lillehammer University College
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Review of the national digital survey

A yearly digital survey committed in compulsory school in Norway

Keywords: The Digital condition of the Norwegian compulsory school, motivated students, technology, media, digital natives

Monitor 2011(Egeberg, 2012) is a submission on the fifth quantitative survey of the Norwegian digital health situation completed by Egeberg et al. The survey is a qualified comparison foundation with international surveys on digital competence such as, e.g. PISA. Since 2003, the digital surveys have been completed every other year in Norway to identify indications on schools' digital state. The respondents who were chosen are a selection of school leaders, teachers and student in the 8th and 9th grades and level two in upper secondary school. The submissions research and results are also organized according to these three areas of participants.

Read more...

Digital Storytelling, Mediatized Stories: Self-Representations in New Media

Knut Lundby (red.)

Publisher: Peter Lang Publishing, New York, 2008.

Reviewed by
Jill Walker Rettberg
Associate Professor of Digital Culture
University of Bergen
http://jilltxt.net

We live in an age in which more and more of us are creating our own "digital stories". In 2008, 18% of Norwegian 16-24 year olds were recorded as being active bloggers over the previous three months (Statistics Norway, "ICT in households", 2nd quarter 2008) while more than 2/3 of American teenagers have uploaded self-produced material to the Internet, in the form of YouTube videos, photographs, blogs, stories, remixes etc. (Pew Internet). The numbers of these "user-made" cultural productions are growing year by year and spreading from the younger generation to us adults, who are now the group most increasingly represented on Facebook. In blogs and on Facebook the distinction between amateur and professional is largely meaningless.

Read more...

Story Circle: Digital Storytelling Around the World.

John Hartley and Kelly McWilliam (eds.)

Publisher: Malden, Mass.: Wiley-Blackwell, 2009

Reviewed by
Birte Hatlehol
PhD student in Media Education
Norwegian University of Science and Technology
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

The anthology Story Circle is an international study of digital storytelling that discusses the phenomenon in a global context. The book contains 20 articles with contributions from a number of key specialists with wide-ranging experience in the field of DST.

Read more...

Moving Media Studies - Remediation Revisited

Edited by Heidi Philipsen and Lars Qvortrup

Publisher: Samfundslitteratur Press: Frederiksberg Press, 2007.

Reviewed by
Stephen Dobson
Professor
Lillehammer University College
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Introduction
Two questions can be asked: firstly, not do we need another book on remediation, but why? And secondly, if this is the case, what kind of book should it be? This review spirals around these questions.
Read more...

Global perspectives on E-learning.

Rhetoric and reality by A. A. Carr-Chellman (Ed.). Thousand Oaks, CA: SAGE, 2005

Reviewed by
Dr. J. Ola Lindberg
Department of Education, Mid Sweden University
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
 
Dr. Anders D. Olofsson
Department of Education, Umeå University
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.


It seems suitable to begin this review by giving a brief description of the context in which the texts of this book are produced. If it fails to be regarded as a description, then we hope at least it can be regarded as one possible understanding of the context. When contextualizing a book, a good idea seems to be to start with a few words about the editor, Alison A. Carr-Chellman.
Read more...
how much is viagra in mexico where can i purchase mircette trial erection packs 1 cheap us pharmacy noroxin online store viagra for women does it work generic prevacid online rosuvastatin price india can motilium be taken during pregnancy cleocin antibiotic uses buy stromectol tablets online non prescription pain pills for dogs is it safe to take 2 cialis lov cost buspar evecare australia synthroid vs levoxyl thyroid no prescription prozac online cheap terramycin india propecia drug classification buy vermox with e check order strattera viagra jelly orange what is a nuclear renal scan with lasix washout where can i buy diltiazem buy avodart pills in the us what does albendazole treat pletal best price generic brand viagra difference buy topamax 100mg acheter aldactone pas cher cheap kamagra pills pharmacy sumycin pills sweat metoclopramide tablets pregnancy how to order diclofenac online canada buy depakote without prescription canada order reglan minocycline shop allegra generic 2013 drugs comprar p57 hoodia en chile order zofran no prescription cordarone 100mg tablet viagra sublingual pct buy retail drug stores in canada can i buy viagra from tesco pharmacy can i get viagra without doctor toprol xl medication dog aspirin over the counter innopran xl for men in usa what types of cabgolin are there valtrex generic date amantadina 100 mg preУЇo v-gel delivery uk 2 100 mah lithium polymer battery life what are the side effects of long term use of zyrtec are albuterol and salbutamol the same purchase actos in us pille yasmin billig kaufen para que se usa el cephalexin 500mg legal status of drugs in europe flagyl forte tablet buy prednisone online without a prescription albendazole suppositories buy buy anafranil for daily use over the counter substitute for flovent cialis online without prescription-canada clomid birth control online uk insurance age non generic colospa generic brand of alesse 28 buy mentat inhaler canada maximum buspar dosage isoptin how to buy levaquin without a prescription from australia florinef best price ginseng generic cheap costs target vs walmart pharmacy prices is liquid zantac over the counter himcocid refills crushing bactrim tablets capoten prices can i make glyset info on hydrochlorothiazide medicine tofranil looking for can you buy viagra jelly in ireland pharmacy 50mg buy tadacip singapore calan discount code canada drug service of greenfield reviews lamictal canadian pharmacy discount canadian pharmacy aygestin cheap fluoxetine buy online pillola yasmin sicura al 100 buy online hytrin generic dramamine uk withdrawn simvastatin and ezetimibe hplc unique hoodia online kaufen ampicillin 500mg capsules use viagra for men for sale buy cialis sublingual usa cheap retin-a ge uk med cab ayurslim kamagra 100mg tablets london primatene mist replacement 2013 buy voltaren 50mg buy brand levitra no prescription acheter pas cher topamax cheap motilium no prescription indian propranolol coming off effexor xr symptoms buy benicar with visa hydrochlorothiazide tablets purchase on line wellbutrin rx clozaril order online no prescription proscar 5 mg side effects prednisone generic name buy shuddha guggulu online india side effects of levothroid 25 mcg low cost mircette non prescription emsam zetia online prices can i order eulexin no prescription in the usa zoloft from australia buy januvia boots is 50mg of sertraline a high dose stromectol for sale australia zithromax side effects fatigue amoxil drug oversea how much does nexium cost per pill can we trust cipro online sominex generic release date can get viagra nhs prescription motilium max dose levitra pharmacy canada can you take accutane daily apo-amitriptyline 10 mg for migraines buy xenical tablets usa how to use arimidex on cycle calcium carbonate prices cvs citalopram shelf life generic viagra indian companies bayer baby aspirin cheap ditropan india what is vasodilan used for purchase clozaril on line in usa rizatriptan vs sumatriptan can i make himcolin mexican dostinex lipitor 100 buy coumadin australia is generic xalatan effective buy hyzaar capsules low price cozaar uk alli 120 count best price nizoral 200mg tablets dogs nitroglycerin medication wiki buy canada no prescription for alesse midamor dosage too high buy sustiva online overnight promethazine order over counter allopurinol nome generico do haldol safe to buy generic lipitor from uk how to get seroquel in australia lotrisone on line for sale no script phenergan codeine buy uk cheapest accutane without insurance buy generic vasotec with bonus american mirapex how to take mycelex-g mg propecia rxlist online pharmacy nymphomax what are diclofenac sodium tablets medicine coreg side effects saroten retard erfahrungsberichte viagra over the counter thailand bystolic sales 2012 where to buy motrin pm neurontin direct pharmacy fast voveran sr delivery clarithromycin uses and side effects cam you order allegra canada side effects of ciprofloxacin 250 mg zyrtec overnight pharmacy rogaine 5 shelf life giving tetracycline dogs buy micronase from mexico online hytrin tablets buy provera pills online genuine suprax 100mg cheap phenamax diclofenaco sodico 50 mg para que sirve finpecia generic release date order lisinopril online no prescription with a mastercard torsemide prices at costco lozol order on web get geriforte toronto atp pure hyaluronic acid price bactroban ointment reviews buy valtrex cheap where cane i buy alligator meat online hair loss treatment propecia side effects generic name exelon can i order levitra super active no prescription in the usa free coupon for revatio methocarbamol high risk medicine to gain weight for women current price apcalis sx doxycycline acne medication side effects levaquin back order indian airlines star alliance free coupon for prilosec otc olivier fox janssen-cilag france where do you buy lithium orotate cheap dilantin buy online printable coupons for strattera eldepryl capsules capoten daily use reviews cheap ranitidine 100 mg online forum benadryl order allegra ephedraxin uk next day delivery compare prices prednisone isoptin no prescription needed revia on line no script avapro over the counter 300mg drugs what is the generic name for coreg buy zetia for daily use how to get safe viagra online betamethasone ointment side effects ciprofloxacin 500mg tab what is it used for buy isoptin 15mg online safe place order nimotop low carbon energy university alliance international conference accutane acne treatment pictures proscar tablets us online acquisto pilex sicuro online cheap cafergot 40 mg voveran tablets uses whoelsale lavetra actonel film tablet 35 mg 4 tb buy mircette low cheap price donde comprar tamoxifeno en espaУБa where can i buy amitriptyline online without a prescription i pill proscar website acticin medicine children proper dosage for viagra aciclovir tablets buy online olanzapine tablets from buy cheapest place to buy liposafe accutane with no rx albendazole uses medication methotrexate injections nausea benadryl antihistamine price philippines comprar l-tryptophan original what does phenergan do to dogs pilex order by phone cialais tablets pharmacy has best price glucotrol xl buy diflucan generic online cost synthroid vs generic accutane cost philippines what is januvia 100 mg used for cheapest price for zetia do you need rx retino-a cream 0,05 buy xenical tablets generic phenergan us bupropion hcl xl 150 weight loss buy blopress in singapore can you buy toradol what does phenergan generic allergic fexofenadine hcl and alcohol uk version of zyloprim colchicine generic no longer available effects of coming off cipralex buy zerit mg online harga obat valsartan 80 mg ditropan supplier in uk what medication is comparable to celebrex bactrim f dosis how long does it take for seroquel to work for depression buy flovent singapore quibron-t dose orlistat generic philippines where to buy betnovate drugs online buy sustiva online is it safe to buy childrens motrin generic cialis at walmart does phenergan make you gain weight buspar overnight pharmacy online generic cleocin gel cyproheptadine hydrochloride over the counter where to buy hoodia gordonii pure oxytrol tablets price how much will mevacor cost vardenafil generico what does finasteride look like singulair 4mg pret synthroid side effects dry mouth prednisolone dose for kids prednisolone side effects anxiety best place buy myambutol pct how long after taking azithromycin can you drink alcohol zanaflex online ordering buy dilantin visa atarax medicine mexican pharmacy no prescription kamagra chewable para que se usa el paroxetine low cost overnight cialis professional how to get viagra free allopurinol over the counter prescription overnight delivery amantadine hydrochloride uses can you get doxycycline over counter order buspar online no prescription with a echeck cutting 5mg finasteride tablets is prinivil available over the counter buy prozac in uk hoodia price in india lipitor uk no prescription nolvadex 40 mg pharmacy how to use prometrium 100mg will 25mg of seroquel make you gain weight order apcalis sx medication by mail bactroban mupirocin calcium cream asthma triggers list buying tretinoin 0,025 generic extendaquin no prescription prednisone treatment for mast cell tumors in dogs is viagra a prescription drug in ireland amoxil pills online in the australia colospa medication best place to buy haldol online precose australia pharmacy seroflo inhaler 100/50 metoclopramide online usa no prescription gabapentin 300mg capsule best generic yasmin sites fertomid prices buy kamagra tablets uk generic what are some reputable site to order valtrex from buy lisinopril online no prescription uk myo rxp lithium where to get natural viagra ordering hytrin here in canada mail order generic lasix order aricept online sumycin price lincocin without prescription tacrolimus prograf generic buy cleocin gel greece femara to buy from europe blue pill uk order zantac cheap buy generic aspirin generic form of mircette micardis plus side effects sex and the city the man the myth the viagra script canadian tadalis sx tablet valtrex cause weight gain zebeta women buy zocor uses medication fluconazole and alcohol how long pinworm treatment vermox dosage indian pharmacy probalan best price for real shatavari pharmacy has best price zanaflex vente de trileptal au quebec phenergan discounted prednisone mastercard payment xenical india companies only cheapest place buy allegra cheap femcare sale uk buy diflucan online uk no prescription buy finpecia inhaler canada superdrug sells viagra how long will it take for citalopram to work get free trial viagra why has betnovate been discontinued african pharmacy online can i buy ventolin in australia kamagra suppliers florida alesse cheap chloramphenicol 40 mg combivent over the counter uk avandamet for sale uk generic rumalaya no prescription online sale of asacol nexium discount voucher coversyl plus 5mg seroflo 40 mg dose aciphex without insurance propecia price comparison online paxel uk acticin shop net finast 100 review naproxen esomeprazole tablets peut on acheter levitra sans ordonnance how much does allegra d cost florinef no prescription needed best generic remeron sites lexapro vs celexa medication mail order generic zestril clomid cost canadian nymphomax no prescription canada combivent canadian pharmacy brand viagra drug schedule albendazole 400 mg india fincar next day shipping sumycin refills how to use diclofenac sodium tablet zoloft buy online mexico aciclovir cream bp 5 w/w doxycycline hyclate capsules usp kamagra jelly sale prescription diclofenac retard 100mg dosage isoptin drugs online purchases price of prilosec at walgreens olanzapine buy canada dapoxetine lawsuit kamagra cost in canada canadian online doctor prescriptions brand name parlodel online does wellbutrin cause weight loss weight gain ventolin tablets they is zantac over the counter for babies lamictal and alcohol effects prevacid drugs for sale betnovate over counter boots premarin prescription assistance program how to take emsam mg mentat ds syrup delivery uk get snovitra super power toronto generic kamagra oral jelly in usa comprar finast original endep tablets purchase on line order mevacor overnight best online alternative viagra is nexium generic in canada side effects of imuran over the counter alli diet pill amitriptyline cheap canada pharmacy meclizine on line purchase strattera mexico pharmacy reputable canadian antibiotic site chinese herbal viagra women is mail order ponstel safe reviews on lamictal side effects side effects of tramadol 50mg kroger pharmacy 4 dollar prescription list cheapest place to buy alavert orally disintegrating can you buy myambutol online water pills to lose weight over the counter where can i buy provera in canada over the counter antibiotic ointment for impetigo cheap crestor 40 mg tadalis sx online in usa amaryl where to purchase medrol suppositories buy zithromax tablets dosage amlodipine maleate 5 mg buy female viagra quick acticin noprescrition needed canada online pharmacy usa today celexa ciprofloxacin 500mg tab dosage can cardizem cause weight gain accutane from canada no rx dramamine now zetia discounts tenormin delivery uk allopurinol medication guide gout ordering low dose ciplox keftab for men in usa zofran paypal canadian levothroid tablet no prescription haldol sale flonase and cough medicine buy colchicine perth australia my rumalaya forte coupons estrace ivf side effects donde comprar acai en barcelona feldene ordering no prescription alphagan now citalopram no prescription uk online pharmacy drugstore side effects of long term use of benadryl in children celexa drug canadian pharmacy can you buy detrol cheap real viagra nolvadex for pct cycle can you buy norvasc over the counter tofranil next day delivery saw palmetto uk online what is content strategy buy over the counter clozaril online bupropion medication assistance misoprostol ukraine buy elavil lowest price buy flagyl er pills liquid sex drugs for women brand name motilium online what is the best drugstore mascara for length volume and curl red pill blue pill alice in wonderland diovan hct vs diovan baclofen australia pharmacy cialis trial pack generic canadian pharmacy cheapest eulexin generic form of robaxin cymbalta cheapest rate common side effects of provera purchase antabuse chronic alcoholism unique hoodia pills buy celebrex canadian pharmacy overnight pharmacy orlistat best pharmacy to order brand viagra generic zanaflex capsules cheap genuine dapoxetine online cost of zocor at walmart cheapest dramamine in the uk clomiphene citrate side effects in males dramamine delivery what does ponstel treat medicine alesse doxycycline hyclate tablets usp 100 mg side effects of thalidomide myeloma metronidazole tinidazole giardia to buy alli abroad alli diet pills instructions disfuncion erectil pdf propranolol 40 g is depakote better than lamictal retino-a cream 0,05 usa cheap kamagra supplier discount code order pletal cheap generic actoplus met buy canada can i get isoniazid procardia price cost of alligator tags albendazole uk online finast online shipping cheap avapro sale uk oral methotrexate shortage cost of medrol dosepak what is cozaar medication used for brahmi mg tablet fincar for men in usa cheapest vermox paypal viagarabuy low cost overnight trileptal where can you buy acai berry juice diploma in pharmacy online india where to buy motilium online doxycycline hyclate 50 mg capsules zestril from canada buy aldactone canada drugs cialis super active generico purchasing gasex online uk dapoxetine 60 mg price in india buy robaxin 40 redustat orlistat reviews sinequan from europe diovan without a script find licensed canadian pharmacy discount code for estrace safe place order doxycycline ortho tri cyclen fast india orlistat dosage information what class of drugs is hydrochlorothiazide donde comprar revatio donde consigo cialis barato digoxin supplier in uk dramamine for daily use canada low dose abilify for depression donde puedo comprar differin cefadroxil without a prescription nitroglycerin pills use emsam online in usa solu medrol 40 mg injection buy zyban next day singulair tablets used best site to buy cialis how to use zyprexa nitroglycerin lingual spray cost can you order diflucan online guaranteed order 6 aciphex mg safe place order lynoral nolvadex pct side effects is there a generic lamictal xr find pharmacy near me buy torsemide 100mg online how long does erythromycin take to work for tonsillitis best pharmacy to order isoptin where can i get cabgolin ciprofloxacin eye drops for ear discount meclizine mg cheap atarax 25 mg trusted online pharmacies reviews does accutane work for body acne buy cheap levaquin using pay pal why is there a shortage of flonase pfizer zithromax 250 mg caverta delivery uk low cost prometrium allegra london facebook is lisinopril available over the counter remeron suppositories buy cheap buspar india tenormin mg uk baby zantac reviews use benicar coupon online shelf life keflex 500 mg free trial viagra for women flomax generic costco zofran tablets on line to buy zyprexa olanzapine 10 mg tablets buy depakote pills in the australia discount aldactone mg liv cost where to buy cymbalta with echeck synthroid dosage by weight how to buy carafate is mail order cafergot safe bull 100 sildenafil citrate for men dipyridamole order online buy sertraline uk buy biaxin online with no prescription where to buy viagra in dublin ireland what is asacol prescribed for fluoxetine cheap mexico pharmacy rhinocort where to get accutane prices without insurance buying carbozyne from canada no prescription singulair new zealand what is the function of metformin tablets womens viagra uk buy acticin uses medication side effects of xeloda oral relafen drug test sleeping pills without prescriptions cefixime 400 mg in pregnancy where can i purchase lexapro benadryl medication where to buy online generic eulexin canadian pharmaies that carry lorazepam where can i get probalan pills buy zetia 15mg online pil perancang keluarga mercilon augmentin from india luvox dose range cilas orleans micardis capsules deltasone generico online ditropan 5 mg tabletki esomeprazole magnesium 40 mg ec cap can you get clomid in australia liv 52 where to get free coupon for pletal amlodipine 20mg canadian drug buy dilantin without a prescription from canadian pharmacy amitriptyline drugs for sale where to buy doxycycline in australia do boots sell viagra over the counter drugs prescription stromectol cost buy over the counter zoloft online is mail order endep safe cialis tabletten testberichte zyrtec in the uk now ordering topamax online quibron-t online ordering levitra plus 100 what is zebeta tablets aarp prescription solutions phone number is generic omeprazole as effective as prilosec price india ampicillin cheap evecare cost canadian buy zyloprim online cheap etodolac supplier in uk 600mg norfloxcin canadian no prescription needed buy atarax how much will requip cost buspiron buspar reviews actoplus met billig kaufen venta de cialis en guadalajara jalisco mexico generic tadapox us what is rumalaya liniment pills used for buy apcalis sx online usa meaning of viagra in italian ephedra diet pills review genuine glycomet best price lotrel pharmacy mail order mupirocin cream 2 lowest price zocor paroxetine hcl 20 mg oral tablet venta de viagra where can i buy viagra professional ranbaxy azax 500 dosage skelaxin tablets price how long is the shelf life for keflex cytoxan next day very cheap toradol buy adalat 15mg online buy depakote us valproic prescription how to take lithium tablets the best weight loss pills on the market cordarone pas cher what is the generic name for zocor como tomar zentel de 200 mg lamictal side effects weight maxalt for sale uk safe place to buy generic cialis is cephalexin available over the counter can i get high on imitrex baclofen drug store online genuine avandamet best price para que sirve ciprofloxacino 250 mg isotretinoin alcohol use champix cost uk indian generics online atorlip-5 bbc s f1 buy lopressor boots pharmacy silagra where to get where to purchase hyzaar diovan without prescription pills tadapox sale ed drugs sildenafil mail-order sumycin grifulvin v 500 mg dosing safety of generic drugs from india fda where to give imitrex injection buying viagra while in mexico exelon medication patch chloramphenicol lawsuit settlements clinica ivalia dermis safe buy generic drugs online get acivir pills las vegas baclofen wanted online review como comprar amantadine trimox spain over counter como comprar viagra en usa what is reglan good for retin a reviews aging canadian pharmacy shallaki post cycle therapy nitroglycerin adderall xr dosage bystolic coupon with insurance donde consigo cialis generico mexico dipyridamole limited india what drug category is norvasc flonase nose bleeds discount canadian pharmacy metformin pomegranate juice prostate cancer avapro for purchase without a prescription prednisone and alcohol side effects rxlist abilify drug advair copd coupons special offers endep 10 what is it used for do water pills make you sweat more generic for hyzaar from walmart evecare 100 use keflex pregnancy generic drug manufacturers association canada is norvasc available over the counter viagra prescription drug australia online is it safe to order bentyl plavix online in usa evista over the counter australia is generic viagra legal in united states purchase propecia uk buy aleve online no prescription us safe dose of valtrex during pregnancy overnight digoxin tadalafil 40 mg buy feldene online with mastercard is it safe to order celadrin top 10 herbal ed pills plavix for sale in canada overseas pharmacy no prescription keppra famvir italiano order prednisone online no prescription with a mastercard much will plavix cost goes generic retin a wrinkles does it work canadian alliance party conservative ulcer medication carafate chloroquine mode of action pdf propecia drug in mexico pharmacy viagra professional no prescription needed canadian online pharmacy vasotec for sale uk retino-a cream 0,025 shop net pilex rx losec tablets 10mg zofran indications and usage urispas tablets uses cicloferon 400 mg imiquimod (aldara) buy antabuse patch ginseng shop net us online pharmacy no prescription zyban avapro generic side effects what are the side effects of ranitidine in infants hen is viagra going generic is retin a better than differin is coumadin available in india actonel pills sweat cialis sublingual comprare risperdal consta australia cabergoline men prazosin dose for bph comprar cialis sin receta cheapest feldene to buy does accutane cause weight gain or loss exercise induced asthma cough what does mobic do pharmacy that sells brand levitra order frumil no prescription maxalt shortage 2012 100mg viagra vs 20 mg levitra how to by robaxin online albendazole treatment hydatid disease levitra professional 100mg buy finast dosage instructions buy nitroglycerin online no prescription united states cabgolin canada online no prescription amitriptyline or trazodone for sleep generic prometrium reviews duphalac tablets side effects zyrtec online overnight shipping is lasix available on line in canada over counter cytoxan tenormin uk boots accidental double dose of claritin what is a 9 cell lithium ion battery purchase nexium 40 mg cardizem 100mg cheap does mirapex cause weight gain 100 pure organic acai berry antioxidant facial cream review aricept pills how to buy abilify avodart india bristol myers plavix coupons med cab saw palmetto buy lithium batteries in bulk viagra ohne rezept paypal zahlung tofranil now co uk how to order fml forte what is zyvox used for keppra express canada seroflo pills sweat cialis viagra cost canadian pharmacy movie viagra salesman zyban not generic prednisone 5mg daily dosage prescription drug pariet worldwide pharmacy albenza ginseng overnight generic coreg cost arava tablets price wellbutrin vs strattera adhd generic name for nexium abilify side effects anxiety lov cost risperdal best site to buy capoten pink viagra side effects lortab 5/325 mg cialis tablets 20 mg price can you proventil buy cheap albuterol sulfate claritin pills sweat clorfenamina dosis maxima confido shoppers drug mart tretinoin 0,05 prix en pharmacie en france phenergan prescription medicine olanzapine bipolar reviews what is the drug noroxin buy cheap colospa pills overseas pharmacy no prescription hyaluronic acid best over counter medicine upper back pain roaccutane nhs top cheap pharmaceutical stocks vytorin 10/10 tabs torsemide noprescrition needed usa online pharmacy addicted to pain pills while pregnant prandin generic drug mail order coreg can you buy femcare generic aleve price india paypal cialis buy biaxin price canada abilify order buy clomid for cheap 25mg half price acticin tetracycline dose for uti treatment medrol dosepak 4 mg oral tablet actavis promethazine with codeine cough syrup what is celexa like Purchase cephalexin 500mg can you get high from zanaflex buy robaxin with e check viagra online india pharmacy canadian acticin online free shipping metformin 500 mg twice a day for pcos discount cheap pills tramadol pyridium dose children can we trust keflex online buy renagel bulk venlor without a script brahmi mail order india tofranil for sale philippines cialis work after ejaculate where to buy lopressor life search quotes buy cialis jelly astrailia coversyl arginine average cost of exelon patch buy minocin paypal buy bactroban 15mg online can you buy aygestin online online pharmacy usa medications buy kamagra soft online from usa tetracycline dose for tooth infection natural fertility drugs for twins can you buy viagra jelly over the counter in germany abilify no prescription needed hydromorphone conversion to fentanyl patch midamor 100 review rosuvastatin website pill identifier crestor craigslist new york boats for sale how to use dulcolax laxative how long does it take to get used to citalopram buy depakote us decadron 40 mg dose what type of antibiotic is tetracycline buy vpxl online from canada revatio dose for pulmonary hypertension generic finast how much does retin a micro gel cost alphagan online without prescriptions monthly cost of topamax how hard is it to get viagra from your doctor can you buy relafen suhagra tablets on line to buy purchase tadacip pills buy cialis super active singapore cialis generic name free advair diskus coupon how safe are prescription drugs from india forest pharmaceuticals discount us pharmacy online amantadine buy abilify 11 pharmacy buy erythromycin antibiotic side effects of medrol steroid pack where can i buy lithium pills he buy ampicillin online uk avodart dutasteride 0.5 mg side effects buy acyclovir cream no prescription health canada altace generic tulasi us pharm support group credit card new alliance east myspace order brand advair diskus online with visa how to get stromectol drug cytoxan overnight delivery bupropion prices orlistat over the counter medicine how to order propecia from canada pharmacy tech jobs us where can i buy rimadyl ordering buy ampicillin online cialis soft suppositories buy arimidex no rx buy promethazine singapore fucidin direct pharmacy where to buy brand viagra online uk search engines 1990 cialis online from canada prescription solutions careers where to buy mifepristone and misoprostol pills medicine toprol xl side effects where can i buy nolvadex online without a prescription where to buy carbozyne ointment fast delivery meds- kamagra where to buy sildenafil andros actonel 35 mg tablet price resources for ginseng lithium now co uk extendaquin pills sweat brahmi dosage too high danazol pharmacy coupons augmentin overseas is generic menosan available in usa cost of wellbutrin sr kamagra now net gel buy levitra without a prescription namenda and exelon side effects midamor pharmacy mail order cheap pravachol india fosamax lawsuits 2010 very cheap effexor how to get allopurinol on line ciprobay 750 side effects trandate best price do you need rx hyaluronic acid atarax discount code online requip overnight delivery buy diclofenac gel 40 generic celebrex availability canada prednisolone 5mg without prescription generic drug sales 2011 online pharmacy zantax paxil delivery london no prescription advair where prednisolone is manufactured where to buy levitra in australia levothroid for purchase best place to order prazosin in us maximum aspirin dosage for dogs can you only get glucophage on prescription does viagra help keep it up where to buy mircette ointment over the counter bronchial inhalers reviews sildenafil citrate+indian brands what does prednisone do for hives is it safe to order fml forte viagra levitra or cialis cost buy over the counter diflucan online diflucan 150mg online is it illegal to order generic lincocin prescription ringworm medication best generic triamterene sites asacol delivery uk order prometrium medication by mail best light coverage drugstore foundation sarafem with no rx order xenical from mexico without prescription buy prescription painkillers online no prescription lidocaine patches for back pain how to buy floxin in canada aricept shipping overseas haddad a john md integrated medicine alliance red bank nj cheap cozaar sale uk claritin 10mg tablets caverta prices usa best pharmacy in tijuana diltiazem injection shortage abilify 10mg price donde comprar viagra sin receta costa rica buy tamoxifen with e check what is allegra 120 used for buy confido next day hydrochlorothiazide brand name in india order albuterol online slovenska viagra-cena т‚Ќ van you order diflucan online baclofen pump and mri retin-a micro gel 0.04 price order eulexin online where can i buy lanoxin safe place order bactrim celebrex 100 mg hard capsules best site get trental buying prescription drugs on the internet fucidin capsules discount terramycin spray 125g cost of accutane 2012 cephalexin in the uk now lopressor ships from india aciclovir 20mg tab long term side effects of testosterone therapy cialis for women free sample drug market order zovirax how much is viagra in ireland cheap triamterene viagra in usa cheap india augmentin price what types of decadron are there boots drugstore thailand amantadine discount pharmacy approved isoniazid cost without insurance valtrex online sales can you take compazine daily venden viagra farmacias similares hoodia shoppers drug mart side effects of enalapril maleate in dogs where to buy silagra drugs online buy capoten online reviews generic viagra in united states colchicine australia buy erection packs 1 mg avalide next day delivery research grade speman kamagra generic mexico eritromicina estearato 500 mg indicaciones how to buy lexapro in london rumalaya ordering no prescription buy actos pioglitazone canada viagra super active tablets on line to buy doxycycline lowest price online augmentin rx info what is keflex for dogs used for buy dramamine with e check generic skelaxin switzerland ordering metformin online canadian decadron prix en pharmacie en france how long does it take for meclizine to start working buspar dosage for cats doxycycline direct pharmacy cheap albendazole free delivery where to buy erythromycin with echeck buy generic periactin with bonus bystolic generic nebivolol finpecia pharmacy2home.com topamax buy online canada aceon usa no prescription what class of drugs is nexium can buy ashwagandha online doxycycline dose for uti colospa usage lasix iv dose for chf buy cheap deltasone online renagel price comparison acai tablets online bystolic pills trileptal maximum dosage discount canadian pharmacy prazosin metoclopramide patient reviews ralista phone orders what is the medicine actos used for buying abortion pill online nasal imitrex dose meridia uk diet pills buy tretinoin gel buy synthroid in mexico what drug category is strattera cam you buy oxycontin at mexican pharmacies what is the drug pravachol furosemide 40 mg used for what does zanaflex show up as in a drug test diuretic blood pressure medication names; canadian pharmacy flonase wild ginseng price vermox woldwide shipping actonel generic cheap costs cephalexin for dogs side effects peeing lowest priced endep viagra wholesale online where to levitra professional drugs cialis use cleocin coupon online where can i get strattera hyzaar 100 12.5 fiyatФБ buy ponstel bulk purchase cystone grocery store generic aisle generic lipitor not covered order renagel what is bactroban ointment used for keftab now co uk effexor xr india no prescription generic zoloft us does viagra come in liquid form images of actos pills nitrofurantoin uses medication ventolin inhaler to buy in uk albuterol cycle guide finpecia from inhouse buy diovan pills in the canada how to get off celexa safely reviews buy allegra paypal accepted kaiser mail order pharmacy portland oregon effexor xr suppositories buy cymbalta online legally finpecia by cipla legit buy yagara 10 buy seroquel online xr lerk thai bugis paroxetine coupon code weight loss injections south africa mircette mg buy anacin online pay paypal allopurinol side effects rx list cheap cleocin sale uk nolvadex drugstore.com over the counter medicine that acts as estrace reviews on premarin users is generic triamterene available in usa buy clomiphene online what does viagra cost in canada zoloft price in pakistan cialis professional mg order average cost of stephanie allin dress dostinex usa no prescription can you take norvasc twice daily depakote dosage for seizures dosage buy blopress 100 what are the side effects of vermox asacol suppository flonase over counter prescription how to use retin a micro gel what does kamagra oral jelly do baclofen online pay paypal indian generics online norvasc cipro for sale australia buy nolvadex with visa is propecia generic available buy toprol xl generic prevacid for infants with reflux buy flagyl online us no prescription que es phenamax differin cream reviews no prescription lopressor how much is remeron tablets neurontin discount program augmentin refills how long does it take to get used to dilantin lamisil from australia finax generic name amaryl 1mg tablet ashwagandha leaves in usa how to order uroxatral buy cheap proventil amantadine overnight delivery list legitimate canadian online pharmacies femara medication for fertility canada aciclovir tablets online cheap citalopram no ex 10 mg calan commercial property buy diclofenac no prescription fast delivery i took 100 mg of fluoxetine aristocort tablet sale can you buy over the counter antibiotic eye drops aristocort on line purchase how long does it take before accutane starts to work nexium over the counter drug nizagara tablets for women viagra wikipedia nederlands trental where to get donepezil side effects uk anxiety uk twitter aripiprazole abilify prescribing information fastest zofran uk delivery goji better than acai brand levitra sale cialis pill minocycline pills drugstore from where to buy viagra in pakistan clonidine medication on line order mobic pill aleve in croatia best atorlip-20 prices amantadine online legally where purchase ortho tri-cyclen benadryl syrup price in india zithromax pharmacy endep discount is valtrex available in the uk vasotec online pharmacy uk ginseng to buy from europe cost of pamelor amoxil side effects uk prospect zentel sirop betnovate skin cream reviews half price coreg will i gain weight taking prednisone for 2 weeks casodex usa cvs prices dosering av voltaren side effects of chloroquine phosphate tablets zoloft overnight delivery nexium reviews patients purchase wellbutrin sr on line in uk licensed pharmacy cozaar can u take motrin 800 while pregnant best generic betapace sites does haldol make you gain weight where can you buy acai berry in canada buy deltasone uk who makes plavix medication generic pills for emsam drug market order brand viagra zyvox cost per pill drugstore free lamictal medication american ginseng price per pound speman forte reviews genuine cipro viagra buy xenical online with no prescription what is zovirax used for other than herpes diovan prescription cost cardura buy online ireland what is the dosage for toradol buy estrofem 1mg is it illegal to order generic retino-a cream 0,05 lithium capsules vs tablets mail order generic abilify azathioprine side effects forum pilex buy on line pravachol buy canada cipla nalanda what is paroxetine 40 mg tablets trandate without rx 100 mg flomax buy reglan dogs 500 mg cheap zyvox buy paxil online for uk protonix tablets prescribing information purchase lithium 300 mg which uk site to buy amantadine can you buy betapace over the counter in germany omifin en hombres ciplox online order online pharmacy rumalaya forte acheter plendil sildenafilo 50mg effexor xr side effects anger mexican pharmacy no prescription finax generic propecia reviews norvasc online price levitra best online non prescription pharmacy doxycycline pills drugstore synthetic drugs for sale online prozac para que se usa buy lisinopril mg online for oral prednisone dosage for children tamoxifen western australia purchase alli on line in uk buy imitrex online motilium 10mg domperidone janssen-cilag purchase betapace 160 mg evista drug class what is the dosage for saw palmetto buy effexor xr with visa diovan sale prescribed canadian alphagan where to purchase how to store prednisolone liquid zofran tablets dosage where does lasix affect the kidney how to get zyban drug buy nizagara discount isoniazid maximum dosage buy acticin mexican pharmacies drugs similar to arimidex luvox for purchase a good web page to buy tamoxifen with no script cymbalta drugs used ketoconazole 2 shampoo walgreens buy revia xr without prescription diovan tablets side effects flonase for sale uk liv sale of business contract buy lithium ion battery online buying singulair canada buy zetia 20 topical erythromycin no prescription mircette 100 review can you drink while your on accutane aciclovir now co uk tadalafil comprar rogaine without propecia didronel cheap uk order of the allied masonic degrees grand council current price tinidazole finax without rx price of cialis 5 mg desyrel suppliers overseas can i take lamisil and birth control pills zoloft no longer working-now what 100 mg remeron emsam patch coupon quinine pregnancy risk benadryl new zealand diclofenac sodium 50mg for sale generic ceftin us viagra professional tablets side effects where to diflucan pharmacy order orlistat 60mg levitra super active pharmacies eldepryl generic reviews prescription prilosec dosing codeine promethazine rxlist half price aciclovir chloroquine resistance costa rica buy noroxin perth australia is vasotec a prescription drug list of cipla drugs azithromycin tablets 250 mg side effects cost of chloroquine tablets lamisil over counter pill cleocin 100 mg generic lanoxin usa pharmacy buying xenical in ireland sustiva india canadian alliance for sustainable healthcare what does phenergan tablets allergy bosley propecia rx antibiotic keflex cost to buy zaditor antihistamine eye drops cleocin gel drug store online propecia online without prescription canada generic topamax usa pharmacy what does astelin histamine purchase abilify 2 pharmacy silagra direct pharmacy generic famvir uk paypal buying lasix using paypal florinef order canada allegra usa cvs prices generic bupropion hcl where can i get tadalis sx pills xenical rxlist original viagra commercial what does cipro target what is mobic pills used for where to buy calan in canada safely flovent mg price insulin passport leicester genuine lamictal 100mg where can you purchase cialis in ireland ceftin pharmacy prices list buy viagra soft hong kong can you order patient beconase aq online buy albuterol sulfate inhalation solution 0.083 diovan hct coupons discounts Purchase accutane 20mg online cipla products for hair loss lamisil over the counter canada what does asacol do for ulcerative colitis prednisolone medication class order triamterene online no prescription with a mastercard singulair 40mg crestor overseas recommended dosage of benadryl for children estrace cream side effects spotting pictures of all vicodin pills can i get wellbutrin in australia can you buy lipothin online buy pilex singapore comprar fertomid pela internet cheap citalopram 40mg parlodel suppositories buy side effects of fertomid 50 mg vasotec reviews and dosage indian generics online procardia generic starlix safe where to purchase nexium 40 mg buy medrol line shipping lithium ion batteries overseas where to buy dutas ointment where purchase pamelor can buy cystone online dapoxetine tablets us online can you buy calan in ireland western drug femara buy promethazine 5 no prescription purim sale unisom on line for sale no script cheapest diamox to buy hyzaar cheap lotrisone overnight online canadian pharm d programs buy aciphex online usaa remeron weight gain dosage quickest female buy cialis prescription can i get pregnant while on coumadin allegra d generic anxiety in children treatment can get viagra toronto bactrim refill pack ethionamide drug class uroxatral generic available genuine xenical best price can you order avapro kamagra sales australia vente de celexa au quebec avapro purchase in canada no prescription hyzaar patient reviews Purchase furosemide 12.5 mg cipro nombre generico y comercial how to use imitrex spray promethazine with codeine syrup high alli cheapest uk accutane roche dosage spironolactone acne initial breakout furosemide generic for zestoretic for dogs buy elavil cod best online site to buy viagra best antibiotic for uti 2012 buy beconase aq for daily use cheapest prednisolone paypal safe toprol xl buy rizatriptan benzoate for migraines where to purchase zestoretic zoloft medicine ocd how to use yasmin as morning after pill guardian pharmacy singapore contact us buy female cialis online buy innopran xl no prescription flonase hong kong buy cheap 20mg order accutane uk pharmacy comment acheter du viagra sur internet topamax reviews for fibromyalgia buying zyloprim what is baclofen for zovirax over the counter cheapest haldol to buy what is prednisone used for 20 mg crestor prices australia order isoptin cheap diflucan com au what pregnancy category is rhinocort hydrochlorothiazide hypertension elderly prinivil usa buy acticin united states fda my erexin-v coupons differin 100 cheap uroxatral sale uk cheap plavix buy online how can i get my doctor to prescribe me wellbutrin buy cheap remeron online prilosec for sale australia viagra professional next day shipping valtrex pills drugstore dosis de aciclovir para herpes labial advair diskus drug in uk pharmacy retino-a cream 0,025 usa sale how long does it take for elavil to work for ic buy lipitor canada why is there a shortage of chloroquine flagyl medication interactions dramamine generic cheap costs vermox 20 mg/ml nolvadex dosage during cycle erexin-v over the couter where to buy alligator clips australia generic buy viagra plus cheap como comprar nitroglycerin buying midamor using paypal what does doxycycline pills look like acai berry slimming pills reviews ginseng refills cymbalta pas cher buy plendil 5 mg methotrexate discontinued what are the side effects of taking benicar norvasc now co uk generic fucidin us antibiotic flagyl breastfeeding overseas pharmacy no prescription reglan cheap liverpool apartments short stay discount canadian pharmacy tadapox zyvox sales 2008 drugs natural viagra alternative for women buy risperdal discount celebrex without a prescription from us requip wanted online review indian pharmaceutical companies nizoral express canada research grade snovitra super power buy isoniazid drug valacyclovir dosage for herpes simplex atarax italiano procardia 10 mg for contractions is value pharmaceuticals legit pamelor phone orders order generic robaxin zoloft lawsuits 2010 buy alesse cheap order pharmacy inderal anxiety reviews serevent online forum generics tamsulosin capsules side effects side effects of zanaflex capsules med cab grifulvin v non generic cialis jelly maximum dose of methotrexate for ectopic pregnancy buy online diabecon generic mexico pharmacies online that sell tetracycline buyers of deltasone canada asacol sale can you buy generic norvasc what is the drug classification of premarin tabs free imitrex coupons canadian nitroglycerin patch order prevacid online without rx azulfidine shortage buy dipyridamole pills buying cytoxan using paypal forum pharm buy benadryl online subject:"canadian pharmacy: viagra + cialis !!" zetia cost costco fucidin cream cold sores flomax birth control online mexico prograf buy online ireland buy retin-a ge inhaler canada buy avapro in singapore is generic levitra professional effective can i get high on buspar can you buy ciprofloxacin in mexico order haldol online with visa sambazon acai coupons best price for diclofenac gel stromectol scabies treatment lamisil tablets 250mg the online drugstore lithium lasix furosemide drug interactions buy proscar online from usa costco pharmacy ethionamide price anacin tablets colchicine pills online in the india furosemide mist canada where to buy brand cialis with visa purchase reglan cheap where can i purchase zyvox brahmi from india uk buy viagra super active without prescription atorvastatin 80 mg trial nizoral shampoo side effects children buy revatio from mexico online how to order voltaren online buy tofranil online buy cipro mexican pharmacies stopping testosterone therapy hair regrowth where to tulasi buy medrol online no prescription pharmacy diltiazem hydrochloride manufacturers india buy actonel online with mastercard does clomid fertility drug really work research grade phexin canadian online pharmacy for lioresal cheap forzest sale uk buy viagra super active 100 buy prescription drugs online without rx chloroquine drugs for sale