Chapter Two
36
should be given to the patient) imply that there is an implicit (volitional)
agent (namely a medical doctor) administering the medicine to an implicit
patient, who fulfills the role of undergoer in this scene. The corresponding
PIL heading How to take Telmisartan Teva Pharma, by contrast, is
realized as an anticipated (rhetorical) question with an active verb (to take)
(indirectly) addressing the patient. It evokes a patient-centered frame in
which the patient fulfills the role of potential agent expecting instructions
of an implicit authority, i.e. the medical doctor.
Similar observations can be made for the textual parts under the
headings. In the SmPC, the information on the posology is again presented
from the expert’s viewpoint, and conceived as expert-to-expert
communication, relying on implicit domain knowledge. The following
excerpt illustrates this:
(10) Hypertension: The usually effective dose is 40 mg once daily. Some
patients may already benefit at a daily dose of 20 mg. In cases where
the target blood pressure is not achieved, the dose of Telmisartan can
be increased to a maximum of 80 mg once daily. Alternatively,
Telmisartan may be used in combination with thiazide-type diuretics,
which have been shown to have an additive blood pressure lowering
effect with Telmisartan. When considering raising the dose, it must be
borne in mind that the maximum antihypertensive effect is generally
attained four to eight weeks after the start of treatment.As example (10) shows, those portions of the hypertension-scene that
are relevant from a doctor’s viewpoint, are linguistically realized in the
linguistic surface structures (e.g. the usually vs. reduced vs. maximum
effective dose of the substance), and placed in the foreground of attention,
while other information remains implicit (e.g. why the substance is used).
In the equivalent PIL version (example 11), by contrast, the same scene is
reframed by providing background knowledge and by foregrounding those
aspects that are relevant from a patient’s viewpoint (e.g. why the drug
should be taken, what precautions to take, what to do in an emergency or
in case of doubt):
(11) For treatment of high blood pressure the usual dose [...] is 40 mg
once a day to control your blood pressure over the 24-hour period. [...]
At the beginning of the preventive therapy [...] blood pressure should
be frequently monitored. [...] If you accidentally take too many tablets,
contact your doctor, pharmacist, or your nearest hospital emergency
department immediately. [...] If you forget to take a dose, do not
worry. Take it as soon as you remember then carry on as before. If you
do not take your tablet on one day, take your normal dose on the next