Clinical recommendations are central features of physician-patient interaction. Mandative adjective extraposition (henceforth MAE; Van linden & Davidse 2009, Van linden & Verstraete 2010) is one of many linguistic forms used by physicians in providing recommendations (e.g., it's important to exercise, it's critical that you take these pills). This study decomposes MAE, a relatively unexplored sociolinguistic variable, into features that contribute both to its pragmatic interpretation as a deontic semi-modal and its social interpretation in the context of physician-patient interaction. These features include MAE's inherent, variable structural components--mandative adjective, complement type, embedded verb type, etc.--as well as MAE's potential suprasegmental hitchhikers (à la Mendoza-Denton 2011), such as intonational contours and creaky voice. The study considers the contributions of these features, in isolation and in concert, to physicians' attempts at balancing their institutional and interpersonal goals when managing consultations. In doing so, it provides a base for understanding how doctors use clusters or layers of linguistic resources (Podesva 2008) to construct their professional personae.Imperative force is proposed as the central dimension across which MAE forms vary and the object of MAE's social/ stylistic evaluation. In an experiment in which participants evaluated doctors' recommendation style, some structural and suprasegmental features were perceived as `strong' (i.e. were highly mandative) while others were perceived as `weak' on a scale of imperative force.Support for participants' intuitions was provided by a corpus study in which strong and weak MAE feature variants were found to consistently co-occur. 1857 tokens of physicians' MAE-type recommendations were drawn from the US-wide Verilogue corpus (Kozloff & Barnett 2006) of medical consultations. The integrated perception and production results collectively point to socialization into medical practice as the major social force impacting MAE variation. Medically relevant categories (e.g., specialty), classifications (e.g., disease severity), and experience are all shown to influence MAE variation in physician-patient interaction, where these factors represent concepts and social distinctions that are specific to the context of medicine. Physicians use strong MAE forms as one of many potential sociolinguistic resources in the construction of an authoritative (confident and trustworthy) professional persona, while using weak forms to construct situationally appropriate indirectness.Overall, this work provides a novel approach to the study of variation in context. It explores stylistically meaningful variability within a single construction, examining patterns of use and perception that define the construction's significance within a professionally constrained subset of transactional discourse. By decomposing MAE into its component variable parts, this dissertation contributes to theories of stylistic compositionality, building on the notion of style clustering whereby "each feature of a style contributes a meaning; the meaning of a style arises out of the intersection of its component features' meanings" (Podesva 2008:4). Moreover, it illustrates the value of cross-disciplinary applications of variationist methodology, quantifying and characterizing patterns of interest to both sociolinguistics and medicine.
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