Interpreter-Mediated Healthcare Communication

Edited by

Srikant Sarangi [+–]

Aalborg University

Srikant Sarangi is Professor in Humanities and Medicine and Director of the Danish Institute of Humanities and Medicine/Health at Aalborg University, Denmark. Between 1993 and 2013, he was Professor in Language and Communication and Director of the Health Communication Research Centre at Cardiff University. Currently he is also Professor in Language and Communication at Norwegian University of Science and Technology (NTNU), Trondheim (Norway); Visiting Research Professor, Centre for the Humanities and Medicine, The University of Hong Kong; and Visiting Professor at University of Malay. In 2012, he was awarded the title of ‘Academician’ by the Academy of Social Sciences, UK.

His research interests include: institutional and professional discourse; quality of life and risk communication in genetic counselling, HIV/AIDS, telemedicine, general practice and palliative care; intercultural pragmatics; language and identity in public life; ethnicity, race and discrimination in multicultural societies.

He is author and editor of twelve books, guest-editor of five journal special issues and has published nearly two hundred book chapters and journal articles in leading journals in discourse and communication. He is the editor of Text & Talk as well as the founding editor of Communication & Medicine and with (C. N. Candlin) of Journal of Applied Linguistics and Professional Practice.

Interpreter-Mediated Healthcare Communication engages conceptually and empirically with the ongoing debate concerning the ‘influence’ occasioned by the participation of an interpreter – whether professionally trained or as a lay family member – in healthcare delivery. Healthcare delivery, especially in the primary care sector, is increasingly becoming multicultural and multilingual in character. This global reality manifests itself as a communicative challenge in interpreter-mediated healthcare consultations, involving professional as well as family members in the role of interpreters. In the context of this book (previously published as a special issue of the journal Communication & Medicine), interpreter-mediated healthcare consultations are seen simultaneously as multilingual and multiparty interactions, as well as being dyadic and triadic communication.

The introductory editorial sets the scene by foregrounding the core notion of ‘communicative vulnerability’ of all participants – the care recipient, the healthcare provider and the interpreter – in relation to the emergent interactional subtleties at the spheres of participation and interaction. In addition to the ‘brought along’ communicative vulnerability of the participants, the interactional trajectory itself, iteratively, contributes to such vulnerability at the contingent level. Especially, the interpreter routinely shifts between ‘just being a linguistic/literal medium/conduit’ to ‘strategically being a communicative mediator/broker’, potentially influencing the processes and outcomes of a given healthcare encounter.

The contributors to the volume, representing different parts of the world (Australia, Italy, The Netherlands, Sweden, UK and USA), address, in different ways, the complexities surrounding the concepts of ‘participation’, ‘mediation’ and ‘shifts in roles/frames/footings’ and their interactional manifestation/consequence. As the empirical studies illustrate, the interpreters – professional or otherwise – position themselves actively in the interaction as their roles and participation formats become situationally and culturally embedded, albeit in varying degrees in different phases of the consultation. The contributions engage along a variety of axes as far as the data settings are concerned – professional vs lay interpreters, primary vs. tertiary healthcare setting and low-stake vs. high-stake encounters. The issues raised in the book – albeit dealing mainly within the confines of the western healthcare landscape – point in the direction of how ‘communicative vulnerability’ may be heightened in relation to the currently dominant paradigms of patient-centredness, patient autonomy and shared decision making.

Series: Studies in Communication in Organisations and Professions

Prelims

List of Figures and Tables vii

Srikant Sarangi FREE

Aalborg University

Chapter 1

Introduction: Communicative Vulnerability and its Mutation in Interpreter-mediated Healthcare Encounters 1-21

Srikant Sarangi £17.50

Aalborg University

Chapter 2

Who is Talking Now? Role Expectations and Role Materializations in Interpreter-mediated Healthcare Encounters [+–] 22-43

Claudia V. Angelelli £17.50

Heriot-Watt University

Claudia V. Angelelli is Professor and Chair in Multilingualism and Communication at Heriot-Watt University, Professor Emerita at San Diego State University and Visiting Professor at Beijing Foreign Studies University. Her work appears in journals such
as AAAL, EUJAL, Interpreting, IJSL, JALPP, Meta, MonTI, The Translator and TIS. She is the author of Revisiting the Interpreter’s Role (John Benjamins, 2004), Medical Interpreting and Cross-cultural Communication (Cambridge University Press, 2004)
and Medical Interpreting Explained (Routledge, 2018). She is also guest editor of The Sociological Turn in Translation and Interpreting Studies (a special issue of Translation and Interpreting Studies [7:2], 2012) , Translators and Interpreters: Geographic
Displacement and Linguistic Consequences (a special issue of the International Journal of the Sociology of Language [207], 2011) and Minding the Gaps: Translation and Interpreting Studies in Academia (a special issue of Cuadernos de ALDEEU [25], 2013) and the co-editor of Testing and Assessment in Translation and Interpreting Studies (John Benjamins, 2009) and Researching Translation and Interpreting Studies (Routledge, 2015).

Complex layers of meaning accompany conversations about illness and medicine in medical encounters. The complexity multiplies in multilingual healthcare interactions when interpreters are asked to bridge the cultural communities of the provider (and medicine) and the patient, not only by interpreting the languages used, but also by taking on different roles, coordinating talk and facilitating answers to questions that providers and patients raise as they communicate with one another. A subset of three segments of interpreter-mediated authentic interactions (n = 392) are presented, to explore the provider and healthcare interpreter’s responsibilities and challenges in constructing and co-constructing meaning in conversations about healthcare information. Findings suggest that interpreters do not volunteer to take on roles above and beyond that of interpreting. However, they are instructed to take on other roles which may not necessarily be aligned with their background or professional practice (e.g. explore medical history, explain the value of ratings on a pain scale). This study has implications for providers and interpreters in regards to responsibility and ethics when communicating with patients who do not use societal languages.

Chapter 3

Understanding Interpreters’ Actions in Context [+–] 44-68

Galina B Bolden £17.50

Rutgers University

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Galina B. Bolden (Ph.D., UCLA) is Professor in the Department of Communication at Rutgers University. She has conducted conversation analytic research on talk-in-interaction in English and Russian in ordinary and institutional settings, as well as bilingual talk. Her recent work centers on repair organization and in social interaction in immigrant families and in mental health contexts.

This article examines the organization of interpreter-mediated communication and demonstrates that interpreters, as autonomous social actors, continuously monitor and analyze the unfolding interaction and make moment-by-moment decisions about their actions. Drawing on a larger conversation-analytic study of audio- and video-recorded consultations (24 in total) between English-speaking doctors, their Russian-speaking patients, and bilingual interpreters (ad hoc and professional), I present a close examination of short segments from two such consultations and show that interpreters’ involvement is not limited to translation. The article demonstrates that interpreters’ actions are shaped by the demands of the interactional and medical activities they are engaged in. The analysis focuses on two kinds of interpreter involvement: first, their management of situations in which participants experience difficulties in understanding each other; and, second, their participation in a physical examination that requires a close coordination of bodily actions. In the first case, interpreters’ orientations to their normative responsibilities as translators may compel them to act in ways that are divergent from doing translation per se. In the second case, we see that interpreters’ participation in the interaction may be primarily constrained by the demands of the ongoing physical examination and so be only minimally responsive to the talk produced by the other parties.

Chapter 4

Managing Uncertainty in Healthcare Interpreter-mediated Interaction: On Rendering Question-answer Sequences [+–] 69-95

Claudio Baraldi,Laura Gavioli £17.50

University of Modena and Reggio Emilia

Claudio Baraldi is Professor of Sociology of cultural and communicative processes at the University of Modena and Reggio Emilia, Italy. His research includes studies on intercultural communication, interlinguistic and intercultural mediation, conflict management and the development of techniques of dialogue. He has published several papers on dialogue interpreting in books and international journals, many with Laura Gavioli. With Laura Gavioli, he has also edited the volume Coordinating Participation
in Dialogue Interpreting (John Benjamins, 2012).

University of Modena and Reggio Emilia

Laura Gavioli is Professor of English Language and Translation at the University of Modena and Reggio Emilia, Italy. Her work includes the study of spoken language in institutional settings, corpus studies for language learning and translation and the pragmatics of English–Italian interaction. She has been engaged in research exploring authentic data of interpreter-mediated conversations involving speakers of English and Italian, mainly in healthcare settings. With Claudio Baraldi, she edited the volume Coordinating Participation in Dialogue Interpreting (John Benjamins, 2012).

This paper analyses healthcare interactions involving doctors, migrant patients and ‘intercultural mediators’ who provide interpreting services. Our study is based on a collection of 300 interactions involving two language pairs, Arabic–Italian and English–Italian. The analytical framework includes conversation analysis combined with insights from social systems theory. We look at question-answer sequences, where (1) the doctors ask questions about patients’ problems or history, (2) the doctors’ questions are responded to and (3) the doctor closes the sequence, moving on to another question. We analyse the ways in which mediators help doctors design questions for patients and patients understand and eventually respond to the doctors’ design. While the doctor’s question design aims at obtaining details which are relevant for the patients’ care, it is argued that collecting such details involves complex interactional work. In particular, doctors need help in displaying their attention to their patients’ problems and in guiding patients’ responses into medically relevant directions. Likewise, patients need help in reacting appropriately. Mediators help manage communicative uncertainty both by showing the doctor’s interest in what the patient says, and by exploring and rendering the patient’s incomplete, extended and ambiguous answers to the doctor’s questions.

Chapter 5

Involvement, Trust and Topic Control in Interpreter-mediated Healthcare Encounters [+–] 96-117

Cecilia Wadensjö £17.50

Stockholm University

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Cecilia Wadensjö is Professor of Interpreting and Translation Studies at Stockholm University, Sweden. She has published extensively on interpreter-mediated social interaction, drawing on recordings of naturally occurring discourse data and exploring interpreting in medical, legal, broadcasted and other institutional encounters. Her publications include the widely cited monograph Interpreting as Interaction (1998, Addison Wesley Longman).

By examining audio-recorded and transcribed, naturally occurring discourse data, this article shows how participants communicate involvement in two interpreter-mediated healthcare encounters. The article demonstrates how the relational exchange in these encounters, each involving a Swedish-speaking care provider, a young mother (one Spanish speaking and one Russian speaking) and a professionally trained interpreter, is affected by the way each participant orients to one another as a conversational partner. The analysis also shows how primary participants’ orientation towards the interpreter as a conversational partner may have unexpected consequences for the interpreter’s degree of involvement and the participants’ control of conversational topics. Adding to previous studies of interpreter-mediated medical encounters explored as interaction, this article demonstrates the significance of shared and mutual focus between physicians and patients when it comes to building rapport and mutual trust across language barriers.

Chapter 6

Mutual (mis)understanding in Interpreting in Consultations between Turkish Immigrant Patients and Dutch General Practitioners [+–] 118-144

Sione Twilt,Ludwien Meeuwesen,Jan D. ten Thije ,Hans Harmsen £17.50

Rotterdam University of Applied Sciences

Sione Twilt wrote her master’s thesis on the discourse of informal interpreting in general practice. She was involved in the European Grundtvig project ‘TRICC’ as a coordinator and researcher (www.tricc-eu.net) and currently teaches healthcare students in Rotterdam. Furthermore she is currently involved in analysing professional interactions between Dutch-speaking speech and language therapists and multilingual clients.

Utrecht University

Ludwien Meeuwesen was associate professor at the Department of Interdisciplinary Social Science at Utrecht University. She was actively involved in research and projects concerning medical communication, specifically migrant health, until shortly before her sudden death.

Utrecht University

Jan D. ten Thije is Professor of Intercultural Communication at Utrecht University. He coordinates the master’s programme in Intercultural Communication and the Intercultural Competence project. His main fields of research concern institutional discourse
in multicultural and international settings, lingua receptiva / receptive multilingualism, intercultural training, language education and functional pragmatics.

Erasmus University

Hans Harmsen worked as a general practitioner in a multicultural neighbourhood in Rotterdam from 1980 until his retirement. As a trainer of GPs he was allied with the Department of General Practice of the Erasmus MC, Rotterdam. In 2003 he obtained
his PhD, with his thesis titled When Culture Meets in General Practice: Improvement in Intercultural Communication Evaluated.

The aim of this exploratory study is to gain insight into the quality of translations of informal interpreters for Turkish immigrant patients consulting Dutch general practitioners. Several questions are addressed: what role does the interpreter take in the medical trialogue, and what is his/her ‘status’?; in what way does the interpreter stimulate or hinder communicative interaction?; and what kinds of miscommunication can be observed, and what are the underlying causes? Data consisted of 16 transcripts of video-recorded medical interviews. Stretches of discourse from eight interviews with good mutual understanding (externally assessed) between patient and doctor were compared with eight interviews with poor mutual understanding. The discourse analysis focused on (1) role-taking behaviour of interpreter, (2) miscommunication and its causes, (3) changes in the translation, (4) additional information and (5) side-talk activities. Findings show substantial differences between the two datasets. In the case of ‘poor mutual understanding’, the instances of miscommunication far exceeded those characterised as ‘good mutual understanding’. Content omissions and side-talk activities seemed to hinder good mutual understanding. This study contributes to knowledge about how informal interpreters stimulate or hinder the medical interaction process.

Chapter 7

Third Party Insurance? Interactional Role Alignment in Family Member Mediated Primary Care Consultations [+–] 145-170

Celia Roberts,Srikant Sarangi £17.50

King’s College, London

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Celia Roberts is Emeritus Professor of Applied Linguistics at King’s College, London.

Aalborg University

This paper deals with general practice consultations where there is a third party present, as a companion, to support the patient and act as a mediator between doctor and patient. Our study contrasts with most, but by no means all, of the studies on interpreting, which (1) focus on a transmission of information model in professional interpreting, (2) do not address monolingual mediated consultations where the third person is a carer and/or (3) do not address issues of trust and feelings which can characterise consultations mediated by family members. The data for this paper is drawn from a London based project: Patients with Limited English and Doctors in General Practice: Educational Issues (PLEDGE). Using Goffman’s participant framework and aspects of narrative performance, we propose a cline of mediation, which can be mapped onto the structure of the clinical consultation – as evidenced through two case studies. The analysis indicates that consultations with companions that act as lay interpreters have more in common with monolingual triadic consultations than with professionally interpreted consultations. The shifts in role-relationships and alignments between the three participants subvert their official position to produce a remarkable intimacy and collaboration, while often subduing but sometimes amplifying the patient’s voice. There are implications of our findings both for family carers as mediators and for primary care health providers.

Chapter 8

The Comparison of Shared Decision Making in Monolingual and Bilingual Health Encounters [+–] 171-198

Charlene Pope,Jason Roberson £17.50

Medical University of South Carolina

Charlene Pope received her PhD in education with a focus on sociolinguistics from the University of Rochester and did a post-doctoral fellowship in preventive cardiology at the University of Rochester. She is Chief Nurse for Research at the Ralph H. Johnson Veterans Affairs (VA) Medical Center, and Affiliate Associate Professor at the Medical University of South Carolina College of Medicine Department of Pediatrics. Her research interests include the Shared decision making in health encounters, role of communication in health service disparities, patient–provider communication, and communication practices of older people of diverse ethnicities with and without Alzheimer’s disease.

Holy Cross Faith Memorial Episcopal Church

Jason Roberson holds an MA in Spanish Linguistics from Pennsylvania State University, an MA in Hispanic Culture and Language from New York University, and an MDiv. from Virginia Theological Seminary. He previously worked at the Medical University of South
Carolina as Coordinator of Interpreter Services and for the MUSC College of Nursing as grant coordinator of the Hispanic Health Initiative, funded by the Duke Endowment. He is an Episcopal priest and currently serves as Assistant Rector at Holy Cross Faith Memorial Episcopal Church in Pawleys Island, SC.

In the United States, Hispanics with limited English proficiency (LEP) experience disproportionate disparities in health services, a phenomenon that relates to communication and decision making. After a quality improvement review identified a disparity in obstetric services for Hispanic women with LEP, a pilot study discussed here explored how LEP and the presence of a medical interpreter affected shared decision making in comparisons of monolingual (English) and bilingual (English-Spanish) encounters with the same physician. A series of 16 prenatal encounters between physicians, patients, and medical interpreters were recorded. First, medical visits were recorded with eight Spanish-speaking mothers using a hospital interpreter to speak with their physician. The same physician was then recorded discussing a similar prenatal agenda with a primary language English-speaking patient. Discourse analysis was used to categorize discursive practices in social interaction. Both encounters were rated using the OPTION shared decision-making scale. Results portray how shared decision making shifts in second-language situations and the associated practices that distinguish monolingual and bilingual encounters. Examples of discursive practices suggest strategies that may mark ethnolinguistic identity and membership categorization indirectly during health encounters.

Chapter 9

Triadic Medical Interaction with a Bilingual Doctor [+–] 199-220

Louisa Willoughby,Marisa Cordella,Simon Musgrave,Julie Bradshaw £17.50

Monash University

Louisa Willoughby, PhD, is a Senior Lecturer in the Linguistics Program at Monash University. Her research focuses on issues affecting speakers of minority languages, particularly in education and health settings. She is also interested in language
maintenance and shift more broadly, language and identity and Deaf studies.

University of Queensland

Marisa Cordella holds a PhD in linguistics from Monash University and is currently a Reader in Spanish at the University of Queensland. Her research interests include discourse analysis, intercultural communication, medical discourse, translation studies and intergenerational second-language learning.

Monash University

Simon Musgrave, PhD, is a Lecturer in the Linguistics Program at Monash University. His research interests include Austronesian languages, language endangerment, African languages in Australia, communication in medical encounters and linguistics as part of digital humanities.

Monash University

Julie Bradshaw has a PhD from the University of York, UK, and is an Adjunct Research Fellow in the Linguistics Program at Monash University. Her research interests include multilingualism and language maintenance, the sociolinguistic aspects of second-language acquisition, minority-language literacy, place-identity and communication in
medical settings.

While studies of interpreted medical interactions are common, there is relatively little research on bilingual doctors who choose to consult in the first language of their migrant patients. This paper presents a case study of one such language-concordant consultation conducted in Italian in the outpatients’ clinic of an Australian hospital, a triadic encounter where the patient was accompanied by her Italian-speaking daughter. In this consultation English medical terms were sometimes introduced but Italian was the main language of the consultation. The communication between all parties was notably very smooth and we reflect on reasons for this. These include the commitment of all parties to using Italian and the proactive role played by the patient’s Italian-speaking daughter in supporting and occasionally challenging her mother’s account of affairs. We conclude by reflecting on issues that bilingual doctors need to be aware of before undertaking to consult in more than one language.

Chapter 10

Interpreter-mediated Aphasia Assessments: Mismatches in Frames and Professional Orientations [+–] 221-240

Peter Roger,Chris Code £17.50

Macquarie University

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Peter Roger is an Associate Professor in Linguistics at Macquarie University. A medical graduate from the University of Sydney, he worked as a medical practitioner for several years before going on to complete a PhD in communication sciences and disorders.
His research interests include communication in healthcare contexts, and individual differences in second language acquisition. He is co-author (with Sally Candlin) of Communication and Professional Relationships in Healthcare Practice (Equinox,
2013).

Exeter University

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Chris Code is Professorial Research Fellow in the School of Psychology, Foundation Professor of Communication Sciences and Disorders (Hon) at the University of Sydney, Visiting professor University of Louisianna at Lafayette and used to be Research Manager for Speakability, the British lobbying and advocacy charity for aphasic people conducting research into the psychosocial consequences of aphasia and is Speakability‘s National Adviser on Aphasia. He is Patron of AphasiaNow. He has also been Fellow of the Hanse Institute for Advanced Stdy, Delmonhurst, Germany and Visiting Professor at the University of Bremen, Germany. His research interests include the cognitive neuroscience of language and speech, psychosocial consequences of aphasia, aphasia and the evolution of language and speech, recovery and treatment of aphasia, the public awareness of aphasia, the neuropsychology of number processing and speech and limb apraxias, facial action. He is co-founding Editor of the international journal Aphasiology, past Editor of the International Journal of Language & Communication Disorders and the Australian Journal of Communication Disorders, and is on the editorial boards of several journals. His books include Aphasia Therapy (1982 with DJ Müller), Language, Aphasia and the Right Hemisphere (1987), The Characteristics of Aphasia (1991) and Classic Cases in Neuropsychology (Vol I, 1996; Vol II, 2002) (with C-W Wallesch, Y. Joanette & AR Lecour) and Milestones in the History of Aphasia (2008) (with Juergen Tesak). He is a Fellow of the British Psychological Society and Fellow of the Royal College of Speech and Language Therapists and was recently honoured with a festschrift, Clinical Aphasiology. edited by MJ Ball & Jack Damico . He received the Robin Tavistock Award for Services to Aphasia in 2010.

A setting which presents special challenges for interpreter-mediated communication is the speech pathology clinic, particularly when the encounter involves the assessment of aphasia. Drawing on a corpus of five interpreter-mediated assessments of aphasia in speakers of a range of languages (Cantonese, Greek, Tagalog and Vietnamese), this paper presents the findings of an interactive framing analysis of the corpus, focusing on illustrative extracts from two of the encounters. Analysis reveals that while the interpreters are frequently oriented towards issues of ‘meaning’ or ‘content’, the speech pathologists are generally oriented to issues of ‘form’. This is evident from the fact that the speech pathologists frequently question the interpreters about the ways in which the speaker’s language is abnormal. The interpreters, however, tend to respond to such questions with reference to their impressions of the person’s intended meaning. It is argued that these differences in orientation can be explained by the different professional knowledge schemata of speech pathologists and interpreters and the fundamentally ‘uninterpretable’ nature of many of the speakers’ utterances. This lack of shared understanding makes the interaction inefficient, and frequently results in a situation where the person with aphasia is put ‘on hold’. The paper concludes with a discussion of some practical implications for the conduct of interpretermediated aphasia assessments.

End Matter

Author Index 241-245

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Aalborg University

Subject Index 246-252

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Aalborg University

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Interpreter-Mediated Healthcare Communication

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Aalborg University

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