Third party insurance?

Interactional role alignment in family member mediated primary care consultations


  • Celia Roberts King's College, London
  • Srikant Sarangi Aalborg University



lay interpreters, mediation, narrative performance, participation frameworks, primary care consultation, role relations, third party


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 Londonbased 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.

Author Biographies

Celia Roberts, King's College, London

Celia Roberts is Professor Emerita in Sociolinguistics and Applied Linguistics, King’s College London. Her publications in language and inequality in institutional contexts include Language and Discrimination (with Davies and Jupp; Longman, 1992), Achieving Understanding (with Bremer et al.; Longman, 1996), Talk, Work and Institutional Order (with Sarangi; De Gruyter, 1996) Language Learners as Ethnographers (with Byram et al.; Multilingual Matters, 2001) and Performance Features in Clinical Skills Assessment (with Atkins and Hawthorne; King’s College London, 2014). Her forthcoming book Linguistic Penalties examines the inequalities migrants face in job interviewing.

Srikant Sarangi, Aalborg University

Srikant Sarangi is Professor in Humanities and Medicine and Director of the Danish Institute of Humanities and Medicine (DIHM) 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 (UK), where he continues as Emeritus Professor. Beginning 2017, he is also Adjunct Professor at Norwegian University of Science and Technology (NTNU), Visiting Professor at the University of Jyväskylä, Finland and Visiting Professor at the College of Medicine, Qatar University. In 2012, he was awarded the title of ‘Fellow’ by the Academy of Social Sciences, UK. His research interests are in institutional/professional discourse studies (e.g., healthcare, social work, bureaucracy, education) and applied linguistics. He is editor of Text & Talk, Communication & Medicine and Journal of Applied Linguistics and Professional Practice.


Angelelli, C. (2005) Medical Interpreting and Cross-Cultural Communication. Cambridge: Cambridge University Press.

Bamberg, M. and Georgakopoulou, A. (2008) Small stories as a new perspective in narrative and identity analysis. Text & Talk 28 (3): 377-396.

Baraldi, C. and Gavioli, L. 2012 (eds) Coordinating Participation in Dialogue Interpreting. Amsterdam: John Benjamins.

Beisecker, A. 1989 The influence of a companion on the doctor-elderly patient interaction. Health and Communication 1 (1): 55-70.

Bolden, G. B. (2000) Toward understanding practices of medical interpreting: Interpreters’ involvement in history taking. Discourse Studies 2 (4): 387-419.

Cohen, S., Moran-Ellis, J. and Smaje, C. (1999) Children as informal interpreters in GP consultations: pragmatics and ideology. Sociology of Health & Illness 21 (2): 163-186.

Cordella, M. (2011) A triangle that may work well: Looking through the angles of a three-way exchange in cancer medical encounters. Discourse and Communication 5 (4): 337-353.

Corsellis, A. (2008) Public Service Interpreting: The First Steps. London: Palgrave Macmillan.

Coupland, N. and Coupland, J. (2000) Relational frames and pronominal address reference: The discourse of geriatric medical triads. In S. Sarangi and M. Coulthard (eds) Discourse and Social Life, 207-229. Harlow, UK: Pearson Education.

Davidson, B. (2000) The interpreter as institutional gatekeeper: The socio-linguistic role of interpreters in Spanish-English medical discourse. Journal of Sociolinguistics 4 (3): 379-405.

Davidson, B. (2002) A model for the construction of conversational common ground in interpreted discourse. Journal of Pragmatics 34 (9): 1273-1300. DELETE

Ebden, P., Carey, O.J., Bhatt, A. and Harrison, B. 1988 The bilingual consultation. Lancet (8581): 347.

Goffman, E. (1974) Frame Analysis: An Essay on the Organisation of Experience. New York: Harper & Row.

Goffman, E. (1981) Forms of Talk. Oxford: Blackwell.

Goffman, E. (1983) The interaction order. American Sociological Review 48 (1): 1-17.

Greenhalgh, T., Robb, N. and Scambler, G. (2006) Communicative and strategic action in interpreted consultations in primary healthcare: A Habermassian perspective. Social Science & Medicine 63 (5): 1170-1187.

Haffner, L. (1992) Translation is not enough: Interpreting in a medical setting. Western Journal of Medicine 157 (3): 255-259.

Hale, S. (2004) The Discourse of Course Interpreting: Discourse Practices of the Law, the Witness and the Interpreter. Amsterdam: John Benjamins.

Labov, W. and Waletzky, J. (1967) Narrative analysis: Oral versions of personal experience. In J. Helms (ed.) Essays on the Verbal and Visual Arts, 12-44. Seattle: University of Washington Press.

Li, S. (2015) Nine types of turn-taking in interpreter-mediated GP consultations. Applied Linguistics Review 6 (1): 73-96.

Li, S., Gerwing, J., Krystallidou, D., Rowlands, A., Cox, A. and Pype, P. (2017) Interaction - A missing piece of the jigsaw in interpreter-mediated medical consultation models. Patient Education and Counseling 100 (9): 1769-1771.

Meyer, B. (2012). Ad hoc interpreting for partially language-proficient patients: Participation in multilingual constellations. In C. Baraldi and L. Gavioli (eds) Coordinating Participation in Dialogue Interpreting, 99-113. Amsterdam: John Benjamins.

Mishler, E. G. (1984) The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, NJ: Ablex.

Pöchhacker, F. (2004) Introducing Interpreting Studies. London: Routledge.

Psathas, G. (1995) ‘Talk and social structure’ and ‘studies of work’. Human Studies 18 (2-3): 139-155.

Putsch, R. W. III (1985) Cross-cultural communication: The special case of interpreters in health care. Journal of the American Medical Association 254 (23): 3344-3348.

Raymond, C. W. (2014a) Conveying information in the interpreter-mediated medical visit: The case of epistemic brokering. Patient Education and Counseling 97 (1): 38-46.

Raymond, C. W. (2014b) Epistemic brokering in the interpreter-mediated medical visit: Negotiating ‘patient’s side’ and ‘doctor’s side’ knowledge. Research on Language and Social Interaction 47 (4): 426-446.

Robb, N. and Greenhalgh, T. (2006) ‘You have to cover up the words of the doctor’: The mediation of trust in interpreted consultations in primary healthcare. Journal of Healthcare Organisation and Management 20 (5): 434-455.

Roberts, C. and Moss, R. (2005) Explanations, explanations, explanations: How do patients with limited English construct narrative accounts in multi-lingual, multi-ethnic settings and how can GPs interpret them? Family Practice 22 (4): 412-418.

Roberts, C., Sarangi, S. and Moss, R. (2004) ‘Presentation of self and symptom in primary care consultations involving patients from non-English speaking backgrounds. Communication & Medicine 1 (2): 159-169.

Roy, C. B. (1999) Interpreting as a Discourse Process. New York: Oxford University Press.

Sarangi, S. (2012) The intercultural complex in healthcare encounters: A discourse analytical perspective. In N. G. Patil and C. L. K. Lam (eds) Making Sense in Communication, 13 -24. Hong Kong: IMHSE Publication.

Schouten, B. and Meeuwesen, L. (2006) Cultural differences in medical communication: A review of the literature. Patient Education & Counselling 64 (1-3): 21-34.

Silverman, D. (1987) Communication and Medical Practice: Social Relations in the Clinic. London: Sage.

Singy, P. and Guex, P. (2005) The interpreter’s role with immigrant patients: Contrasted points of view. Communication & Medicine 2 (1): 45-51.

Stokes, R. and Hewitt, J. P. (1976) Aligning actions. American Sociological Review 41 (5): 838-849.

Swinglehurst, D., Roberts, C., Li, S., Weber, O. and Singy, P. (2014) Beyond the ‘dyad’: A qualitative re-evaluation of the changing clinical consultation. BMJ Open 4 (9): e006017.

Tannen, D. and Wallat, C. (1983) Doctor/mother/child communication: Linguistic analysis of a paediatric interaction. In S. Fisher and A. D. Todd (eds) The Social Organisation of Doctor-Patient Communication, 203-219. Washington, DC: Center for Applied Linguistics.

Tsai, M. (2007) Who gets to talk?: An interactive framework evaluating companion effects in geriatric triads. Communication & Medicine 4 (1): 37-49.

Vertovec, S. (2007) Super-diversity and its implications. Ethnic and Racial Studies 30 (6): 1024-1054.

Vertovec, S. (2010) Towards post-multilingualism? Changing communities, conditions and contexts of diversity. International Science Journal 199: 83-95.

Vickers, C. Goble, R and Deckert, S. (2015) Third party interaction in the medical context: Code-switching and control. Journal of Pragmatics 84: 154-171.

Wadensjö, C. (1998) Interpreting as Interaction. Harlow, UK: Addison Wesley Longman.



How to Cite

Roberts, C., & Sarangi, S. (2020). Third party insurance? Interactional role alignment in family member mediated primary care consultations. Communication and Medicine, 15(2), 191–205.