Communication & Medicine <p>Since its inception in 2004,&nbsp;<em>Communication &amp; Medicine</em>&nbsp;has been consistently interrogating the `black box’ of what is routinely characterised as `the communicative turn’ in healthcare practice in clinical and public health domains. It is now firmly established as a leading forum for these critical debates.</p> Equinox Publishing Ltd. en-US Communication & Medicine 1612-1783 <p>copyright Equinox Publishing Ltd.</p> Communicative vulnerability and its mutation in interpreter-mediated healthcare encounters Srikant Sarangi Copyright (c) 2020 Equinox Publishing Ltd. 2020-03-14 2020-03-14 15 2 111 122 10.1558/cam.40888 Who is talking now? Role expectations and role materializations in interpreter-mediated healthcare encounters <p><span style="font-weight: 400;">Complex layers of meaning accompany conversations about illness and medicine in medical encounters. The complexity multiplies in multilingual healthcare encounters 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 sub-set of three segments of interpreter-mediated authentic interactions (<em>n</em>=392) are presented to&nbsp;</span><span style="font-weight: 400;">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 the one of interpreting. Instead 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.&nbsp;</span></p> Claudia V. Angelelli Copyright (c) 2020 Equinox Publishing Ltd. 2020-03-14 2020-03-14 15 2 123 134 10.1558/cam.38679 Understanding interpreters’ actions in context <p>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.</p> Galina B. Bolden Copyright (c) 2020 Equinox Publishing Ltd. 2020-03-14 2020-03-14 15 2 135 149 10.1558/cam.38678 Managing uncertainty in healthcare interpreter-mediated interaction <p>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.</p> Claudio Baraldi Laura Gavioli Copyright (c) 2020 Equinox Publishing Ltd. 2020-03-14 2020-03-14 15 2 150 164 10.1558/cam.38677 Involvement, trust and topic control in interpreter-mediated healthcare encounters <p>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.</p> Cecilia Wadensjö Copyright (c) 2020 Equinox Publishing Ltd. 2020-03-14 2020-03-14 15 2 165 176 10.1558/cam.38681 Mutual (mis)understanding in interpreting in consultations between Turkish immigrant patients and Dutch general practitioners <div>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.</div> Sione Twilt Ludwien Meeuwesen Jan D. ten Thije Hans Harmsen Copyright (c) 2020 Equinox Publishing Ltd. 2020-03-14 2020-03-14 15 2 177 190 10.1558/cam.38673 Third party insurance? <div>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.</div> Celia Roberts Srikant Sarangi Copyright (c) 2020 Equinox Publishing Ltd. 2020-03-14 2020-03-14 15 2 191 205 10.1558/cam.38675 The comparison of shared decision making in monolingual and bilingual health encounters <div>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.</div> Charlene Pope Jason Roberson Copyright (c) 2020 Equinox Publishing Ltd. 2020-03-14 2020-03-14 15 2 206 221 10.1558/cam.38674 Triadic medical interaction with a bilingual doctor <p>While studies of interpreted medical interactions are common, there is relatively little research on bilingual doctors who choose to consult in the migrant patients’ first language. 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.</p> Louisa Willoughby Marisa Cordella Simon Musgrave Julie Bradshaw Copyright (c) 2020 Equinox Publishing Ltd. 2020-03-14 2020-03-14 15 2 222 232 10.1558/cam.31956 Interpreter-mediated aphasia assessments <div>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.</div> Peter Roger Chris Code Copyright (c) 2020 Equinox Publishing Ltd. 2020-03-14 2020-03-14 15 2 233 244 10.1558/cam.38680