Analyzing medical discourse through the lens of the non-English-speaking patient / interpreter / physician interaction
Analyzing medical discourse through the lens of the non-English-speaking patient / interpreter / physician interaction
Sean Shadaia
This paper examines the imbalanced exchange of power in medical discourse through the lens of the physician – non-English speaking patient – third party interpreter scenario. It analyzes the challenges in the current configuration through presenting the idea of discourse analysis and the impact of language and power dynamic on the dialogue, as well how this impacts effective communication and patient and doctor satisfaction. In terms of improvements, the strengths of the doctor as the third party interpreter are considered. However, the lack of availability in all situations is an issue. The third party interpreter, both family and professional, and their role in the discourse are introduced. It analyzes the impact, as well as unique challenges and advantages, of both types of interpreter.
With regards to non-English speaking patients, it is crucial to understand all of the factors inhibiting their effective communication and actively working towards improving all of them. This means not only providing interpreters, but getting family members to act as advocates. It also means training the professional interpreters and multilingual physicians in understanding the sociolinguistic characteristics of the power dynamic within the medical discourse; particularly, to understand what types of “talk” patterns empower patients and encourage involvement, and to facilitate those communications. Through the application of these “talk” based strategies within the doctor-patient-interpreter discourse, it is possible to shift the basis of discourse away from an interview, where one party is innately active and the other is, therefore, innately passive, towards a conversation, in which both parties are engaged and empowered. Having a family member present who can act as an advocate and a professional interpreter present who can act as an information conduit and cultural broker for the physician allows both parties to “play to their strengths” and provide the best possible scenario for effective doctor-patient communication.
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Language and Societies 
Hi Sean- this is such an important topic and critical at this point in the history of American healthcare. I commend you on this topic! Family members as health advocates, interpreters, and culture brokers can be much more thoroughly explored. In the work that I do in a Mexican-American community, the children, grandchildren, and neighbors play this role. This looks a lot different in the medical community I am sure but maybe not. It would be great to see how family members of all ages could be engaged in the healthcare of aging grandparents in more creative ways so that they have the tools to support their family members and also take a more proactive role in their our health.
Hi Sean, this sounds fascinating. I teach the Doctor -Patient consultation models to post graduate medics in the UK. The variety of communication flows contained within this medical discourse is of particular interest to our team of Post Graduate Educators. We use a variety of consultation models and are developing some of our own using narrative methodology. The factors inhibiting and facilitating information flow between the Doctor and patient are numerous in face to face situations and even more so when there is third party involvement.
We call the involvement of the third party interpreter a ‘triadic consultation’ . As well as in non – English speaking patients, to us this also includes situations where parents and children are involved, when the accompanying carer is dominant. .I will be curious to see your finished article in what type of ‘talk patterns’ empower conversation.
Sean: you may address this in the paper, but the abstract might also hint at the way that this circumstance generalizes to mono-languaged interactions as well. The visit of an 11-year-old (English-speaking) boy to the doctor with his mother is one such triadic situation. But even where there are only the patient and doctor, one might propose an “imaginary” third person who problematizes and provides opportunities in a medical circumstance in much the same way an interpreter does. When this third person is “invisible,” then “language” itself becomes the third person–our supposedly steadfast interpreter who nevertheless somehow misrepresents us (sometimes fatally) to our caregivers. I suggest this so that a more general readership, seeing that the research is directed to multilingual scenarios, do not pass over the paper, thinking, “Oh, that has nothing to do with me or my interests or circumstances I might find myself in.”
I must respectfully disagree with some of the previous statements made by some regarding the use of family members – especially children – as interpreters between the medical provider and the patient. The medical community is well aware of the needs of improving communications, however there are many factors to be considered when it comes to choosing an interpreter.
First and foremost are HIPAA regulations which bans the provider from sharing medical information with a 3rd party – even family – without the express & free consent of the patient. I, myself have run into youngsters who assume they will be the interpreter only because they’ve been doing it for the parent in other situations. However, when I questioned the child on their understanding of medical terminology I almost invariably found a huge gap in what I’d said and they’d comprehended. English is tricky by itself: add med-speak to that and it’s a recipe for chaos.
In order to ensure proper – and legal – communications a professional interpreter is used for several reasons. First, to ensure the patient understands what will be shared between the doctor and the interpreter is in strict confidence – which family rarely hold to. The second factor is the provider is assured the interpreter can clearly understand complex medical terms and make them known to the patient in full. I have known of doctors and nurses who used children in their teens or younger as interpreters with disastrous results. The child could not comprehend what the doctor was saying or how to convey the meaning and gave an erroneous translation. The patient refused life-saving treatment because the translation of the risks came over so grossly misinterpreted the patient was understandably scared to proceed. In other situations the family member didn’t think the patient could handle the ‘bad’ news & didn’t translate the message accurately on purpose.
The use of trained medical interpreters has been available for at least two decades (I’ve been practicing for 30+) and they are available 24/7 through 800 hot lines. I have used these interpreters many times and the patient is often far more comfortable speaking to someone who is familiar with their culture as well as the med-speak which best translates what I’m saying into their dialect. Further, it removes a great deal of tension from the child who should NEVER be placed into such a position. I could not imagine asking a 10, 12 or even 18 year old to describe advanced ovarian cancer treatment to their mother – especially a male child. The illness is traumatic enough without forcing the child to describe it in clinical terms to the mother. I’ve found on some occasions they tried to shield their parent from the worst by ‘softening’ or even eliminating some points with which they, themselves couldn’t deal due to fear or sorrow.
Nurses and physicians are now required to take courses in cultural sensitivity and dealing with trans-cultural communications. We must learn what/when eye contact is proper or means something, when touching is proper or improper, why in some cultures not readily answering a question is a sign of respect, not misunderstanding, why husbands will wait outside in some cultures and stand by their wives in another, etc.
I would far prefer a professional medical interpreter both for the sake of my patient and my own peace of mind. I have noted far better results using ‘pros’ rather than family and I will never put a child into the difficult & often uncomfortable position of interpreting for the parent except in the most dire emergency.