Item Details

Managing uncertainty in healthcare interpreter-mediated interaction: On rendering question-answer sequences

Issue: Vol 15 No. 2 (2018) Special Issue: Interpreter-Mediated Healthcare Encounters

Journal: Communication & Medicine

Subject Areas: Healthcare Communication Linguistics

DOI: 10.1558/cam.38677


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.

Author: Claudio Baraldi, Laura Gavioli

View Full Text

References :

Angelelli, C. (2004) Medical Interpreting and Cross-Cultural Communication. Cambridge: Cambridge University Press.


Angelelli, C. (2012) Challenges in interpreters’ coordination of the construction of pain. In C. Baraldi and L. Gavioli (eds) Coordinating Participation in Dialogue Interpreting, 251-268. Amsterdam: John Benjamins.


Aranguri, C., Davidson, B. and Ramirez, R. (2006) Patterns of communication through interpreters: A detailed sociolinguistic analysis. Journal of General Internal Medicine 21 (6): 623-629.


Baraldi, C. (2009) Forms of mediation. The case of interpreter-mediated interactions in medical systems. Language and intercultural communication 9 (2): 120-137.


Baraldi, C. (2012) Interpreting as dialogic mediation: The relevance of expansions. In C. Baradi and L. Gavioli (eds) Coordinating Participation in Dialogue Interpreting, 297-326. Amsterdam: John Benjamins.


Baraldi, C. and Gavioli, L. (2007) Dialogue interpreting as intercultural mediation: An analysis in healthcare multicultural settings. In M. Grein and E. Weigand (eds) Dialogue and culture, 155-175. Amsterdam: John Benjamins.


Baraldi, C. and Gavioli, L. (2012) Understanding coordination in interpreter-mediated interaction. In C. Baraldi and Laura Gavioli (eds) Coordinating Participation in Dialogue Interpreting, 1-21. Amsterdam: John Benjamins.


Baraldi, C. and Gavioli, L. (2015) On professional and non-professional interpreting: The case of intercultural mediators. European Journal of Applied Linguistics 4 (1): 33-55.


Baraldi, C. and Gavioli, L. (2017) Intercultural mediation and ‘(non)professional’ interpreting in Italian healthcare institutions. In R. Antonini, L. Cirillo, L. Rossato and I. Torresi (eds) Non-Professional Interpreting and Translation: State of the Art and Future of an Emerging Field of Research, 83-106. Amsterdam: John Benjamins.


Barry, C., Stevenson, F., Britten, N., Barber, N. and Bradley, C. (2001) Giving voice to the lifeworld: More human, more effective medical care? A qualitative study of doctor-patient communication in general practice. Social Science & Medicine 53 (4): 487-505.


Beach, W. and Dixson, C. N. (2001) Revealing moments: Formulating understandings of adverse experiences in a health appraisal interview. Social Science & Medicine 52 (1): 25-44.


Bergen, C. and Stivers, T. (2013) Patient disclosure of medical misdeeds. Journal of Health and Social Behavior 54 (2): 221-240.


Bischoff, A., Bovier, P. A., Rrustemi, I., Gariazzo, F., Eytan, A. and Loutan, L. (2003) Language barriers between nurses and asylum seekers: Their impact on symptom reporting and referral. Social Science & Medicine 57 (3): 503-512.


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


Bridges, S., Yiu, C. and McGrath, C. (2011) Multilingual interactions in clinical dental education: A focus on mediated interpreting. Communication & Medicine 8 (3): 197-210.


Cambridge, J. (1999) Information loss in bilingual medical interviews through an untrained interpreter. The Translator 5 (2): 201-219.


Clemente, I., Heritage, J., Meldrum, M., Tsao, J. and Keltzer, L. (2012) Preserving the child as a respondent: Initiating patient-centered interviews in a US outpatient tertiary care pediatric pain clinic. Communication & Medicine 9 (3): 203-213.


Clemente, I., Lee, S.-H. and Heritage, J. (2008) Children in chronic pain: Promoting paediatric patients’ symptom accounts in tertiary care. Social Science & Medicine 66 (6): 1418-1428.


Cohn, E., Cortes, D., Hook, J., Yinusa-Nyahkoon, L. S., Solomon, J. and Bokhour, B. (2009) A narrative of resistance: Presentation of self when parenting with children with asthma. Communication & Medicine 6 (1): 27-37.


Collins, S., Britten, N., Ruusuvuori, J. and Thompson A. (eds) (2007) Patient Participation in Health Care Consultations: Qualitative Perspectives. Milton Keynes: Open University Press.


Davidson, B. (2000) The interpreter as institutional gatekeeper: The social-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.


De Maesschalck, S., Deveugele, M. and Willems, S. (2011) Language, culture and emotions: Exploring ethnic minority patients’ emotional expressions in primary healthcare consultations. Patient Education and Counseling 84 (3): 406-412.


Deppermann, A. and Sprang-Fogasy, T. (2011) Doctors’ questions as displays of understanding. Communication & Medicine 8 (2): 111-122.


Egbert, M., Yufu, M. and Hirataha, M. (2016) An investigation of how 100 articles in the Journal of Pragmatics treat transcripts of English and non-English languages. Journal of Pragmatics 94: 98-111.


Gavioli, L. (2012) Minimal responses in interpreter-mediated medical talk. In C. Baraldi and L. Gavioli (eds) Coordinating Participation in Dialogue Interpreting, 201-228. Amsterdam: John Benjamins.


Gavioli, L. (2015) On the distribution of responsibilities in treating critical issues in interpreter-mediated medical consultations: The case of ‘le spieghi(amo)’. Journal of Pragmatics 76: 159-180.


Gavioli, L. and Baraldi, C. (2011) Interpreter-mediated interaction in healthcare and legal settings: Talk organization, context and the achievement of intercultural communication. Interpreting 13 (2): 205-233.


Gudykunst, W. (1994) Bridging Differences: Effective Intergroup Communication. Thousand Oaks, CA: Sage.


Harmsen, J., Bernsen, R., Bruijnzeels, M. and Meeuwesen, L. (2008) Patients’ evaluation of quality of care in general practice: What are the cultural and linguistic barriers? Patient Education and Counseling 72 (1): 155-162.


Heritage, J. (2010) Questioning in Medicine. In A. Freed and S. Ehrlich (eds) ‘Why Do You Ask?’: The Function of Questions in Institutional Discourse, 42-68. New York: Oxford University Press.


Heritage, J. and Clayman, S. 2010. Talk in Action. Interactions, Identities, and Institutions. Chichester, UK: Wiley-Blackwell.


Heritage, J. and Maynard, D. (eds) (2006) Communication in Medical Care: Interactions between Primary Care Physicians and Patients. Cambridge: Cambridge University Press.


Heritage, J. and Robinson, J. (2006) The structure of patients’ presenting concerns: Physicians’ opening questions. Health Communication 19 (2): 89-102.


Heritage, J., Robinson, J., Elliott, M., Beckett, M. and Wilkes M. (2007) Reducing patients’ unmet concerns in primary care: The difference one world can make. Journal of General Internal Medicine 22 (10): 1429-1433.


Hsieh, E. (2006) Interpreters as co-diagnosticians: Overlapping roles and services between providers and interpreters. Social Science & Medicine 64 (4): 924-937.


Jones, A. and Collins, S (2007) Nursing assessments and other tasks. Influences on participation in interactions between patients and nurses. In S. Collins, N. Britten, J. Ruusuvuori and A. Thompson (eds), Patient Participation in Health Care Consultations: Qualitative Perspectives, 143-163. Milton Keynes: Open University Press.


Kale, E., Finset, A., Eikeland, H.-L. and Gulbrandsen, P. (2011) Emotional cues and concerns in hospital encounters with non-Western immigrants as compared with Norwegians: An exploratory study. Patient Education and Counseling 84 (3): 325-331.


Leanza, Y., Boivin, I. and Rosenberg, E. (2013) The patient’s lifeworld: Building meaningful clinical encounters between patients, physicians and interpreters. Communication & Medicine 10 (1): 13-25.


Luhmann, N. (1990) Der medizinische code. In N. Luhmann Soziolgische Aufklärung 5, 183-195. Opladen, Germany: Westdeutscher Verlag.


Luhmann, N. (1994) Social Systems. Stanford, CA: Stanford University Press.


Luhmann, N. (2012) Theory of Society, Volume 1. Stanford, CA: Stanford University Press.


Mason, I. (2006) On mutual accessibility of contextual assumptions in dialogue interpreting. Journal of Pragmatics 38 (3): 359-373.


Meeuwesen, L., Tromp, F., Schouten, B. C. and Harmsen, J. A. M. (2007) Cultural differences in managing information during medical interaction: How does the physician get a clue? Patient Education and Counseling 67 (2): 183-190.


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


Moss, B. and Roberts, C. (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.


Paterniti, D., Fancher, T., Cipri, C., Timmermans, S., Heritage, J. and Kravitz, R. (2010) Getting to ‘no’. Strategies primary care physicians use to deny patient requests. Archives of Internal Medicine 170 (4): 381-388.


Penn, C. and Watermeyer, J. (2012) Cultural brokerage and overcoming communication barriers: A case study for aphasia. In C. Baraldi and L. Gavioli (eds) Coordinating Participation in Dialogue Interpreting, 269-296. Amsterdam: John Benjamins.


Pilnick, A. and Dingwall, R. (2011) On the remarkable persistence of asymmetry in doctor/patient interaction: A critical review. Social Science & Medicine 72 (8): 1374-1382.


Pöchhacker, F. (2008) Interpreting as mediation. In C. Valero-Garces and A. Martin (eds) Crossing Borders in Community Interpreting. Definitions and Dilemmas, 9-26. Amsterdam: John Benjamins.


Psathas G. and Anderson, T. 1990. The practices of transcription in conversation analysis. Semiotica 78 (1-2): 75-99.


Roberts, C. and Sarangi, S. (2005) Theme-oriented discourse analysis of medical encounters. Medical Education 39 (6): 632-640.


Robinson, J. (2001) Closing medical encounters: Two physician practices and their implications for the expression of patients’ unstated concerns. Social Science & Medicine 53 (5): 639-656.


Ruusovuori, J. (2007) Managing affect: Integration of empathy and problem-solving in health care encounters. Discourse Studies 9 (5): 597-622.


Stivers, T. (2002) Presenting the problem in paediatric encounters: ‘Symptoms only’ versus ‘candidate diagnosis’ presentations. Health Communication 14 (3): 299-338.


Stivers, T. (2005a) Non-antibiotic treatment recommendations: Delivery formats and implications for parent resistance. Social Science & medicine 60 (5): 949-964.


Stivers, T. (2005b) Parent resistance to physicians’ treatment recommendations: One resource for initiating a negotiation of the treatment decision. Health Communication 18 (1): 41-74.


Suurmond, J. and Seeleman, C. (2006) Shared decision-making in an intercultural context: Barriers in the interaction between physicians and immigrant patients. Patient Education and Counseling 60 (2): 253-259.


Tebble, H. (1999) The tenor of consultant physicians: Implications for medical interpreting. The Translator 5 (2): 179-200.


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