Item Details

Negotiating roles in pharmacy practice: Interactions across linguistic and cultural barriers

Issue: Vol 9 No. 1 (2012)

Journal: Communication & Medicine

Subject Areas: Healthcare Communication Linguistics

DOI: 10.1558/cam.v9i1.83


There has been relatively little discussion of the effects of cultural and linguistic differences on communication in consultations. Moreover, communication in community pharmacy is largely under-researched. This study explores interactions between pharmacists, pharmacy assistants and patients conducted across cultural and linguistic barriers. We drew on a data set collected in a pharmacy in London. The data consisted of 12 video recorded consultations in which patients spoke in Sylheti (a dialect of Bengali), the pharmacists spoke in English and pharmacy assistants used both languages. These data were supplemented with focus groups. Despite the fact that the pharmacy assistant was the only person able to follow all the interactions, pharmacists worked to fulfil their legal and professional duties. It could be argued that the very existence of cultural and linguistic barriers prompted the pharmacists to engage to ensure that the patient understood how to use their medicine. There was no acknowledgement that the pharmacy assistants were fulfilling an additional role. It is likely that explicit negotiation of a flexible and adaptive communicative model would lead to a more satisfying encounter for all participants.

Author: Fiona Stevenson, Grant McNulty, Miranda Leontowitsch

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References :

Bissell, P., May, C. R, and Noyce, P. R. (2004) From compliance to concordance: Barriers to accomplishing a re-framed model of health care interactions. Social Science and Medicine 58 (4): 851–62.
Buttny, R. (1993) Social Accountability in Communication. London: Sage.
Chen, J. and Britten, N. (2000) ‘Strong medicine’: An analysis of pharmacist consultations in primary care. Family Practice 17 (6): 480–83.
Dysart-Gale, D. (2007) Clinicians and medical interpreters. Negotiating culturally appropriate care for patients with limited English ability. Family and Community Health 30 (3): 237–46.
Friedland, D. and Penn, C. (2003) Conversation analysis as a technique for exploring the dynamics of a mediated interview. International Journal of Language and communication Disorders 38 (1): 95–111.
Greenhalgh, T., Robb, N. and Scambler, G. (2006) Communicative and strategic action in interpreted consultations in primary health care: A Habermasian perspective. Social Science and Medicine 63 (5): 1170–87.
Harding. G, and Taylor, K. (1997) Responding to change: The case of community pharmacy in Great Britain. Sociology of Health and Illness 19 (5): 547–60.
Heritage, J. and Sefi, S. (1992) Dilemmas of advice: Aspects of the delivery and reception of advice in interactions between health visitors and first time mothers. In P. Drew and J. Heritage (eds) Talk at Work, 359–417. Cambridge: Cambridge University Press.
Holloway, S.W. F., Jewson, N. D. and Mason, D. J. (1986) Reprofessionalization or occupational imperialism – some reflections on pharmacy in Britain. Social Science and Medicine 23 (3): 323–32.
Hsieh, E. (2007) Interpreters as co-diagnosticians: Overlapping roles and services between providers and interpreters. Social Science and Medicine 64 (4): 924–37.
Hsieh, E. (2010) Provider-interpreter collaboration in bilingual health care: Competitions of control over interpreter-medicated interactions. Patient Education and Counseling 78 (2): 154–59.
Merrills, J. and Fisher, J. (2006) Pharmacy Law and Practice. Oxford: Elsevier.
Moss, M. and Roberts, C. (2005) Explanations, explanation, 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): 412–18.
Penn, C., Watermeyer , J., Koole, T., de Picciotto, J., Ogilvy, D. E. and Fisch, M. (2010) Cultural brokerage in medicated health consultations: An analysis of interactional features and participant perceptions in an audiology context. Journal of Interactional Research in Communication Disorders 1 (1): 135–56.
Pilnick, A. (2003) ‘Patient counselling’ by pharmacists: Four approaches to the delivery of counselling sequences and their interactional reception. Social Science and Medicine 56 (4): 835–49.
Robb, N. and Greenhalgh, P. (2006) ‘You have to cover up the words of the doctors’. The mediation of trust in interpreted consultations in primary care. Journal of Health Organization and Management 20 (5): 434–55.
Roberts, C., Moss, B., Wass, V., Sarangi, S. and Jones, R. (2005) Misunderstandings: A qualitative study of primary care consultations in multilingual settings, and educational implications. Medical Education 39 (5): 465–75.
Rogers, A., Hassell, K., Noyce, P. and Harris, J. (1998) Advice-giving in community pharmacy: Variations between pharmacies in different locations. Health and Place 4 (4): 365–73.
Salter, C., Holland R., Harvey, I. and Henwood, K. (2007) ‘I haven’t even phoned my doctor yet’. The advice giving role of the pharmacist during consultations for medication review with patients aged 80 or more: Qualitative discourse analysis. British Medical Journal 334 (7603): 1101. Epub 2007 20 April.
Shah, M. B., King, S., Patel, A. S. (2004) Intercultural disposition and communication competence of future pharmacists. American Journal of Pharmaceutical Education68 (5): 1–5.
Temple, B. (1997) Watch your tongue: Issues in translation and cross-cultural research. Sociology 31 (3): 607–18.
Watermeyer , J. (2011) ‘She will hear me’: How a flexible interpreting style enables patients to manage the inclusion of interpreters in medicated pharmacy interactions. Health Communication 26 (1): 71–81.
Watermeyer ,J. and Penn, C. (2009a) The organization of pharmacist-patient interactions in an HIV/Aids clinic. Journal of Pragmatics 41 (10): 2053–71.
Watermeyer, J. and Penn, C. (2009b) ‘Tell me so I know you understand’: Pharmacists’ verification of patients’ comprehension of antiretroviral dosage instructions in a cross-cultural context. Patient Education and Counseling 75 (2): 205–13.
Watermeyer, J. and Penn, C. (2009c) ‘Come let me show you’: The use of props to facilitate communication of antiviral dosage instructions in multilingual pharmacy interactions. In L. Lagerwerf, H. Boer and H. Wasserman (eds) Health communication in Southern Africa: Engaging with Social and Cultural Diversity, 191–216.Amsterdam: Rozenberg Publishers.