Abstract
BACKGROUND: Numerous articles have detailed how the presence of an interpreter leads to less satisfactory communication with physicians; few have studied how actual communication takes place through an interpreter in a clinical setting.
OBJECTIVE: Record and analyze physician-interpreter-patient interactions.
DESIGN: Primary care physicians with high-volume Hispanic practices were recruited for a communication study. Dyslipidemic Hispanic patients, either monolingual Spanish or bilingual Spanish-English, were recruited on the day of a normally scheduled appointment and, once consented, recorded without a researcher present in the room. Separate postvisit interviews were conducted with the patient and the physician. All interactions were fully transcribed and analyzed.
PARTICIPANTS: Sixteen patients were recorded interacting with 9 physicians. Thirteen patients used an interpreter with 8 physicians, and 3 patients spoke Spanish with the 1 bilingual physician.
APPROACH: Transcript analysis based on sociolinguistic and discourse analytic techniques, including but not limited to time speaking, analysis of questions asked and answered, and the loss of semantic information.
RESULTS: Speech was significantly reduced and revised by the interpreter, resulting in an alteration of linguistic features such as content, meaning, reinforcement/validation, repetition, and affect. In addition, visits that included an interpreter had virtually no rapport-building “small talk,” which typically enables the physician to gain comprehensive patient history, learn clinically relevant information, and increase emotional engagement in treatment.
CONCLUSIONS: The presence of an interpreter increases the difficulty of achieving good physician-patient communication. Physicians and interpreters should be trained in the process of communication and interpretation, to minimize conversational loss and maximize the information and relational exchange with interpreted patients.
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Aranguri, C., Davidson, B. & Ramirez, R. Patterns of communication through interpreters. J Gen Intern Med 21, 623–629 (2006). https://doi.org/10.1111/j.1525-1497.2006.00451.x
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DOI: https://doi.org/10.1111/j.1525-1497.2006.00451.x