Medical Interpreting and Cross-cultural Communication

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Language interpreters are often portrayed as invisible language facilitators. According to this perception of invisibility, interpreters are not considered to be parties to the conversation, but rather they are seen as language-switching operators in line with the conduit model of communication Reddy As such, interpreters are expected to pay close attention to the meaning of the message expressed by the parties to a conversation and to convey that same meaning into the other language, without omissions or additions.

This perception of invisibility is represented as a model in figure 1. Based on conference interpreting, this belief supports the idea that only one meaning exists for each verbal utterance and that this meaning is not subject to co-construction.


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Thus, there exists only one possible rendition for that meaning. An alternative conceptualization of the role of interpreters is represented in figure 2. This approach to interpreting as interaction shifts the conceptualization of mechanical or invisible interpreters to more active co-participants. Research in sociolinguistics emphasizes crucial differences in the participatory role of interpreters, and these differences depend upon the nature of the interpreted communicative event ICE Hymes Davidson , and Metzger challenge the notion of neutrality, while studying the participation of interpreters during interactions.

Roy discusses interpreting as a special case of discourse process. She performs a deep analysis of a conference between a professor and a deaf student mediated by an American Sign Language—English interpreter, and shows the Questioning invisibility 9 active participation of the interpreter in the interaction. These scholars call for further research to study the role of interpreters as co-participants in the interaction.

They also underscore the fact that interpreting does not happen in a social vacuum and the importance of describing the role of interpreters in the social context where the interaction is embedded. This book begins to address this call by investigating the visible role of interpreters as it materializes in a medical setting.

The concept of visible interpreters goes beyond the fact that they are active participants in the linguistic interaction. It takes into consideration the power that interpreters possess. The model of visibility that I propose portrays interpreters who are not only linguistically visible, but who are also visible with all the social and cultural factors that allow them to co-construct a definition of reality with the other co-participants to the interaction.

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Interpreters enter the interaction with all of their deeply held views on power, status, solidarity, gender, age, race, ethnicity, nationality, socio-economic status SES , as well as the cultural norms and societal blueprints that encompass the encounter; they use all of these to construct and interpret reality. Interpreters, as members of society, do more than merely co-construct and interact in the communicative event. They are powerful parties who are capable of altering the outcome of the interaction, for example, by channeling opportunities or facilitating access to information.

They are visible co-participants who possess agency. This visible model is highly complex because of several factors present in interpreting situations. Firstly, the ICE does not happen in a social vacuum.


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  6. It occurs within one institution that is permeable to the mandates of society. As a consequence, various layers of institutional and societal influences surround the ICE, adding to its complexity. Secondly, each party to the ICE brings to the encounter its own social factors race, ethnicity, age, gender, SES , adding to the complexity of the interaction. Figure 3 represents the complex role of the visible interpreter.


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    The upper box represents cultural norms and blueprints. The outer circle shows how society enacts them. The middle circle represents the effect and re-creation of those cultural norms and blueprints within the institution. Within this circle lies another set of institutional norms and blueprints which get reconstructed and funneled to permeate the interactions that occur within its boundaries.

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    In the inner circle, the interlocutors bring to the interaction their own set of beliefs, attitudes, and deeply held views on interpersonal factors, such as gender, race, ethnicity, and SES. As the ICE unfolds, the interpreter brings not only the knowledge of languages and the ability to language switch or assign turns, but also the self. Through the self, the interpreter exercises agency and power, which materialize through different behaviors that alter the outcome of the interaction.

    Interpreters are opaque rather than transparent, or visible rather than invisible. It takes the following critical perspective: interpreters, as members of speech communities Hymes in which there are asymmetrical relations between speakers of more and less dominant groups, possess deeply held views about power and solidarity Davidson , Questioning invisibility 11 Like any other human beings, interpreters also possess deeply held views regarding social factors, all of which are present as they interpret and interact during speech events Brewer ; Festinger ; Stouffer et al.

    The visible model presents interpreters who are capable of actively and consciously managing those issues as the interpretation unfolds. In practice, this is observed in varying degrees. This model posits interpreters who make use not just of interpersonal and sociopolitical skills but also of the linguistic and psycholinguistic skills portrayed by the literature on interpreting.

    They follow the traffic flow instead of controlling it and ignore differences in register. Taking an ethnographic approach to studying the role of the medical interpreter, I followed ten interpreters during a period of twenty-two months, and collected data from ICEs. For these data to be meaningful, it is important to first consider the current literature on interpreting in a medical setting. On cross-linguistic communication, Bolden analyzes two interviews between English-speaking doctors and Russian-speaking patients. She examines the role of medical interpreters in structuring interaction between patients and providers in the history-taking phase of medical consultations.

    Bolden challenges the image of interpreters as non-participants to the interaction, whose role is limited to language conversion, and demonstrates that they orient toward obtaining medically relevant information from patients and conveying that information to providers.

    Focusing on a different linguistic group, Cambridge analyzes seven extempore simulated consultations between general medical practitioners and Spanish-speaking volunteer patients. Interpreting was provided by native speakers of Spanish who were not trained, professional interpreters. The results show that appropriate interlocutor roles are not always occupied by all parties and that dangers exist due to a lack of common ground within the transaction. In a similar setting and with the same language pair, Davidson investigates medical discourse mediated by an interpreter. He examines the construction of reciprocity and meaning in interpreted conversations and offers a model which he then applies to ten interpreted and ten same-language medical interviews collected from a pool of fifty.

    Davidson concludes that the difficulties in interpreted conversations lie in the construction of reciprocal understanding as well as in the accurate transformation of semantic and pragmatic content, and that the role of the interpreter as linguistic facilitator varies according to the parties to the interaction. For the physician, the interpreter is the instrument that keeps the patient on track. For the patient, the interpreter is a coconversationalist.

    He states that interpreters do not act merely as machines of semantic conversion, but rather as active participants in the diagnostic process, aligning with healthcare providers, and thus acting as gatekeepers for the recent immigrants for whom they interpret.

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    In a similar cross-linguistic environment, Prince investigates conversations between doctors and patients, using the question as the unit of analysis. She reports an asymmetric distribution in the number of questions asked and answered during a doctor—patient interview. Doctors asked the vast majority of information-seeking questions. Interpreters only initiated one percent of the questions. Three interpreter-related distortions identified in the discourse were: 1 answering instead of translating questions generally occurring in the Questioning invisibility 13 patient-substitute model ; 2 incomplete translations generally occurring in multiple-part questions ; and 3 incorrect translations sometimes related to the level of technicality of the term used or to the lower language proficiency of either the doctor or the interpreter, mishearing, and failure to check information.

    The elicitation of information through the use of questions is of utmost importance in the medical interview. However, as stated by Shuy , this elicitation generally presents various problems triggered by differences in linguistic and cultural backgrounds as well as their goals and understanding of the interaction. Kaufert and Putsch look at the dilemmas faced by medical personnel when two cultural systems clash in emergency situations.

    Their study considers day-to-day workplace pressures and ethical dilemmas, focusing on informed consent and end-of-life decisions mediated by interpreters. The cases used were part of a larger ethnographic study on the role of Aboriginal health interpreters in Winnipeg, Canada. Observations from healthcare providers in Seattle were also included. The discussion centers on issues of power and dominance in clinical communication, the challenge of monolingualism in multicultural medical practice and the role of language intermediaries interpreters.

    Examining English-ASL medical interviews, Metzger analyzes two cases and compares the influence that interpreters have on interpreted interactions. The first case is a pre-recorded role-play of a medical interview interpreted by an interpreting student.

    The second is an authentic interpreted medical interview facilitated by a professional interpreter. She concludes that interpreters have the power to influence interpreted discourse by misrepresenting the source-message footings with their renditions and also by interpreter-generated utterances.

    She says that interpreters co-construct meaning together with the interlocutors and that responsibility during interpretation is shared by all parties to the conversation. In this sense, the co-construction of meaning and the responsibility as team players within a conversation of both the interlocutors and the interpreter sheds light on other skills that interpreters display, beyond those of linguistic code switching and information processing. The quote by Marx at the beginning of this chapter reminds us that outward appearances of things do not necessarily portray their essence.

    So far in this discussion, we have considered interpreters as invisible language switchers, as co-participants, and as interlocutors whose visible role falls within a continuum of visibility. The linguistic gap in the ICE is not the only factor that determines the role of interpreters.

    The nature of any medical encounter, bilingual or monolingual, is in itself complex. From the cradle to the grave, human relationships are vital Adler Every human relationship involves a connectedness between individuals, which is molded by both verbal and non-verbal communicative processes.

    Without communication, successful relationships would not be possible. In fact, even poor relationships depend greatly on communicative processes between individuals. The importance of effective communication in the building of a successful relationship is well illustrated in the healthcare provider HCP —patient situation. Although physicians of today are better educated and more scientific than ever before, they sometimes do not communicate effectively with their patients Jacobs et al.