English 3 Unit 2: Mediating Specialised Discourse in Healthcare

English 3 (MED3) - Unit 2: Mediating Specialised Discourse in English

Lesson 6: November 3, 2023 - Interpreter-mediated Healthcare Encounters

STUDIORUM MEI UNIVERSITAS ST MEDIOLANENSIS English 3 (MED3) Unit 2 - Mediating specialised discourse in English Lesson 6: November 3, 2023 Interpreter-mediated healthcare encounters Prof. Jekaterina NIKITINA / Paola CATENACCIO Università degli Studi di Milano Dipartimento di Lingue, Letterature, Culture e MediazioniLesson 6: outline

• Healthcare context and public service interpreting
• Types of interpreters in healthcare: theory and reality

• Healthcare encounters as a communicative event
• Main information exchange stages
• Medical interpreter's competence
• Positions and approaches towards interpreting in healthcare
• A case study

Public Service Interpreting in Healthcare

• Healthcare setting -> public service interpreting (PSI).
• ISO 13611:2014 defines healthcare interpreters as a subcategory of community interpreters.

• Of all PSI, healthcare interpreting is the one with most variables
• Mental health, paediatric, dental, palliative care, physiotherapy, health tourism, etc.
• The setting: interview between a service provider (SP) and someone who needs or wants the services (a client/ patient) and who has limited language proficiency (LLP).
• The interview arises out of some sort of crisis in the life of the client/patient.
• Significant risk inherent in the situation.
• Cultural differences between a healthcare professional and a client increase the initial risk inherent in a healthcare encounter

Interpreter-mediated Healthcare Encounters: Scope and Modalities

• WHERE: in a range of sectors from emergency medicine to geriatrics and psychiatry and in a range of different settings: hospital wards and clinics, consulting rooms and patients' homes, community health centres;
• WHO: they interpret for patients and doctors, and also for nurses, physiotherapists and speech pathologists, occasionally administrative staff too;
• WHAT: not only do they provide dialogue interpreting, but are asked to translate documents or write documents and letters in the foreign language, even contact foreign insurance companies and embassies over the telephone.
• On-site bilateral interpreting (short-consecutive, with note-taking)
• Remote interpreting (telephone and, rarely, video)
• Sight translation

Language Mediation in Healthcare Settings: Challenges and Solutions

• Effective communication in healthcare is vital
• Global world = global patients
• in most countries there is no statutory obligation for medical institutions to provide professional interpreting services, so there is hardly any control on the professional competence of persons used as interpreters
• In the US: 58% of serious adverse events in healthcare stem from miscommunication (Chapter 4, p. 131)
• the interpreter is often relied on by both the institution and the patient to provide much more than translation
• cultural factors are particularly important in medical interpreting: the perception of pain, for instance, varies from culture to culture, and there are several taboos in different cultures which need to be taken into consideration
• Healthcare settings are among the settings where reliance is often made not on professional interpreters/mediators, but on emergency solutions, e.g family members and hospital staff.

Language Mediation in Healthcare: Non-professional vs. Professional Solutions

Non-professional "emergency" solutions

Professional solutions

"Getting by" Solutions

using facial expressions and gestures, or using a few key words or phrases in the target language or pointing to an area of the body, making grimaces as if in pain + Google Translate

Ad hoc Interpreters

anyone available who speaks both languages, such as the patient's friends, roommates, colleagues, etc

DISADVANTAGES: inaccuracy (e.g. information edited, withheld or misunderstood; incorrect translation); compromising the patient's right to privacy; patients' reluctance to speak freely in front of family members (spouse, sibling or child)]

Professional Interpreters

Professionally trained specialists not only provide with excellent knowledge of both languages, trained in interpreting techniques and competent in specialized vocabulary + bound by a code of ethics/standards of practice

Cultural Mediators

interpretive services, but also interpret cultural and social circumstances that may affect the patient's care

US: a medium-sized hospital (225 beds) has 5-7 in-house interpreters

Cf. Villarruel, A.M., Portillo, C.J., & Kane, P. (1999). "Communicating with limited English proficiency persons: implications for nursing practice." Nursing Outlook, 47(6), 262-270.

Collaboration of Healthcare Professionals with Interpreters

• 81/112 HP have collaborated with interpreters
• 54 (=66.7%) "patient's bilingual family member or close acquaintance"
• 50 (=61.7%) worked with professional interpreters in person
• 33 (=40.7%) "Professional telephone interpreting", also known as Over-the-Phone interpreting (OPI)
• 24 (=29.6%) "native speaker who is not acquainted with the patient"
• 23 (=28.4%) "bilingual healthcare professionals working in the facility"
• 4 (=4.9%) "professional video remote interpreting"
• 4 (=4.9%) "other" - to add Google Translate / "cultural mediator"

Montenovo 2022; Montenovo and Nikitina 2023

Improving Cooperation Between Interpreters and Medical Practitioners (QMI)

1. "Through greater recognition of the role of the medical interpreter and the proper training of health personnel on how to carry out their work with linguistic mediation “
2. "I think the basis is to give a preview of the linguistic intervention to be done with the patient, but I believe that the best way to improve cooperation is by better training the healthcare staff to manage the work with an interpreter. "
3. "If the healthcare staff knew that interpreters are prepared for this job. I have often seen healthcare workers use macaronic English without asking for help even though I was literally 2 meters away. Perhaps they think that the intermediation of the interpreter slows down the times too much and they prefer to make do in order to be fast"
4. "the team should warn the interpreter before things that can be shocking happen such as opening the rib cage for example, once I even had a surprise autopsy after a surgery course"
5. "Through interprofessional training when both parties are still at university"
6. "Trying to train medical staff to work with interpreters, to be collaborative"

Video on how to work with interpreters

Montenovo and Nikitina 2023

Interprofessional Training for Healthcare Professionals and Interpreters

Healthcare professionals

Have you ever attended training courses, seminars or similar on collaboration with interpreters for your profession?

Sì/Yes . No 87.5% 12.5%

Medical interpreters

Have you ever attended an interpreting training where you had to practice medical interpreting with a real medical practitioner (acting or student)?

71.4% 28.6%

Structure of a Healthcare Encounter

there are many scientific models of its structure, produced in different disciplines (medical anthropology, psychology, communication in healthcare, clinical sciences, ethnomethodology, applied linguistics, etc.), mostly developed for doctor training

an example: the Enhanced Calgary - Cambridge Guide (2002)

Initiating the Session Providing Structure Gathering Information Building a Relationship Physical Examination Explanation and Planning Closing the Session

Suzanne Kurtz & Jonathan SilvermanKurtz. 1996. "The Calgary-Cambridge Observation Guides: an aid to defining the curriculum and organising the teaching in Communication Training Programmes". Medical Education 30, 83-89., available also here

Initiating the Session Stages

Preparation Establishing Initial Rapport Identifying reason(s) for consultation

Gathering Information Stages

Exploration of patient's problem to discover: *Biomedical Perspective *Patient Perspective *Background information/context

Physical Examination

Explanation and Planning Stages

Provide correct amount/type of info Accurate recall/understanding Shared understanding (including patient illness frame- work) Planning: Shared decision making

Closing the Session Stages

Ensure appropriate point of closure Future Planning

Building a Relationship Aspects

Appropriate non-verbal be- haviour Developing rapport Involving the patient

Providing Structure Aspects

Making organisation overt Attending to flow

The Interpreter-mediated Medical Encounter: 11 Stages

11 stages, 3 of which are optional (in parenthesis) Cf. Tebble 1999

EC-C Guide 2002 Stages

Initiating session Gathering Information Physical Examination Explanation and planning Closing the Session

Tebble 1999 Stages

Greetings Introductions (Contract [between doctor/patient & interpreter]) Stating/ Eliciting Problem Ascertaining Facts (Diagnosing Facts) Stating Resolution/ Exposition (Decision by Client) Clarifying any Residual Matters Conclusion Farewell

EC-C Guide 2002 Detailed Stages

Initiating session Preparation Establishing rapport Identifying the reason(s) for consultation Gathering Information Explorations of the patient's problems to discover: Biomedical perspective / Patient's perspective Background information - context Physical Examination Explanation and planning Providing the correct amount & type of information Aiding accurate recall and understanding Achieving a shared understanding; incorporating the patietnt's illness framework Planning, shared decision-making Closing the Session Ensuring appropriate point of closure Forward planning

Tebble 1999 Detailed Stages

Greetings Introductions (Contract [between doctor/patient & interpreter]) Stating/ Eliciting Problem Ascertaining Facts (Diagnosing Facts) Stating Resolution/ Exposition (Decision by Client) Clarifying any Residual Matters Conclusion Farewell

Information Exchange in Healthcare Encounters

Gathering Information

Doctor trying to elicit information from the patient or client by asking questions, e.g. when taking a patient's history or when trying to assess the patient's condition after surgery or other forms of treatment.

Explanation and Planning

Doctor giving the patient instructions which are essential for preventing complications and for managing the patient's condition, e.g. what to watch out for after a head injury, or lifestyle changes for a patient with diabetes.

Doctor giving information about a procedure for which he requires the patient's Informed Consent.

Explanation and planning / decision by patient

Crezee 2013: 12-13, see also Wadensjo (1998, 2002), Meyer (2000, 2003) and Tebble (1998, 2004)