Professional Interpreter

What Do Physicians and Patients Talk about when a Professional Interpreter Joins Them? 1 Rosenberg ,

2 Leanza ,

3 Lussier ,

3 Richard

Ellen Yvan Marie-Thérèse Claude 1Family Medicine, McGill University, Montreal, Canada 2Psychology, Université Laval, Québec 3Médecine Familiale, Université de Montreal Context Professional interpreters can improve outcomes for patients with limited language proficiency . Physicians not trained to work with professional interpreters underuse them. Understanding communication behaviors of untrained physicians may lead to appropriate training programs.

Objective

Results

Conclusions Many physicians and patients gave evidence of their belief in the PI’s ability to serve as an information conduit.

Participants 18 patients and their 15 physicians Language

Number

Tamil

4

Bengali

3

Punjabi

2

Design

Urdu

2

Quantitative descriptive study of videotaped clinic visits between family physicians and patients with limited language proficiency.

Cambodian

1

Cantonese

1

Methods

Hindi

1

Setting: Urban teaching family medicine clinic

Portuguese

1

Intervention:

Russian

1

Turkish

1

Vietnamese

1

To describe communication between patients with limited language proficiency, professional interpreters and physicians who are inexperienced and untrained in working with professional interpreters.

Addition of a Professional Interpreter (PI) during one scheduled return visit

Patient Doctor

Participants addressed a mean of 6.8 (SD 3.9) problems (range 4-23) and 3.4 medications (SD 1.9) (range 1-7) per patient.

Outcomes

Issue Raised

Visit Content

Pain Diabetes CVD risk factors Prevention/Screening Mental Health Social History , Illness of family member Gyn conditions Urinary conditions Pregnancy Past Obstetrical problems Explanation of tests Symptoms without diagnosis Others

Biomedicine Communicative Action Habermas’ Communicative Action Theory presents a distinction between •the System characterized by strategic action: oriented to success •the Lifeworld characterized by communicative action: oriented to understanding Mishler describes the Voice of Medicine 1) a specialized/expert language (jargon) 2) questions or interventions on context free facts or symptoms, possibly measured and quantified 3) questions or interventions which exclude family and socio-cultural contexts and affective elements … and the Voice of the Lifeworld 1) a lay language 2) questions or interventions which include contextualized facts, historically situated, accompanied by affective comments

Number of patients 10 10 8 8 6 8

Number of Issues 24

6 5 5 3 5 13 10

8 8

Interpreter

Physicians clarified previously puzzling symptoms of 4 patients and past pregnancy losses of 3 pregnant women. They explained complex issues, e.g. cord blood donation, to 3 patients Eight patients (44%) asked for an explanation of a problem in a manner suggesting that the question would not have been posed without the PI. Some physicians and patients saw the PI as a conduit to the patient’s Lifeworld.

8

Physicians initiated the discussion of symptoms for 49% of problems. Patients were the initiators for 17% of problems.

Physicians initiated discussion of the patient’s Lifeworld in relation to 26% of problems. Patients raised Lifeworld information about 38% of problems.

Some physicians and patients ‘used’ a PI to increase understanding of symptoms and of the patient’s Lifeworld. The other physicians missed an opportunity, treating the PI as a translating machine. Training programs need to teach physicians how to collaborate with PIs to invite patients to share their concerns and the realities of their lives.

Acknowledgements This project was funded by the Heart and Stroke Foundation of Canada. We thank Cindy Ibberson for project co-ordination and participant recruitment. The participation of the family physicians, patients and the professional interpreters from the Banque Interrégional d’Interprètes was essential to the work.