Transcending medical consultationsEntering the in-between zone to study the role of healthcare interpreters

  1. Cristina Álvaro Aranda 1
  1. 1 University of Alcalá (FITISPos-UAH Research Group)
Revista:
Revista española de lingüística aplicada

ISSN: 0213-2028

Año de publicación: 2024

Volumen: 37

Número: 2

Páginas: 682-719

Tipo: Artículo

DOI: 10.1075/RESLA.22043.CRI DIALNET GOOGLE SCHOLAR

Otras publicaciones en: Revista española de lingüística aplicada

Resumen

The role of healthcare interpreters has attracted much interest over the years, with particular emphasis on the distance between an invisible, uninvolved prescribed behaviour that contrasts with the interpreters’ behaviour in practice as active participants. However, much of the existing literature focuses on unfolding medical consultations where providers, patients and interpreters are simultaneously present, often overlooking situations when interpreters are left alone with patients. This involves areas of special role complexity in which interpreters must choose whether or not to become visible to the patient in what has been defined as the in-between (Shaffer, 2020). This contribution aims to observe the healthcare interpreter’s role beyond the very act of the medical interview. Inspired by Shaffer (2020), we examine 66 moments “in-between” involving a sample of six interpreters (including four student interns) that took place prior, mid and end of consultations in a Spanish hospital. Rather than staying invisible, our analysis reveals that interpreters of the sample often participate in moments in-between (89.39%) to enact different roles (i.e., companion/confidant, advocate for the profession, mediator, institutional navigator, and healthcare ambassador). Among other aspects, triggers for role adoption in the in-between space include preventing conflict and deploying empathy. In this study, the behaviour of interpreters has demonstrated to influence the subsequent development of medical consultations (e.g., saving time or facilitating history taking). In light of preliminary findings that must be interpreted considering our research context, the next step is to examine how the healthcare interpreter’s behaviour in the in-between zone can facilitate interprofessional collaboration to provide patients with quality-care.

Referencias bibliográficas

  • Aguilera Ávila, L. (2015) Estrategias de prevención y autoayuda para intérpretes que trabajan en contextos de violencia de género. InToledano Buendía, C., & del Pozo Triviño, M. (Eds.), Interpretación en contextos de violencia de género (pp.272–293). Tirant Humanidades.
  • Álvaro Aranda, C., & Lázaro Gutiérrez, R. (2021) La formación en interpretación sanitaria y su camino hacia la profesionalización: un análisis de itinerarios formativos propuestos desde distintas entidades en España. Panace@, XXII(53), 69–77.
  • Álvaro Aranda, C., González, C., & Lázaro Gutiérrez, R. (2021a) La enseñanza bimodal de la interpretación sanitaria: Una experiencia docente en un máster universitario en TISP. Lenguas Modernas, 581, 137–153.
  • Álvaro Aranda, C., Lázaro Gutiérrez, R., & Li, S. (2021b) Towards a collaborative structure of interpreter-mediated medical consultations: Complementing functions between healthcare interpreters and providers. Social Science & Medicine, 2691. 10.1016/j.socscimed.2020.113529 https://doi.org/10.1016/j.socscimed.2020.113529
  • Álvaro Aranda, C. (2020a) Formación y experiencia profesional como diferenciadores en la actuación de intérpretes sanitarios: un estudio de caso desde la sociología de las profesiones [Training and professional experience as differentiators in the performance of healthcare interpreters: A case study from the sociology of the professions] [Unpublished Doctoral dissertation] University of Alcalá.
  • (2020b) Analysing the healthcare interpreter’s role in the “in-between”: An exploratory study of patient-interpreter spoken interactions in a hospital setting. SKASE, 13(2), 22–37. www.skase.sk/Volumes/JTI19/pdf_doc/02.pdf
  • (2021) “I don’t know, I’m just the interpreter”: A first approach to the role of healthcare interpreters beyond bilingual medical encounters. TRANS, 251, 395–412. 10.24310/TRANS.2021.v1i25.10128 https://doi.org/10.24310/TRANS.2021.v1i25.10128
  • (2022a) Finding ethics in and out of deontological codes: ethical dilemmas faced by healthcare interpreting student interns. Hikma, 21(2), 257–286. 10.21071/hikma.v21i2.14284 https://doi.org/10.21071/hikma.v21i2.14284
  • (2022b) Functions and transmission of humour in interpreter-mediated healthcare consultations: An exploratory study. Revista Española de Lingüística Aplicada/Spanish Journal of Applied Linguistics, 36(1), 87–119. 10.1075/resla.20041.cri https://doi.org/10.1075/resla.20041.cri
  • (2023) Examining teach-back in healthcare interpreting through case study research. Transletters, 7(2), 18–44.
  • Angelelli, C. (2004a) Medical interpreting and cross-cultural communication. Cambridge University Press. 10.1017/CBO9780511486616 https://doi.org/10.1017/CBO9780511486616
  • (2004b) Revisiting the interpreter’s role: A study of conference, court, and medical interpreters in Canada, Mexico and the United States. John Benjamins Publishing Company. 10.1075/btl.55 https://doi.org/10.1075/btl.55
  • (2019) Healthcare interpreting explained. Routledge. 10.4324/9781315310978 https://doi.org/10.4324/9781315310978
  • Bischoff, A., Kurth, E., & Henley, A. (2012) Staying in the middle: A qualitative study of health care interpreters’ perceptions of their work. Interpreting, 14(1), 1–22. 10.1075/intp.14.1.01bis https://doi.org/10.1075/intp.14.1.01bis
  • Bolden, G. B. (2000) Toward understanding practices of medical interpreting: Interpreters’ involvement in history taking. Discourse Studies, 2(4), 387–419. 10.1177/1461445600002004001 https://doi.org/10.1177/1461445600002004001
  • Braun, V., & Clarke, V. (2021) Thematic analysis: A practical guide to understanding and doing. Sage Publications.
  • Bridges, S. M., Yiu, C. K., & McGrath, C. P. (2011) Multilingual interactions in clinical dental education: A focus on mediated interpreting. Communication & Medicine, 8(3), 197–210. 10.1558/cam.v8i3.197 https://doi.org/10.1558/cam.v8i3.197
  • Butow, P. N., Sze, M., Eisenbruch, M., Bell, M. L., Aldridge, L. J., Abdo, S., Tanious, M., Dong, S., Iedema, R., Vardy, J., Hui, R., Boyle, F., Liauw, W., & Goldstein, D. (2013) Should culture affect practice? A comparison of prognostic discussions in consultations with immigrant versus native-born cancer patients. Patient Education and Counseling, 92(2), 243–252. 10.1016/j.pec.2013.03.006 https://doi.org/10.1016/j.pec.2013.03.006
  • Costa, B. (2022) Interpreter-mediated CBT – A practical implementation guide for working with spoken language interpreters. The Cognitive Behaviour Therapist, 15(e8). 10.1017/S1754470X2200006X https://doi.org/10.1017/S1754470X2200006X
  • Cox, A. (2015) Do you get the message? Defining the interpreter’s role in medical interpreting in Belgium. MonTI. Monografías de Traducción e Interpretación, 21, 161–184. 10.6035/MonTI.2015.ne2.6 https://doi.org/10.6035/MonTI.2015.ne2.6
  • Cragun, R., & Cragun, D. (2014) Introduction to sociology. Tampa: Blacksleet River.
  • Davidson, B. (2000) The interpreter as institutional gatekeeper: The social-linguistic role of interpreters in Spanish-English medical discourse. Journal of Sociolinguistics, 4(3), 379–405. 10.1111/1467‑9481.00121 https://doi.org/10.1111/1467-9481.00121
  • Davitti, E. (2019) Healthcare Interpreting. InBaker, M., & Saldanha, G. (Eds.), Routledge encyclopedia of translation studies. 3rd edition. Routledge. 10.4324/9781315678627‑48 https://doi.org/10.4324/9781315678627-48
  • Espinoza Suarez, N., Urtecho, M., Jubran, S., Yeow, M., Wilson, M. E., Boehmer, K. R., & Barwise, A. K. (2021) The roles of medical interpreters in intensive care unit communication: A qualitative study. Patient Education and Counseling, 104(5), 1100–1108. 10.1016/j.pec.2020.10.018 https://doi.org/10.1016/j.pec.2020.10.018
  • Fatahi, N., Mattsson, B., Hasanpoor, J., & Skott, C. (2005) Interpreters’ experiences of general practitioner–patient encounters. Scandinavian Journal of Primary Health Care, 23(3), 159–163. 10.1080/02813430510018509 https://doi.org/10.1080/02813430510018509
  • Flores, G. (2005) The impact of medical interpreter services on the quality of health care: A systematic review. Medical Care Research and Review, 62(3), 255–299. 10.1177/1077558705275416 https://doi.org/10.1177/1077558705275416
  • Gavioli, L. (2015) On the distribution of responsibilities in treating critical issues in interpreter-mediated medical consultations: The case of ‘le spieghi(amo)’, Journal of Pragmatics, 761, 169–180. 10.1016/j.pragma.2014.12.001 https://doi.org/10.1016/j.pragma.2014.12.001
  • Groenman, N. H., Buckenham, M., & Slevein, O. (1992) Social and behavioural sciences for nurses: Psychology, sociology and communication for project 2000. Nelson Thornes.
  • Hancock, R. D., & Algozzine, B. (2017) Doing case study research. A practical guide for beginning researchers (3rd ed.). Teachers College Press.
  • Herefordshire Language Network Herefordshire Language Network. (No date). Guidance on working with an interpreter. https://www.herefordshire.gov.uk/downloads/file/3633/guidance-on-working-with-an-interpreter
  • Heritage, J. (2003) Conversation analysis and institutional talk. Analyzing data. InSilverman, D. (Ed.), Qualitative research: Theory, method and practice (2nd ed.) (pp.222–245). Sage Publications.
  • Herrmann, T., Jahnke, I., & Loser, K. (2004) The role concept as a basis for designing community systems. Journal of Computer-Mediated Communication, 22(6), 337–362, 10.1.1.198.2899 https://doi.org/10.1.1.198.2899
  • Hsieh, E. (2007) Interpreters as co-diagnosticians: Overlapping roles and services between providers and interpreters. Social Science & Medicine64(4), 924–937. 10.1016/j.socscimed.2006.10.015 https://doi.org/10.1016/j.socscimed.2006.10.015
  • (2013) Health literacy and patient empowerment: The role of medical interpreters in bilingual health care. InDutta, M. J., & Kreps, G. L. (Eds.), Reducing health disparities: Communication intervention (pp.35–58). Peter Lang.
  • (2016) Bilingual health communication. Working with interpreters in cross-cultural care. Routledge. 10.4324/9781315658308 https://doi.org/10.4324/9781315658308
  • IMIA IMIA (2010) IMIA guide on medical interpreter ethical conduct. https://www.imiaweb.org/uploads/pages/376_2.pdf
  • InterpreLink. Professional Language Services InterpreLink. Professional Language Services. (No date). Interpreter standards. interprelink.com/
  • Juckett, G., & Unger, K. (2014) Appropriate use of medical interpreters. American Family Physician, 90(7), 476–480. https://www.aafp.org/afp/2014/1001/p476.html
  • Karliner, L. S., Pérez-Stable, E. J., & Gregorich, S. E. (2017) Convenient access to professional interpreters in the hospital decreases readmission rates and estimated hospital expenditures for patients with limited English proficiency. Med Care, 55(3), 199–206. 10.1097/MLR.0000000000000643 https://doi.org/10.1097/MLR.0000000000000643
  • Kilian, S., Swartz, L., Hunt, X., Benjamin, E., & Chiliza, B. (2021) When roles within interpreter-mediated psychiatric consultations speak louder than words. Transcultural Psychiatry, 58(1), 27–37. 10.1177/1363461520933768 https://doi.org/10.1177/1363461520933768
  • Komarovsky, M. (1992) The concept of social role revisited. Gender and Society, 6(2), 301–313. www.jstor.org/stable/189667. 10.1177/089124392006002010 https://doi.org/10.1177/089124392006002010
  • Krystallidou, D., Devisch, I., Van de Velde, D. & Pype, P. (2017) Understanding patient needs without understanding the patient: The need for complementary use of professional interpreters in end-of-life care. Medicine Health Care and Philosophy, 20(4), 477–481. 10.1007/s11019‑017‑9769‑y https://doi.org/10.1007/s11019-017-9769-y
  • Krystallidou, D. (2013) The interpreter’s role in medical consultations as perceived and as interactionally negotiated: A study of a Flemish hospital setting, using interview data and video recorded interactions. [Doctoral dissertation, Ghent University]. hdl.handle.net/1854/LU-4086069 (2016) Investigating the interpreter’s role(s). The A.R.T. framework. Interpreting, 18(2), 172–197. 10.1075/intp.18.2.02kry https://doi.org/10.1075/intp.18.2.02kry
  • Labovitz, S. (1977) An introduction to sociological concepts. Wiley.
  • Lara Otero, K., Weil, J., Guerra, C., Cheng, J., Youngblom, J., & Joseph, G. (2019) Genetic counselor and healthcare interpreter perspectives on the role of interpreters in cancer genetic counseling. Health Communication, 34(13), 1608–1618. 10.1080/10410236.2018.1514684 https://doi.org/10.1080/10410236.2018.1514684
  • Lázaro Gutiérrez, R. (2014) Use and abuse of an interpreter. InValero Garcés, C., Vitalaru, B., and Mojica López, E. (Eds.), (Re)considerando ética e ideología en situaciones de conflicto=(Re)visiting ethics and ideology in situations of conflict (pp.214–221). Servicio de Publicaciones de la Universidad de Alcalá.
  • (2018) Interpretación para víctimas de violencia de género. Panace@, XIX(47), 96–105.
  • Leanza, Y., Boivin, I., & Rosenberg, E. (2010) Interruptions and resistance: A comparison of medical consultations with family and trained interpreters. Social Science and Medicine, 70(12), 1888–1895. 10.1016/j.socscimed.2010.02.036 https://doi.org/10.1016/j.socscimed.2010.02.036
  • Leanza, Y. (2005) Roles of community interpreters in pediatrics as seen by interpreters, physicians and researchers. Interpreting, 7(2), 167–192. 10.1075/intp.7.2.03lea https://doi.org/10.1075/intp.7.2.03lea
  • Li, S., Gerwing, J., Krystallidou, D., Rowlands, A., Cox, A., & Pype, P. (2017) Interaction – A missing piece of the jigsaw in interpreter mediated medical consultation models. Patient Education and Counseling, 100(9), 1769–1771. 10.1016/j.pec.2017.04.021 https://doi.org/10.1016/j.pec.2017.04.021
  • Lindholm, M. J., Hargraves, L., Ferguson, W. J., & Reed, G. (2012) Professional language interpretation and inpatient length of stay and readmission rates. Journal of General Internal Medicine, 27(10), 1294–1299. 10.1007/s11606‑012‑2041‑5 https://doi.org/10.1007/s11606-012-2041-5
  • Llewellyn-Jones, P., & Lee, R. G. (2014) Redefining the role of the community interpreter: The concept of “role-space”. SLI Press.
  • Major, G., & J. Napier (2019) ‘I’m there sometimes as a just in case’: Examining role fluidity in healthcare interpreting. InMeng, J., Taibi, M., and Crezee, I. H. M. (Eds.), Multicultural health translation, interpreting and communication (pp.183–204). Routledge. 10.4324/9781351000390‑9 https://doi.org/10.4324/9781351000390-9
  • Martínez Gómez, A. (2015) Invisible, visible or everywhere in between? Perceptions and actual behaviors of non-professional interpreters and interpreting users. The Interpreters’ Newsletter, 201, 175–194. https://www.openstarts.units.it/handle/10077/11859
  • McDowell, L., Hilfinger Messias, D. K., & Dawson Estrada, R. (2011) The work of language interpretation in health care: Complex, challenging, exhausting, and often invisible. Journal of Transcultural Nursing, 22(2), 137–147. 10.1177/1043659610395773 https://doi.org/10.1177/1043659610395773
  • Medical Division of the American Translators Association Medical Division of the American Translators Association (2022) Caduceus. https://ata-md.org/caduceus/Caduceus-Spring2022.pdf
  • Mental Welfare Commission for Scotland Mental Welfare Commission for Scotland (2018) Good practice guide. Working with an interpreter. Toolkit for practitioners and interpreters. https://www.mwcscot.org.uk/sites/default/files/2019-06/interpreters_toolkit_feb2018.pdf
  • Merlini, R., & Gatti, M. (2015) Empathy in healthcare interpreting: Going beyond the notion of role. The Interpreters’ Newsletter, 201, 139–160. hdl.handle.net/11393/195681
  • Migrant & Refugee Women’s Health Partnership Migrant & Refugee Women’s Health Partnership (2019) Guide for clinicians working with interpreters in healthcare settings. https://culturaldiversityhealth.org.au/wp-content/uploads/2019/10/Guide-for-clinicians-working-with-interpreters-in-healthcare-settings-Jan2019.pdf
  • Navaza, B., Guionnet, G., Navarro, M., Estévez, L., Pérez-Molina, J. A., & López-Vélez, R. (2012) Reluctance to do blood testing limits HIV diagnosis and appropriate health care of sub-Saharan African migrants living in Spain. AIDS and Behaviour, 16(1), 30–35. 10.1007/s10461‑010‑9871‑0 https://doi.org/10.1007/s10461-010-9871-0
  • NHS Dumfries & Galloway NHS Dumfries & Galloway (2013) Interpreting and translation policy and procedures. https://www.nhsdg.co.uk/wp-content/uploads/2019/07/Interpreting_and_Translation_Policy_and_Procedures.pdf
  • Northern Ireland Health and Social Services Interpreting Service Northern Ireland Health and Social Services Interpreting Service (2004) Code of ethics and good practice guidelines for interpreters. www.saludycultura.uji.es/archivos/NIHSSIS_CoE_and_Good_Practice_for_Interpreters_(NIreland).pdf
  • Penn, C., Watermeyer, J., Koole, T., de Picciotto, J., Ogilvy, D., & Fisch, M. (2010) Cultural brokerage in mediated health consultations: An analysis of interactional features and participant perceptions in an audiology context. JIRCD Journal of Interactional Research in Communication Disorders, 1(1), 135–156. 10.1558/jircd.v1i1.135 https://doi.org/10.1558/jircd.v1i1.135
  • René de Cotret, F., Brisset, C., & Leanza, Y. (2020) A typology of healthcare interpreter positionings. When ‘neutral’ means ‘proactive’. Interpreting, 23(1), 103–126. 10.1075/intp.00052.cot https://doi.org/10.1075/intp.00052.cot
  • Resera, E., Tribe, R., & Lane, P. (2015) Interpreting in mental health, roles and dynamics in practice. International Journal of Culture and Mental Health, 8(2), 192–206. 10.1080/17542863.2014.921207 https://doi.org/10.1080/17542863.2014.921207
  • Rosenbaum, M., Dineen, R., Schmitz, K., Stoll, J., Hsu, M., & Hodges, P. D. (2020) Interpreters’ perceptions of culture bumps in genetic counseling. Journal of Genetic Counseling, 29(3), 352–364. 10.1002/jgc4.1246 https://doi.org/10.1002/jgc4.1246
  • Schwandt, T. A., & Gates, E. F. (2018) Case study methodology. InDenzin, N., & Lincoln, Y. (Eds.), The Sage Handbook of Qualitative Research. Fifth Edition (pp.341–358). Sage Publications.
  • Schwartz, M. A., Elder, B. C., Chhretri, M., & Preli, Z. (2022) Falling through the cracks: Dead new Americans and their unsupported educational needs. Education Sciences, 12(1), 1–9. 10.3390/educsci12010035 https://doi.org/10.3390/educsci12010035
  • Seale, C., Rivas, C., Al-Sarraj, H., Webb, S., & Kelly, M. (2013) Moral mediation in interpreted health care consultations. Social Science and Medicine, 981, 141–148. 10.1016/j.socscimed.2013.09.014 https://doi.org/10.1016/j.socscimed.2013.09.014
  • Shaffer, L. (2020) In-between: An exploration of visibility in healthcare interpreting. Inde V. Souza, I. E. T., & Fragkou, E. (Eds.), Handbook of research on medical interpreting (pp.188–208). IGI GLOBAL. 10.4018/978‑1‑5225‑9308‑9.ch008 https://doi.org/10.4018/978-1-5225-9308-9.ch008
  • Sleptsova, M., Hofer, G., Marcel, E., Grossman, P., Morina, N., Schick, M., Daly, M., Weber, I., Kocagöncü, O., & Langewitz, W. A. (2015) What do interpreters understand as their role in a medical consultation and how do they carry it out in reality?Psychother Psychosom Med Psychol, 65(9–10), 363–369. 10.1055/s‑0035‑1554691 https://doi.org/10.1055/s-0035-1554691
  • Sleptsova, M., Hofer, G., Morina, N., & Langewitz, W. (2014) The role of the health care interpreter in a clinical setting – A narrative review. Journal of Community Health Nursing, 31(3), 167–184. 10.1080/07370016.2014.926682 https://doi.org/10.1080/07370016.2014.926682
  • Wadensjö, C. (1998) Interpreting as interaction. Routledge.
  • Zendelel, R., Schouten, B., van Weert, J., & van Den Putte, B. (2018) Informal interpreting in general practice: The migrant patient’s voice. Ethnicity and Health, 23(2), 158–173. 10.1080/13557858.2016.1246939 https://doi.org/10.1080/13557858.2016.1246939
  • Zhu, C., & Li, J. (2020) Information manipulation in three non-conduit roles in medical interpreting: A process-based analysis. InSinner, C., Paasch-Kaiser, C., & Härtel, J. (Eds.), Translation in the digital age (pp.41–55). Cambridge Scholars Publishing.
  • Zorzi, D. (2012) Mediating assessments in healthcare settings. InBaraldi, C., & Gavioli, L. (Eds.), Coordinating participation in dialogue interpreting (pp.229–250). John Benjamins Publishing Company. 10.1075/btl.102.10zor https://doi.org/10.1075/btl.102.10zor