The Hospital-based Interpreter as Institutional Gatekeeper

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Examining the role of the hospital-based interpreter as presented by Brad Davidson's research

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The Hospital-based Interpreter as Institutional Gatekeeper

  1. 1. Written by: Brad Davidson Presented by: Toyin Ola THE INTERPRETER AS INSTITUTIONAL GATEKEEPER: THE SOCIAL-LINGUISTIC ROLE OF INTERPRETERS IN SPANISH- ENGLISH MEDICAL DISCOURSE
  2. 2. Introduction Table 1. Riverview General Hospital Patient Demographics, by year Background -The interpreter as conversational participant -Institutions and the mediation of post-colonial discourses -Medical discourse and medical interpretation -Methods and Data The Interpreter in Medical Interviews -The interpreter as co-interviewer -Quantifiable patterns of interference in interpreted medical interviews Table 2. Treatment of Patient-generated direct responses in 10 same-language visits Table 3. Treatment of Patient-generated direct responses in 10 interpreted visits Table 4. Complaints addressed and diagnosed in visits 6 and 7 -The loss of patient complaints Conclusions and Discussion OVERVIEW
  3. 3. INTRODUCTION
  4. 4.  In 1995, as part of a survey of 83 hospitals, it was found that 11% of all patients require an interpreter  The interpreter has a unique position as being the only participant who can follow both sides of a cross-linguistic interaction  Increase in view that the interpreter must act as a negotiator or point of exchange for the differing social contexts of the physician and patient  Uncontested, yet largely under-researched, hypothesis WHY THE INTEREST?
  5. 5.  Conflicting expectations  Hospital administrators and physicians believe that it is possible to render an interpretation with no additions, subtractions, or changes  Research has show that perfect interpretation is “unattainable”  Management of conversational goals  Inherent power differential in medical encounter  Cross-cultural hospital encounters as 3rd World immigrants vs. agents of 1st World institutions  Interpreter as institutional agent  The “interpretive habits” or patterned ways in which changes to the linguistic form of utterances influences the discourse  What do interpreters think is their reason for interpreting (i.e. how do they conceive of their role)? PRESENT RESEARCHER‟S INTEREST
  6. 6. The number of LEP patients seen at Riverview doubled from 1981 to 1993 Spanish-speaking LEP patients make- up 25% of all patients seen at the hospital
  7. 7. BACKGROUND
  8. 8.  Oral mode of translation (i.e. conversion of written texts)  Monologues  “Linguistic conversions of isolated utterances”  Hymes‟ SPEAKING model  Interpreter as „spokesperson‟ or „sender‟ rather than „source‟ or „addressor‟  Goffman  Interpreter as „animator‟ rather than „author‟ or „principal‟  “Interpreter‟s obligation to be a perfect echo of the primary interlocutors” PAST APPROACHES
  9. 9.  Consequences of interpreter‟s role as a…  Historical agent  Linguistic intermediary  Social intermediary  Interpreter‟s responsibility for the achievement of conversational goals  Wadensjö  Effect of interpreter‟s choices on the outcomes  Interpreter as a co-constructor  Shaping messages “in the name of those for whom [she] speaks”  Also, consider the impact of the social and historical facts surrounding the interpreted speech event THE INTERPRETER AS CONVERSATIONAL PARTICIPANT
  10. 10.  Location of speech events in the historical-political timeline  Institutionally defined goals and institutionally reinforced habits  Gives clear expectations of how communication should proceed for those familiar with the institution (e.g. learned medical interview)  Consider Grice‟s cooperative principle  Interpreter as a double gatekeeper  Conflict between providing a service and exercising control inherent in interpreting +gatekeeping for the institution  Gatekeeping =filtering information to facilitate the achievement of certain goals INSTITUTIONS AND THE MEDIATION OF POST-COLONIAL DISCOURSE
  11. 11. Main goal of this research  To examine to what extent the nature of an institutionalized, structured speech event (a hospital-based medical interview) influenced an interpreter‟s “interpretive habits”  The nature of the medical interview :  “The medical habit of differential diagnosis”  “Reality of chronic time shortages” INSTITUTIONS AND THE MEDIATION OF POST-COLONIAL DISCOURSE CON‟T
  12. 12.  Medical interview  Learned by physicians in medical schools  Consider Tebble‟s schema  Elaborated goals of the medical interview 1) “from the data provided, determine what, if anything, is wrong with the patient” 2) “elaborate a plan of treatment for that aliment” 3) “convince the patient of the validity of the diagnosis so that treatment will be followed” MEDICAL DISCOURSE & MEDICAL INTERPRETATION
  13. 13.  Diagnosis as an interpretive process  “a matching of unorganized experiences against familiar patterns or human vulnerability to disease” MEDICAL DISCOURSE & MEDICAL INTERPRETATION Physicians gather patient‟s physical and verbal data Physicians re- analyze this data by passing the information through a biological and social grid „Irrelevant‟ patient data is excluded “The story of the disease is constructed” How do interpreters fit into this differential diagnosis process?
  14. 14.  Riverview Hospital in Northern California  Internal medicine  Patients with chronic illness (regular visits)  Interpreters “professional in the sense that they were paid employees of the hospital”  “ad hoc vacuum of accountability”  100 visits; 50 audiotaped; 20 transcribed  Questionnaires and interviews  Paired bilingual and monolingual interviews  Observed both the hospital-based interpreter and the institutional setting  How interpreter presence shaped (course/content) the medical interview  How interpreter mediated institutional goals (diagnosis and treatment in a timely fashion) vs. patient goals METHODS & DATA
  15. 15. Research Questions:  What is the role of the interpreter within the goal-oriented, learned form of interaction known as the „medical interview‟?  What is the „interpretive habit,‟ and how does one engage in the practice of interpreting?  If interpreters are not neutral, do they challenge the authority of the „physician-judge,‟ and act as patient „ambassadors‟ or „advocates‟; or do they reinforce the institutional authority of the physician and the healthcare establishment, and should we create a model for the „interpreter-judge‟? METHODS & DATA
  16. 16. THE INTERPRETER IN MEDICAL INTERVIEWS
  17. 17.  At Riverview, it was common for the interpreter to arrive before the physician and begin gathering information from the patient  Consider time constraints  Consider the differential diagnosis process  Two effects from interpreter serving as co-interviewer  Pro: from the physician‟s point of view, it was easier to discern the chief complaint since the patient‟s information had been simplified  Con: the interpreter often continued to lead the interview even after the physician had arrived THE INTERPRETER AS CO-INTERVIEWER
  18. 18. TRANSCRIPTION CONVENTIONS
  19. 19. QUANTIFIABLE PATTERNS OF INTERFERENCE IN INTERPRETED MEDICAL INTERVIEWS Interpreter does not render an utterance even when explicitly asked to do so Interpreter has subsumed other participants‟ roles (e.g. doctor only speaks when they are looking for a stool to put the patient‟s foot on) Interpreter is running the interview and managing parallel and related conversations
  20. 20. Interpreter decides that the patient‟s explanation about telling the doctor at a prior visit (i.e. and indirect response detailing when the symptom began) is not relevant, so she negotiates with the patient until he provides a direct response to the doctor‟s question Consider threats to institutional goals and hierarchy Again, the interpreter is the dominant participant in the interaction
  21. 21. QUANTIFIABLE PATTERNS OF INTERFERENCE IN INTERPRETED MEDICAL INTERVIEWS
  22. 22. QUANTIFIABLE PATTERNS OF INTERFERENCE IN INTERPRETED MEDICAL INTERVIEWS (To what extent) Are interpreters answering patient questions to insulate physicians from patient challenges to their authority? Why is it problematic that patients‟ questions aren‟t being answered? • Patients seen as passive (more likely to be diagnosed as having psychosomatic illness) • Physicians cannot follow-up (because the are unaware of the issues)
  23. 23. THE LOSS OF PATIENT COMPLAINTS
  24. 24. CONCLUSIONS & DISCUSSION
  25. 25.  What is the role of the interpreter within the goal-oriented, learned form of interaction known as the „medical interview‟?  What is the „interpretive habit,‟ and how does one engage in the practice of interpreting?  If interpreters are not neutral, do they challenge the authority of the „physician-judge,‟ and act as patient „ambassadors‟ or „advocates‟; or do they reinforce the institutional authority of the physician and the healthcare establishment, and should we create a model for the „interpreter-judge‟? RESEARCH QUESTIONS RE-VISITED
  26. 26.  Lack of Status & Funding  7 full-time Spanish interpreters to service 33,000 patients  Explicit discouragement of drawing attention to the need for more interpreters because there were no funds to do so  Lack of Training  Interpreters only required to have self-professed fluency in English and Spanish + the ability to translate 50 medical terms on a written assessment  No training for staff on how to work with interpreters  Lack of Time  Short-staffed throughout the hospital  Ex: over 100 nurses fired during the data collection  Physicians expected to see an increasing number of patients in the same amount of time INSTITUTIONAL PROBLEMS
  27. 27.  Role of the interpreter  Expected:  Physicians, researchers, etc. believe that interpreters often serve as patient advocates on ambassadors  Interpreters also expected to keep patient “on track” and save time  Observed :  Selective interpreting in a patterned fashion  Based on the interpreter‟s belief that she is an informational/institutional gatekeeper meant to keep the medical interview “on track” (i.e. minimize the amount of time that interpreted interactions take)  Interpreter-judge DIFFERENT PERCEPTIONS
  28. 28.  Idea of “neutral” conduit is unrealistic  Differences in conceptual conveyance of information between linguistic systems  Interpreter as social agent and (special category of) participant in an interaction  “Good job at a bad task”  Must consider context of the communication (e.g. time pressure) when viewing transcripts of failed interactions  No institutional support  No clearly defined expectations  No training for the tasks they‟re expected to do (e.g. establish therapeutic rapport, gather information, etc.)  Invisibility of co-diagnostician role  Unethical to align “wholesale” with the institution (i.e. the hospital)  Cannot discard other responsibilities to serve as a time saver INTERPRETER FAILURE?
  29. 29. CONTINUE TO ACTIVITY!

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