Patterns of communication through interpreters: a detailed sociolinguistic analysis.
BACKGROUND
Numerous articles have detailed how the presence of an interpreter leads to less satisfactory communication with physicians; few have studied how actual communication takes place through an interpreter in a clinical setting.


OBJECTIVE
Record and analyze physician-interpreter-patient interactions.


METHODS
Primary care physicians with high-volume Hispanic practices were recruited for a communication study. Dyslipidemic Hispanic patients, either monolingual Spanish or bilingual Spanish-English, were recruited on the day of a normally scheduled appointment and, once consented, recorded without a researcher present in the room. Separate postvisit interviews were conducted with the patient and the physician. All interactions were fully transcribed and analyzed.


METHODS
Sixteen patients were recorded interacting with 9 physicians. Thirteen patients used an interpreter with 8 physicians, and 3 patients spoke Spanish with the 1 bilingual physician.


METHODS
Transcript analysis based on sociolinguistic and discourse analytic techniques, including but not limited to time speaking, analysis of questions asked and answered, and the loss of semantic information.


RESULTS
Speech was significantly reduced and revised by the interpreter, resulting in an alteration of linguistic features such as content, meaning, reinforcement/validation, repetition, and affect. In addition, visits that included an interpreter had virtually no rapport-building "small talk," which typically enables the physician to gain comprehensive patient history, learn clinically relevant information, and increase emotional engagement in treatment.


CONCLUSIONS
The presence of an interpreter increases the difficulty of achieving good physician-patient communication. Physicians and interpreters should be trained in the process of communication and interpretation, to minimize conversational loss and maximize the information and relational exchange with interpreted patients.
Aranguri
Cesar
C
King Drew Medical Center, Los Angeles, CA 90059, USA. caranguri@doctor.com
Davidson
Brad
B
Ramirez
Robert
R
D003142:Communication; D006801:Humans; D007802:Language; D009633:Nonverbal Communication; D010817:Physician-Patient Relations; D013060:Speech