title: The challenge of tetradic relationships in medically interpreted pediatric primary care visits: A descriptive study of communication practices.
abstract: OBJECTIVE
  To examine spoken interactions between pediatricians and community-based interpreters speaking with adolescents and parents with Limited English proficiency (LEP) in primary care to identify the challenges of interpreting in a four-person or tetradic visit, its sources of co-constructed errors, and specific practices for educational intervention.
  
  
  METHODS
  As part of a larger study of vaccine decision-making at six clinical sites in two states, this descriptive study used discourse analysis to examine 20 routine primary care visits in a Latino Clinic in interactions between adolescents, parents, community-based interpreters, and pediatricians. Specific patterns of communication practices were identified that contributed to inaccuracies in medical interpretation
  
  
  RESULTS
  Practices needing improvement were tallied for simple frequencies and included: omissions; false fluency; substitutions; editorializing; added clarification, information, or questions; medical terminology; extra explanation to mother; and, cultural additions. Of these speaking practices, omissions were the most common (123 out of 292 total) and the most affected by pediatricians.
  
  
  CONCLUSIONS
  The dynamics of both pediatricians and interpreters contributed to identification of areas for improvement, with more adolescent participation in bilingual than monolingual visits.
  
  
  CONCLUSIONS
  These observations provide opportunities for mapping a communication skills training intervention based on observations for future testing of an evidence-based curriculum.
authors.affiliation: College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street SN511, MSC 160, Charleston, SC 29425-1600, USA; Ralph H. Johnson Veterans Affairs (VA) Medical Center, 109 Bee Street, Charleston, SC 29401, USA. Electronic address: popec@musc.edu.
authors.forename: C A
authors.initials: CA
authors.lastname: Pope
authors.affiliation: Bilingo LLC, Goose Creek, SC. Electronic address: eskobarm@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Escobar-Gomez
authors.affiliation: Department of English, University of North Carolina at Charlotte, 9201 University City Boulevard, Fretwell 255A, Charlotte, NC 28223, USA. Electronic address: bdavis@uncc.edu.
authors.forename: B H
authors.initials: BH
authors.lastname: Davis
authors.affiliation: Department of Pediatrics, Medical University of South Carolina College of Medicine, 135 Rutledge Avenue, MSC 561, Charleston, SC 29425, USA. Electronic address: robertsj@musc.edu.
authors.forename: J R
authors.initials: JR
authors.lastname: Roberts
authors.affiliation: Department of Pediatrics, Medical University of South Carolina College of Medicine, 135 Rutledge Avenue, MSC 561, Charleston, SC 29425, USA. Electronic address: obriene@musc.edu.
authors.forename: E S
authors.initials: ES
authors.lastname: O'Brien
authors.affiliation: Department of Pediatrics, Medical University of South Carolina College of Medicine, 135 Rutledge Avenue, MSC 561, Charleston, SC 29425, USA. Electronic address: HintonE@musc.edu.
authors.forename: E
authors.initials: E
authors.lastname: Hinton
authors.affiliation: General & Community Pediatrics, Oklahoma University Health Sciences Center, 1200 Children's Avenue, Suite 12400, Oklahoma City, OK 73104-4637, USA. Electronic address: paul-darden@ouhsc.edu.
authors.forename: P M
authors.initials: PM
authors.lastname: Darden
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D002648:Child; D003144:Communication Barriers; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D009035:Mothers; D019303:Multilingualism; D010290:Parents / Q000523:psychology*; D010372:Pediatrics; D010817:Physician-Patient Relations; D011320:Primary Health Care; D014175:Translating
keywords: Adolescent; Communication barriers; Healthcare disparities; Hispanic Americans; Linguistics; Primary care