The document summarizes research on the role of medical interpreters in Spanish-English medical discourse. It finds that interpreters often take on an expanded role beyond neutral translation due to a lack of institutional support and training. Interpreters are expected to help move interviews along more quickly but may fail to fully convey patient complaints and questions. This can negatively impact diagnoses if physicians are unaware of issues. While interpreters see themselves as facilitating institutional goals, they may unintentionally reinforce power imbalances by selectively interpreting information in a way that minimizes patient participation in their own care. Better support and defined expectations are needed to improve interpreted medical encounters.

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. 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. INTRODUCTION

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.  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. 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. BACKGROUND

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.  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.  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. 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.  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.  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.  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. 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. THE INTERPRETER IN
MEDICAL INTERVIEWS

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. TRANSCRIPTION CONVENTIONS

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. 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. QUANTIFIABLE PATTERNS OF INTERFERENCE IN
INTERPRETED MEDICAL INTERVIEWS

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. THE LOSS OF PATIENT COMPLAINTS

24. CONCLUSIONS &
DISCUSSION

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.  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.  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.  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. CONTINUE TO ACTIVITY!