Doctor-patient communication through an ad hoc interpreter on the emergency department: what is lost in translation?

International migration is driving demographic change and contributing to diversity in hospitals around the world. Hospital staff increasingly need to interact with patients with whom they do not share a language, and this poses a challenge to the quality of health care. To overcome language barriers in healthcare, the use of professional interpreters is recommended.

However, this is complicated by organizational, time and financial constraints in the emergency department (ED); and clinicians often revert to non-trained ad hoc interpreters, mostly family or friends who accompany the patient and are more proficient in the hospital language. There is a pressing need for better insights in the pitfalls of working with ad hoc interpreters in the ED, and whether these can be overcome through targeted practitioner training. To identify the causes of misunderstandings between clinicians and patients, this project studies the micro-dynamics of clinician-patient interactions (and in particular those mediated by ad hoc interpreters) in the ED in the presence of language barriers. We draw on an existing dataset of 130 audio-recorded consultations collected in a super-diverse Brussels hospital ED in 2013-2014. The dataset is complemented by ethnographic notes on relevant contextual elements and information from interviews with clinicians. The data analysis follows a multidisciplinary approach, involving specialists in applied linguistics, medicine, and intercultural psychology.