Samenvatting
Background [This paper is the first part of the presentation of the results of the research Doctor patient communication via an ad hoc interpreter in the Emergency Department: what is lost in translation?] Emergency medicine is a predominantly oral activity in which medical errors often result from poor communication. Due to the increasing diversity of patients in Emergency Departments (ED), especially in the light of the current refugee influx into Europe, emergency physicians have to take history from patients with whom they do not share a language. Sometimes, these patients bring along companions with some (often-limited) knowledge of the hospital’s language to support the communication process. While these companions are often helpful, they may add additional sources of uncertainties to the communication process and hence of potential miscommunication. So far, the literature on language barriers in the ED has mainly focussed on health outcomes in the presence of language barriers, and the impact of interventions such as interpreting on these outcomes. This study aims to contribute to insights on the process of communication, by dissecting different levels of miscommunication and describing how they are interrelated.
Methods We audio-recorded linguistically diverse 16 multi party consultations in an ED and collected the corresponding contextual information via ethnographic participant observation (including note taking and after action interviews with clinicians). The consultations were transcribed, translated, and multimodally analysed from a medical, interactional sociolinguistic and social psychological or role dynamical perspective. This paper presents the interactional sociolinguistic analysis. Both talk and bodily movements were analysed with regard to miscommunication. We performed also member checking with the clinician in question, with members of the community of practice of ED medicine and members of the speech community of the patients and their companions.
Findings We identified a set of recurrent interaction patterns that lead to miscommunication at different levels.
Based on these, we developed a taxonomy of different levels of miscommunication that lead to problems of
clinical significance. Miscommunication was often ascribed to linguistic, social psychological and (non-)verbal
reasons or aspects. Our taxonomy is dynamic in that one aspect may trigger or resolve the other one. We also
noticed that a language barrier is not absolute. Depending on the questions asked, the tasks performed or the role
dynamics, a language barrier can be at times thick and at other times thin during the same consultation.
Discussion Miscommunication can be the result of linguistic, social psychological or (non-) verbal reasons;
however, these are often interdependent and complex. Our dynamic taxonomy allows researchers to track
communication problems within a linguistically complex multi-party ED consultation, based on a multi-angled
and multi-disciplinary approach. Knowing in detail why and how miscommunication arises can help to produce
tailor-made guidelines for clinical skills training on linguistically diverse doctor-patient consultations and other
interventions.
Methods We audio-recorded linguistically diverse 16 multi party consultations in an ED and collected the corresponding contextual information via ethnographic participant observation (including note taking and after action interviews with clinicians). The consultations were transcribed, translated, and multimodally analysed from a medical, interactional sociolinguistic and social psychological or role dynamical perspective. This paper presents the interactional sociolinguistic analysis. Both talk and bodily movements were analysed with regard to miscommunication. We performed also member checking with the clinician in question, with members of the community of practice of ED medicine and members of the speech community of the patients and their companions.
Findings We identified a set of recurrent interaction patterns that lead to miscommunication at different levels.
Based on these, we developed a taxonomy of different levels of miscommunication that lead to problems of
clinical significance. Miscommunication was often ascribed to linguistic, social psychological and (non-)verbal
reasons or aspects. Our taxonomy is dynamic in that one aspect may trigger or resolve the other one. We also
noticed that a language barrier is not absolute. Depending on the questions asked, the tasks performed or the role
dynamics, a language barrier can be at times thick and at other times thin during the same consultation.
Discussion Miscommunication can be the result of linguistic, social psychological or (non-) verbal reasons;
however, these are often interdependent and complex. Our dynamic taxonomy allows researchers to track
communication problems within a linguistically complex multi-party ED consultation, based on a multi-angled
and multi-disciplinary approach. Knowing in detail why and how miscommunication arises can help to produce
tailor-made guidelines for clinical skills training on linguistically diverse doctor-patient consultations and other
interventions.
Originele taal-2 | English |
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Titel | IPRA Book of Abstracts |
Subtitel | 15th International Pragmatics Conference, Belfast, 16-21 July 2017 |
Pagina's | 181-181 |
Status | Published - 2017 |
Evenement | 15th International Pragmatics Conference: Pragmatics in the real world - Waterfront Centre Belfast, Belfast, United Kingdom Duur: 16 jul 2017 → 21 jul 2017 https://www.ulster.ac.uk/ipra |
Conference
Conference | 15th International Pragmatics Conference |
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Land/Regio | United Kingdom |
Stad | Belfast |
Periode | 16/07/17 → 21/07/17 |
Internet adres |