“When he makes pipi, is it painful?”: English as a lingua franca in the Emergency Department (ED)

“When he makes pipi, is it painful?”
English as a lingua franca in the Emergency Department (ED)

Research has shown that medical errors in the Emergency Department (ED) often result from poor communication (Eisenberg et al. 2005). Conditions for communication in the ED are very different to those in primary care encounters, due to time pressure, the potential diffusion of concentration resulting from interruptions and long and tiring clinical shifts, a lack of prior information about the patients involved, and a general – even frequently acute – sense of urgency (Chisholm et al. 2001; Knopp et al. 1996). Given the fact that 80 percent of medical diagnoses made depend on oral communication (Watt 2008), we focus on how English as a lingua franca plays a part in these ED encounters.
In this paper we draw on data from ethnographic participant observation and audio recordings gathered during night and day shifts at the ED of an inner city public hospital in Brussels. Encounters between patients and medical staff during which English was used as a lingua franca were recorded. The utterances produced by ad hoc interpreters, patients and medical staff when they attempted to get a message across were mapped and analysed in reference to the ethnography of communication (Hymes 1974) and interactional sociolinguistics (Gumperz 1982). While the former is considered ideal to describe the broader linguistic and extra-linguistic context of the interaction, the latter finds its origins in ethnography and focuses on the turn-by-turn level of the interaction while taking the communicative goals of the medical encounter into account (Bickley 2013). Both the data collection and analysis benefited from an interdisciplinary collaboration between applied linguists and clinicians.
Preliminary results hint at a considerable amount of confusion with regard to both the understanding and production of utterances in English as a lingua franca. This confusion is often due to differences in pronunciation, as well as to grammatical and lexical skills on the participants’ part that seem insufficient for the exchange of information required. For this reason we believe that this empirical study is complementary to the mainly quantitative literature that suggests language barriers in health care encounters can have a negative impact patient health. (Divi et al. 2007; Karliner et al. 2012; Schillinger and Chen 2004).