Time constraints led ad hoc interpreters to pressure psychiatric patients into short answers, cutting off their narratives

Description #

In a public psychiatric hospital where bilingual nurses, social workers, and cleaners served as ad hoc interpreters, the time pressure of a busy hospital setting led both clinicians and interpreters to truncate patients' narratives. A clinician told the interpreter "We should hurry up," after which the interpreter pressed the patient for concise answers; the interpreter herself became frustrated by the patient's long turns and explicitly demanded that the patient only answer the doctor's questions. This is a qualitative mechanism by which interpreter-mediated care under time constraints reduces the patient's ability to give a full account.

"In one of the consultations, the clinician told the interpreter 'We should hurry up,' and in a raised voice asked the interpreter what the patient was saying. In response, the interpreter attempted to get the patient to give a concise response instead of a more detailed one." (Kilian, 2021, p. 31)

"Interpreter Y: I said to you, you will only answer questions that are being asked by the doctor otherwise we won't finish." (Kilian, 2021, p. 31)

Methods Context #

What? #ⓘ

The observable: how interpreters and clinicians managed the flow and length of patient turns during recorded consultations, coded for the recurring theme of time constraints.

"The theme of time constraints was a common one that emerged throughout the data. Below, we present examples of instances in which the theme of time constraints featured prominently in the video recordings." (Kilian, 2021, p. 31)

How? #ⓘ

Conversation Analysis of 13 video-recorded interpreter-mediated psychiatric consultations plus content analysis of 18 audio-recorded semi-structured interviews; transcripts transcribed verbatim and forward/back-translated from isiXhosa and Afrikaans.

"The first author video-recorded 13 interpreter-mediated psychiatric consultations and conducted 18 semi-structured interviews (audio-recorded) with the interpreters and clinicians who participated in the abovementioned 13 interpreter-mediated psychiatric consultations." (Kilian, 2021, p. 28)

Who? #ⓘ

Public psychiatric hospital in the Western Cape, South Africa (one of three in the province); two inpatient wards (~30 beds each); isiXhosa-proficient patients, English/Afrikaans first-language registrar clinicians, and bilingual nurse/social-worker/cleaner ad hoc interpreters; no formal interpreters employed.

"At the time of data collection, the hospital did not employ formal interpreters. As such, bilingual health care workers, cleaners, or security guards were used to provide language services." (Kilian, 2021, p. 28)

Other Notes #

A perceived/experiential mechanism observed in conversation, not a measured length-of-stay or visit-duration effect. Interpreters themselves cited time consumption as a main reservation about the role (Extract 6, p. 31). </content> </invoke>

Caveats #

• Small exploratory single-site sub-study of 13 consultations at one South African psychiatric hospital limits generalizability The authors describe this as a small exploratory sub-study nested in a larger project, based on 13 video-recorded consultations and 18 interviews at a single public psychiatric hospital in the Western Cape, South Africa, with ad hoc (informal) interpreters and no formal interpreting service. The findings characterize interpreter roles in this specific resource-constrained, informal-interpreting setting; they should not be read as effect estimates and may not generalize to settings with trained/professional interpreters or other clinical contexts.