As clinician and ad hoc interpreter negotiated roles, the patient's voice was lost in interpreter-mediated psychiatric consultations

Description #

Across the four interpreter roles, the study's overarching finding was that the patient's voice becomes lost as the clinician and interpreter negotiate their respective roles, with the interpreter more likely to take center stage when lay interpreters are used. Because two parties (clinician and interpreter) represented the medical establishment and only one represented the patient, the patient struggled to make their own agenda the priority of the consultation. This is a qualitative mechanism by which informal interpreting can erode patient-centeredness even when all parties have good intentions.

"Our findings suggest that, despite interpreters and clinicians having the patient's best interests at heart, it is the patient's voice that becomes lost while the clinician and interpreter negotiate the roles played by each party." (Kilian, 2021, p. 27)

"In our findings, as two people were representing the world of the medical establishment (the clinician and the interpreter), and only one the world of the patients, this dynamic is likely to pervade." (Kilian, 2021, p. 35)

"it is the patient's voice that becomes lost while the clinician and interpreter negotiate the roles played by each party, with the latter more likely to take center stage when lay interpreters are used." (Kilian, 2021, p. 35)

Methods Context #

What? #ⓘ

The observable: the relative prominence of patient, clinician, and interpreter voices across the recorded consultations and interviews, synthesized across the four identified interpreter roles.

"Our findings suggest that interpreters took on the following four roles during the interpreter-mediated psychiatric consultations: regulating turn-taking, cultural broker, gatekeeper and advocate." (Kilian, 2021, p. 27)

How? #ⓘ

Exploratory sub-study using Conversation Analysis of 13 video-recorded consultations and content analysis of 18 semi-structured interviews; aim was rich description rather than theory development.

"Here, we report on a smaller exploratory sub-study nested within the larger project. We provide a detailed account of what happens when bilingual health care workers and cleaners haphazardly take on the additional role of interpreter." (Kilian, 2021, p. 28)

Who? #ⓘ

isiXhosa-speaking Black psychiatric inpatients (6 female, 7 male across 13 consultations) consulting English/Afrikaans-speaking registrars via female bilingual nurse, social-worker, and cleaner ad hoc interpreters at a Western Cape public psychiatric hospital.

"In 11 of the interpreter-mediated psychiatric consultations the registrars were female, and in two of the consultations one male registrar was involved. All the interpreters were female, while six patients were female and seven were male." (Kilian, 2021, pp. 28–29)

Other Notes #

The authors temper the finding by noting that the patient's voice may regain prominence outside the consultation, where interpreters continue their work as patient advocates (p. 35).

Caveats #

• Study did not assess how clinician and interpreter demographics shaped the interpreter roles observed The authors state it was outside the scope of the study to assess how clinician and interpreter demographic characteristics influenced the roles interpreters took on. Because all interpreters were female and most registrars were female and white, the role dynamics observed may be confounded by these characteristics, and the study cannot attribute the observed roles specifically to the interpreting arrangement versus participant demographics.
• 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.