Conflicts in how interpreters manage their roles in provider–patient interactions

Abstract

Interpreters face challenges because of the various role expectations that others have placed on them and then adopt specific strategies to manage these conflicts. This study examines the conflicts in medical interpreters’ role performances, the sources of these conflicts, and interpreters’ strategies for resolving conflicts. It is based on in-depth interviews with 26 medical interpreters from 17 languages in the Midwestern area of the USA. The results showed that interpreters experienced four sources of conflicts in their role performances: (a) others’ communicative practices, (b) changes in participant dynamics, (c) institutional constraints, and (d) unrealistic role expectations. To resolve conflicts, interpreters justified their roles by identifying the source and location of an assignment, (re)defining the relationships and identities of the provider and the patient, and adopting specific communicative strategies. This study highlights the importance of speaker and contextual factors on interpreters’ communicative strategies and management of role conflicts.

Introduction

The inequality of health services faced by patients with limited-English-proficiency (LEP) in the United States highlights the urgent need to develop effective interventions, one of which is to provide interpreters in health care settings (Department of Health and Human Services, 2001; Doty, 2003). Dysart-Gale (2005) argued that the interpreter traditionally has been conceptualized as “a ‘conduit’ transmitting messages between parties reliably and without distortion” (p. 92), an oversimplified role to describe the interpreter's practice. Nevertheless, after reviewing codes of ethics developed for medical interpreters from more than 20 institutions, Kaufert and Putsch (1997) concluded that many of those codes emphasize an objective and neutral role. The conduit role also is advocated by health care providers (Flores et al., 2003; Hatton & Webb, 1993).

A conduit, in essence, is an interpreting model that requires the interpreter to perform in a neutral, faithful, and machine-like manner. The Cross Cultural Health Care Program (CCHCP) proposed that a conduit is the default role and involves rendering in one language literally what has been said in the other without any additions, omissions, editing, or polishing (Roat, Putsch, & Lucero, 1997). In addition, the interpreter is trained to use the first-person singular (i.e., speaking as if he or she were the original speaker), creating the illusion of dyadic physician–patient communication and minimizing their presence.

Empirical studies on the practice of medical interpreters, however, have suggested that interpreters often are not neutral. For example, interpreters often side with providers rather than patients when faced with physician–patient conflicts (Bolden, 2000; Cambridge, 1999). Researchers have consistently found that interpreters enact roles that are not allowed in a conduit model (Angelelli, 2004; Davidson, 2000). Many studies have focused on the errors (e.g., editing information) made by interpreters, arguing that a lack of training was the cause of interpreters deviating from the conduit role (Cambridge, 1999; Elderkin-Thompson, Silver, & Waitzkin, 2001).

Interpreters, however, have argued that a successful medical encounter requires them to assume roles other than a conduit (Dysart-Gale, 2005; Hatton & Webb, 1993). Although no research systematically investigates the causes of the interpreter's non-conduit like behaviors, I propose that some of the non-neutral performances may be caused by interpreters’ efforts to resolve conflicts in their role performances and others’ role expectations. This is a new approach to conceptualize bilingual medical encounters: Whereas past research has focused on examining the interpreter as the person who is solely responsible for the quality of bilingual interactions, this approach highlights the interdependence of all individuals’ (i.e., the provider's, the patient's, and the interpreter's) communicative behaviors as well as the larger communicative contexts (e.g., social settings and institutional policies).

This approach has great importance and potential for several reasons. First, researchers have noted that the interpreter may be motivated to deviate from the conduit role to facilitate provider–patient interactions. In a medical encounter, especially between individuals using different languages, the provider and the patient may have diverse goals, cultural differences, and expectations. In these situations, interpreters have been observed to actively assess the communicative contexts and adopt non-conduit roles to resolve conflicts (Davidson, 2000; Kaufert, Putsch, & Lavallée, 1998). Second, the interpreter is not solely responsible for the quality of interpreter-mediated interactions. The ability of other speakers to coordinate with the interpreter may also affect the quality of provider–patient communication (Roy, 2000). From this perspective, individuals’ communicative behaviors in a medical encounter are interdependent (Elderkin-Thompson et al., 2001). Finally, contextual factors (e.g., institutional culture and policies) may have significant influence on how interpreters mediate the provider–patient relationship in areas of power, treatment choices, and cultural conflicts (Kaufert & Putsch, 1997). In short, this new approach allows researchers to investigate and improve bilingual health communication through the perspectives (e.g., contextual factors and other speakers’ behaviors) that have not been explored in prior studies.

The current study aims to examine the conflicts in medical interpreters’ role performances, the sources of these conflicts, and interpreters’ strategies for resolving conflicts. By understanding these issues from the interpreter's perspective, researchers will have a deeper understanding of the dynamics of bilingual health communication.