Multilingual consultations in urgent medical care

ABSTRACT

More than half of the world’s displaced population has moved to urban or peri-urban areas, and in Brussels, the superdiverse Belgian and European capital, the emergency care sector provides an important setting for analysing the multilingual challenges faced by health practitioners. To gain a better insight in the interactional dynamics of emergency department consultations with immigrant patients, this paper focuses on multilingual strategies that include ‘ad hoc’ communicative solutions used in the absence of professional interpreters (lingua franca use, non-verbal communication, medical translation software, language mediation through companions or hospital staff). Despite their efforts, the participants in our two case-studies lacked the linguistic and interpreting subtleties needed to perform complex linguistic-interactional tasks, and in this way, a form of ‘false fluency’ was created. Ad hoc multilingual solutions, significant as they are, require additional language support to avoid diagnostic insecurity. At the level of patient management, a ‘linguistic assessment’ of patients could potentially be integrated into the triage process, and clinicians should be trained on how to recognise and remediate communication problems under the specific conditions of the emergency department.

KEYWORDS:

• Multilingual consultations
• emergency medicine
• migrants
• clinical skills
• linguistic ethnography

Disclosure statement

No potential conflict of interest was reported by the authors.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1. The ED in question has a triage system in which both doctors and nurses assess the initial complaints of the patients.

2. The medical interactions studied in our analysis were all of a triadic nature, involving a doctor, a patient, communication tools and the patient’s companion. The analysis was enriched with data from immediate feedback interviews and member checking sessions with the involved doctors. For practical and privacy reasons, however, it was not possible to perform member checking with the patient and the patient’s companion.

3. Transcription conventions:(.)short pause(….)long pausetextback translation of the original interactiontextUDR transcription(())researcher’s meta-comments*increased pitch//final fall=latching, overlaps

4. The spoken utterances in Punjabi were transcribed into Latin script and translated into English. The Polish utterances by the patient and the companion were translated into English. The utterances in Polish by UDR were available in Polish in the app.

5. For the back translations of the utterances in Punjabi, we consulted two Punjabi and Urdu speakers from Pakistan: A Punjabi and Urdu-speaking man who is familiar with both the Belgian and Pakistani health contexts and a Punjabi speaker who has the experience of being an immigrant himself in both Belgium and Sweden.

6. Other symptoms include chest discomfort, shortness of breath, lightheadedness, sweating, anxiety, and heart palpitations.

7. For the back translations, we consulted two Polish speakers: The first, who has a PhD in pharmaceutical sciences, is familiar with health care in both Belgium and Poland and has experience with interpreting in healthcare settings; the second has an extensive experience in intercultural communication.

8. At an earlier stage in this fieldwork project, the researcher had informed the doctor about the existence of the UDR application and they had discussed the possibility of piloting it together.

Additional information

Notes on contributors

Antoon Cox

Antoon COX is a postdoctoral researcher at the Brussels Institute of Applied Linguistics at Vrije Universiteit Brussel and a visiting scholar at the School of Medical Education at King’s College London. He is a lecturer in Spanish interpreting at KU Leuven and a trainer of community interpreters. His research focuses on interpersonal communication in stressful multilingual settings such as the emergency department and asylum reception centres. He has authored and co-authored papers in Patient Education and Counselling (2017), Monti (2015), and New Voices in Translation studies (2015).

Katrijn Maryns

Katrijn MARYNS is an assistant professor in the Department of Translation, Interpreting and Communication at Ghent University, Belgium. Her linguistic-ethnographic research examines multilingual discursive practices and linguistic inequality in institutional contexts of globalisation, with a particular focus on asylum and migration. She has published on diverse aspects of the Belgian asylum procedure, including the role of narrative construction, credibility assessment, interpreting and lingua franca interaction. She is the author of ‘The asylum speaker: Language in the Belgian asylum procedure’ (Routledge 2006), editor (with Philipp Angermeyer, York University) of the book series ‘Translation, Interpreting and Social Justice in a Globalised World’ (Multilingual Matters), and she has published in various international peer-reviewed journals (Applied Linguistics, Language in Society, Journal of Sociolinguistics, Language & Communication).