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ABSTRACT
Among the important bulk of research devoted to medical consultations, one recurrently discussed issue has been that of patients’ alignment with practitioners’ recommendations. If this question has not always been formulated in terms of alignment, all the studied cases deal with how patients comply, or not, with practitioners’ first actions. They show that social actions such as suggestions, proposals, offers, etc. are not unilaterally offered by practitioners to patients, but frequently discussed and negotiated. This may result in patients being more willing to comply with jointly achieved solutions. In this paper, we will fill in some more details of this picture by focusing on interactional resources used by patients to show their disalignment toward less investigated types of first actions (i.e. non-medication recommendations, home remedies, proposals or suggestions to accomplish certain activities), thereby acknowledging the central role played by patients in two different healthcare settings (general and mental health). We will also compare how linguistic and cultural diversity are handled when patients and practitioners communicate directly as well as when communication is interpreter-mediated, thereby problematizing the presence of an interpreter who needs to grasp the variety of resources used by patients in order to render both their disalignment and practitioners’ responses to it. Taking into account audio- and video-recorded naturally occurring data collected in Italy and France, we will additionally show the relevance of multimodal analysis for a better understanding of the resources involved, as well as of the dynamics of interpreter-mediated communication in healthcare.
Transcription conventions
| [] | = | overlap (onset & end) |
| (.) | = | micro-pause (< 0.5 seconds in Ex. 1-4, < 0.2 seconds in Ex. 5) |
| (2.0) | = | pause in second |
| / \ | = | rising/and falling\intonation |
| (they) | = | uncertain transcription |
| ((laughter)) | = | non-verbal features |
| the: | = | sound stretch |
| xxx | = | incomprehensible segment |
| = | = | latching |
| °here° | = | low volume |
| NO | = | increased volume |
| par- | = | cut-off |
| * * | = | ALB’s gesture delimitation |
| + + | = | PYA’s gaze delimitation |
| - - ->> | = | movement or gaze continuing after the end of the extract |
| # | = | image in the transcription. The symbol appears twice, first to indicate the presence of an image in the line, second in the precise place where the image has been taken |
Notes
1. The expected turn pattern in interpreter-mediated conversations between A and B, where I is the interpreter and A and B the co-participants.
2. This is the project whose final event this special issue stems from, and whose title was Analysis of communication with migrant patients and suggestions for improvements in the healthcare system (see Niemants, Citation2018 for more details).
3. All the data collected for this project were recorded with all the participants’ informed consent and a set of ethical precautions, established in agreement with the legal services and ethical committees of the academic and healthcare institutions concerned, were respected in the collection, analysis, storage, and publication of excerpts of the data. See http://www.icar.cnrs.fr/sites/projet-remilas/corpus/.
4. See Robinson and Kevoe-Feldman (Citation2010) about repeats problematizing the relevance of first-pair parts such as questions.