Greenhalgh Trisha, Robb Nadia, Scambler Graham
University College London, UK.
Soc Sci Med. 2006 Sep;63(5):1170-87. doi: 10.1016/j.socscimed.2006.03.033. Epub 2006 May 11.
We report a qualitative study of accounts of interpreted consultations in UK primary care. The study sought to explore how three Habermasian tensions between (a) system and lifeworld, (b) communicative and strategic action, and (c) interpersonal and macropolitical spheres played out in the triadic consultation between clinician, interpreter and patient. In a total of 69 individual interviews and two focus groups, we collected narratives from service users (through interpreters or bilingual researchers), interpreters and doctors and other staff in general practice. We recorded, transcribed and analysed these, taking the story as the main unit of analysis. Our data suggest that the preconditions for communicative action are rarely met in the interpreted consultation. The interpreter's presence makes a dyadic interaction into a triad, adding considerable complexity to the social situation and generating operational and technical challenges. Lack of trust, intense pressure of time, mismatch of agendas (biomedical versus lifeworld), firm expectations of a specific outcome (e.g. referral, prescription) and profound power imbalances all promote strategic action (i.e. speech that seeks consciously or unconsciously to manipulate an outcome) rather than communicative action (i.e. sincere efforts to achieve understanding, and reach consensus) by all parties. In consultations interpreted by family members (an option traditionally seen as 'second best' by policy makers), the social situation is very different. Family members are generally trusted, share the lifeworld agenda, and shift the power balance in the patient's favour. The interpreter occupies multiple social roles, including translator, interpersonal mediator, system mediator, educator, advocate, and link worker. The essence of professionalism in interpreting is shifting judiciously between these potentially conflicting roles. We discuss the implications of our findings for communication with limited English speakers in healthcare consultations and for realizing contemporary policy goals such as concordance, shared decision-making, empowerment, and choice.
我们报告了一项关于英国初级医疗中口译会诊情况的定性研究。该研究旨在探讨哈贝马斯提出的三组矛盾关系，即（a）系统与生活世界、（b）沟通行动与策略行动、（c）人际领域与宏观政治领域之间的矛盾，是如何在临床医生、口译员和患者之间的三方会诊中呈现的。我们总共进行了69次个人访谈和两次焦点小组讨论，收集了服务使用者（通过口译员或双语研究人员）、口译员、医生以及全科医疗中的其他工作人员的叙述。我们对这些内容进行了记录、转录和分析，将故事作为主要分析单位。我们的数据表明，在口译会诊中，沟通行动的前提条件很少得到满足。口译员的存在将二元互动变成了三元互动，给社会情境增加了相当大的复杂性，并产生了操作和技术方面的挑战。缺乏信任、时间压力巨大、议程不匹配（生物医学议程与生活世界议程）、对特定结果（如转诊、开处方）的坚定预期以及严重的权力失衡，都促使各方采取策略行动（即有意识或无意识地试图操纵结果的言语），而不是沟通行动（即真诚地努力达成理解并达成共识）。在由家庭成员担任口译的会诊中（政策制定者传统上认为这是“次优”选择），社会情境则大不相同。家庭成员通常受到信任，共享生活世界议程，并将权力平衡转向有利于患者的方向。口译员扮演着多种社会角色，包括翻译、人际调解人、系统调解人、教育者、倡导者和联络人员。口译专业精神的本质在于在这些潜在冲突的角色之间明智地转换。我们讨论了研究结果对医疗会诊中与英语水平有限的患者进行沟通以及实现当代政策目标（如一致性、共同决策、赋权和选择）的意义。
