The patient's Lifeworld: building meaningful clinical encounters between patients, physicians and interpreters.

In this paper, our objectives are first to explore the different ways physicians and interpreters interact with patients' Lifeworld, and second, to describe and compare communication patterns in consultations with professional and those with family interpreters. We conducted analyses of transcriptions of 16 family practice consultations in Montreal in the presence of interpreters. Patterns of communication are delineated, grounded in Habermas' Communicative Action Theory and Mishler's operational concepts of Voice of Medicine and Voice of Lifeworld. Four communication patterns emerged: (1) strategically using Lifeworld data to achieve biomedical goals; (2) having an interest in the Lifeworld for itself; (3) integrating the Lifeworld with biomedicine; and (4) referring to another professional. Our results suggest physicians engage with patients' Lifeworld and may benefit from both types of interpreters' understanding of the patient's specific situations. A professional interpreter is likely to transmit the patient's Lifeworld utterances to the physician. A family member, on the other hand, may provide extra biomedical and Lifeworld information, but also prevent the patient's Lifeworld accounts from reaching the physician. Physicians' training should include advice on how to work with all types of interpreters and interpreters' training should include mediation competencies in order to enhance their ability to promote the processes of co-construction of meaning.