Repetition in the Health History Segment of Spanish Language Clinical Consultations: A Conversation Analysis.

BACKGROUND

Patient history-taking sequences may be repeated across medical speech events with different healthcare providers and subsequently co-constructed differently, which can lead to disparate patient history information with implications for patient care outcomes. Encounters that include language discordance between patients with limited English language proficiency and healthcare workers can also impact patient outcomes.

OBJECTIVES

We examined the repetition of patient history-taking sequences in consultations in which healthcare providers used Spanish as a first and second language with monolingual Spanish-speaking patients. The aim was to understand how repetition affects patient care processes and outcomes.

METHODS

Conversation analysis was used. The target population was bilingual healthcare providers and monolingual Spanish-speaking patients. The accessible population was composed of healthcare providers and patients from an urban, low-income, community health clinic in Southern California. In three exemplar cases from among 50 that were studied, instances of repetition in the history-taking segment of clinical consultations were located. We identified which aspects of patient reports were repeated across intake nurse-patient consultations and nurse practitioner-patient consultations, as well as how patient reports were differently co-constructed across these events.

RESULTS

Information elicited during the intake nurse-patient history event may be elicited again when a nurse practitioner repeats the elicitation of particular aspects of the patient's complaints and health history. Repetition of patient history information was co-constructed differently by different healthcare providers, sometimes led to seamless teamwork, and sometimes led to time wasting. Healthcare provider second language use of Spanish did not substantially impact how patient history information was co-constructed.

DISCUSSION

This analysis sheds light on the effects of repetition across medical events and assessed the effects of repetition on communication among members of a healthcare team and patient care outcomes. It also informs how medical provider second language use may affect how information is conveyed. Our study has implications for understandings of medical consultations that involve nurse triage prior to consultation time in multilingual settings.