Patients' experiences of communication support in Japanese-English medical encounters
Date
2017
Authors
Matsumoto, Nami
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Abstract
This thesis explores patients’ experiences of cross-linguistic
medical encounters, with a particular focus on encounters by
Japanese speakers in the Australian health care system. It aims
to identify the views and practices of Japanese speakers when
negotiating communication, and their views on preferred
communication supports. The thesis identifies gaps between the
perceptions of health care interpreters held by patients through
their real experiences and the idealised model of
interpreter-mediated health communication which underpins the
Australian language service industry and quality improvement in
interpreter practice.
Language barriers are a major obstacle to accessing health care.
In Australia, language service agencies send credentialed,
professional interpreters to health care facilities. However, the
uptake of their services is low, even in Australia which provides
fee-free, rapid-access telephone interpreters to doctors in
private practice, and where interpreter provision is an
accreditation requirement for hospitals. The barriers are
generally assumed to be lack of knowledge by clinicians, lack of
supportive systems, or insufficient interpreters. There is little
research on the perspectives of patients towards interpreters.
Australia and Japan are highly monolingual countries; thus
visitors from each country to the other frequently need language
support. Australia differs from Japan in that it has a highly
developed, government-funded interpreter system which has been
promoted to clinicians. I interviewed thirty-one adults who have
experienced Japanese-English medical consultations, four doctors
with extensive experience in cross-linguistic communication;
attended as a participant observer seminars and workshops on
health care interpreting in Japan and Australia, and a seminar
for Japanese residents in Australia on how to access Australian
health services; and analysed technical documents in English and
Japanese used in the interpreting and health communication
fields.
Most Japanese-speaking interviewees were reluctant to use
interpreters. The socially constructed meanings which Japanese
patients attach to the English language suggests that Japanese
patients may feel humiliated if they find a professional
interpreter has been arranged for them, leading them to further
avoid interpreting services. The interpreter’s flexibility to
adopt different roles and their emotional proximity to the
patient helped dismantle boundaries which patients draw to
exclude outsiders. Preference for relationship-centred
communication interventions over professional interpreting
services was particularly prominent among Japanese women who have
English-speaking partners, irrespective of how fluent the
partner’s Japanese was.
The ideal model promoted in the Australian code of ethics for
interpreters emphasises accurate rendition of verbal statements
and detachment of the interpreter from the speakers. There is a
discrepancy between this ideal model held by the interpreting
profession and the expectations of interpreters’ engagement in
communication held by patients and medical practitioners.
Japanese patients often expect an interpreter to render their
tacit messages which often carry culturally nuanced connotations.
Doctors often assume that interpreters are able to recognise
these tacit messages, too.
Many multicultural health policies in Australia warn health
professionals of the risks of using interpreters who do not have
professional credentials. Findings from this study suggest the
necessity for revisiting this position and focusing on
relationship-based care in cross-linguistic medical encounters,
incorporating interpreters and other language support.
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Keywords
Healthcare services, Interpreters, Japanese, Language barriers
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Thesis (PhD)
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