Patients' experiences of communication support in Japanese-English medical encounters
Creators: name: Matsumoto, Nami
Publisher: name: The Australian National University
Year: 2017
Subjects: Healthcare services
Interpreters
Japanese
Language barriers

description: 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.