Exploring the complexities of interpreter-mediated dental interactions in Hong Kong

Abstract

This thesis aims to examine interactions in clinical consultations which are influenced by the movement of populations driven by the forces of globalisation. Healthcare in Hong Kong is highly internationalised due to its socio-demographic context and the increasing global migration of healthcare professionals. This is particularly evident in the dental teaching hospital which forms the context of this study. In such a setting, issues related to language and culture contribute to the existing interactional complexities of routine dental consultations (Bridges et al., 2011; 2012; 2015; Martineau et al., 2002; Walton-Roberts, 2015). This study examines multilingual clinical dental interactions which involve interpretation. It adopts Conversation Analysis (CA) to uncover the underlying structure and participants’ co-construction (Heritage, 2006).

The thesis examines a subset of 27 multilingual dental consultations drawn from a larger data corpus of 199 video-recorded consultations. Each case contains triadic participants structure (dentist, dental surgery assistant (DSA), patient), with English as the medium of instruction by the dentist. The patients are predominantly Cantonese first language (L1) speakers and the DSAs, draw upon a bilingual repertoire (Cantonese-English). In cases where the dentist and the patient are not able to communicate in English directly, the DSA enacts the role of the interpreter.

The analysis presented begins with generating the overall structure of the selected data corpus to identify its distinctive features. Then the first observation was that orientation to language choice occurs very early in these clinical dental consultations. Further analysis drew on the concept of preference organisation (Schegloff and Sacks, 1973; Sacks, 1967a; Schegloff, 1968; Bowles, 2006) to identify three distinct patterns formulated in the opening phase. Deeper analysis at the level of turn design examined intersubjectivity in the cases where the DSA acted as nurse-interpreter (20/ 27 cases). In these cases, the DSA’s work here is far beyond direct linguistic translation with mediation work enacted throughout the consultation to align participants and balance asymmetrical knowledge territories through ‘epistemic brokering’ (Heritage, 2012; Raymond, 2014a; 2014b). Analysis of DSA-dentist brokering indicated reformulations of questions and expansion of instructions to the patient in order to build and maintain common ground among participants. Analysis of DSA-patient brokering indicated reformulations of patient responses, requests and unvoiced concerns to the dentist in order to enhance clinical relevance and advocate on behalf of the patient.

The thesis expands upon previous studies to contribute to widening our understanding of interpreter-mediated clinical dentistry through the lens of ‘epistemic brokering’ (Bridges et al., 2015; Bolden, 2000; Raymond, 2014a; 2014b). For this type of interaction, one may focus on miscommunication or focus on direct translation. However, this study unveils the significant role of DSAs in enhancing mutual understandings through a mediated approach to interpreting. The analysis illustrates how this approach is formulated to support participants in achieving the collective goal of positive health outcomes. The findings of this study could potentially inform dentist and dental nurse/hygienist education with the goal of enhancing clinical communication when working with diverse populations.