Coordination and mediaton of doctor's questions and patients' answers in bilingual interactions

This paper focuses on bilingual interaction in medical settings and looks at one way in which interpreting contributes to promote patients’ participation and to enhance doctors’ identification of diagnosis. I analyse audio-recorded interactions in Italian healthcare services, involving Italian doctors, migrant Arabic patients and Arabic intercultural mediators working as interpreters. In particular, I look at question-answer sequences of interaction, initiated by doctors’ history-taking questions, which are questions that collect detailed information about the history of the patient’s illness and symptoms. In doctor-patient interactions, these questions gather information and set doctors’ agendas by constraining patients’ answers. I focus on interpreter-mediated interactions including (1) doctors’ history-taking questions, (2) interpreter-patient sequences of communication leading to patients’ answer, and (3) interpreters’ renditions of patients’ answers. The analysis deals with the interactional sequence including the doctors’ history-taking questions and their treatment by the mediators, helping the patients to expand their answers in ways that can be recognised by the doctors as relevant to make a diagnosis. I analyse the ways in which mediators’ interpreting activity influences the dynamics of doctors’ attentiveness for patients’ active participation, and achievement of effective medical examination. This analysis highlights that interpreting can work as reflexive coordination of interactions, which is a way of mediators’ coordination of talk focusing on the communication process. In the analysed sequences, reflexive coordination means promoting expansions of patients’ turns in order for them to be more effective for doctors; it means promoting patient’s expanded answers and doctors’ perspective-taking on these answers. By promoting patients’ expanded answers, mediators’ interpreting activity reduces medical control on the interaction, but leads to patients’ contributions which are more in line with doctors’ questions. Interpreting as reflexive coordination may be considered a form of mediation, which helps achieve a balance between attentiveness for patients’ needs and effectiveness of medical inquiry.