Patients’ Initiatives and the Achievement of Medical Compliance in Talk with Migrant Patients and with(out) Interpreting Aid

This paper provides an analysis of migrant patients’ initiatives in medical interactions. The initiatives we look at are claims for knowledge about health and illness, extended narratives of personal experience, rejection of or resistance to medical prescriptions, reactions to medical disapproval of patients’ behaviour and practices. The data analysed include interactions with a language mediator providing interpreting service, and interactions without interpreting, where talk is managed by clinicians in Italian or in a lingua franca like English. In this paper, patients’ initiatives are examined as potentially novel elements in relation to the set of expectations entailed in the medical system of communication. Drawing on transcriptions of audio-recorded interactions, we look at how such “taking initiative” is negotiated in the interactional sequence, with particular reference to the achievement of patients’ compliance and patients’ empowerment. Our analysis leads to reflections concerning patients’ positioning and participants’ authority in accessing knowledge.