Meanings and forms of intercultural coordination: the pragmatics of interpreter-mediated healthcare communication

This chapter proposes an analysis of healthcare interactions involving speakers of different languages and an interpreter. In particular, the analysis focuses on the actions of the interpreter. Pioneering research suggests that interpreters play a crucial role in medical encounters, in that they coordinate talk activity by selecting information to translate, asking and providing clarification, and giving support to the interlocutors (Wadensjö 1998; Bolden 2000; Davidson 2000,2001,2002).

In the context of Western medical systems, one of the most important practices used by institutions to encourage foreign groups to access public facilities is interpreter-mediated interaction (henceforth mediation) (Angelelli 2004; Baker 2006; Baraldi and Gavioli 2011; Niemants 2013; Pöchhacker and Kadric 1999; Schouten et al. 2012). Mediation is a form of triadic interaction involving two primary participants (the service provider and the service user) and a third one (the interpreter), who is required to support the user in accessing the service needed (Mason 2006).

Wadensjö (1998) suggests that interpreters play a double role in healthcare communication: they translate and coordinate the talk activity. Such coordinating activity is aimed at making the interaction between the participants of different languages possible and successful and promotes their participation and understanding.

The use of mediation to support the access to medical care is developing in the context of healthcare systems that are gradually acknowledging the importance of patients' emotions for successful treatment and care (Barry et al. 2001; Epstein et al. 2005; Mead and Bower 2000; Zandbelt et al. 2006).

In opposition to the cultural presuppositions of doctor-centred healthcare (Mishler 1984; Barry et al. 2001), in which the patient is expected to follow instructions delivered by the technical experts in the care of the body, in the framework of a patient-centred healthcare it is assumed that doctors' affective involvement helps patients to comply with treatment (Kieslerand Auerbach 2003; Mangione-Smith et al. 2003; Robinson and Heritage 2005; Stivers 2002). In patient-centred healthcare, providers are invited to observe illness through the patient's eyes and "treat the patient, rather than just the disease" (Heritage and Maynard 2006, 355). In patient-centred healthcare, the most important function of the interpreter-mediator (henceforth: the mediator) is not simply that of translating faithfully what the participants say; rather, it includes coordinating the information flow and promoting an interpersonal relationship between the patient and the doctor (Davidson 2000, 2001).
Given that affectivity is nowadays considered a key factor for both the relational effectiveness and success of therapies (Charles et al. 1999; Epstein et al. 2005; Mead and Bower 2000; Zandbelt et al. 2006), the current paper focuses on the emotional dimension in healthcare communication, and discusses interac- tions in which mediation activity includes or excludes migrant patients' emotions in the healthcare relationship. Integration between translation and coordination is a complex process: the actions of the mediator have an impact on the possibility of the participants to express their personal and cultural views (Baraldi and Gavioli 2008,2012; Davidson 2002; Leanza et al. 2010; Maynard and Heritage 2005). By analysing the treatment of patients' expressions of emotions in interpreter-mediated medical encounters, this chapter discusses how participants in multilingual encounters co-construct their interactional identities as doctors with specific goals, patients with specific needs, and interpreters with specific responsibilities.