The social and material complexities of interpreter mediated dentistry in Hong Kong: How do clinical interactants orient to language choice?

Abstract

As a relatively new setting for micro-analytic studies of medical interactions, dentistry has the distinctive features of combining consultation and treatment often in multiparty formulations. In Hong Kong, the dental teaching hospital is highly internationalized due to the migration of healthcare professionals with issues related to language and culture contributing to the existing complexity of clinical communication (Walton-Roberts 2014; Martineau et al., 2002; Bridges et al., 2010; 2015). This project aims to uncover this complexity through examining how dental clinical and patients co-construct interactions in this setting. The project adopts Conversation Analysis (CA). Drawing from a larger corpus of 199 dental consultations, a subset of 27 cases where English is the clinician’s medium of communication were selected for analysis. The examination focuses on the openings of dental consultations (Robinson, 1998; Pilnick et al., 2009; Cheung, 2015). In this particular setting, the opening phase is not only the stage that patient present problems, it is also the stage that clinicians and patients negotiate the language of communication. The 27 selected cases are all multiparty formulations, for each case, participants include a dentist who is non-Cantonese speaking expatriate clinician; a patient who is Cantonese L1 Speaker and a dental surgery assistant (DSA) who is usually a Cantonese L1 speaker as well. In these cases, the DSA normally plays the role as the interpreter and mediator of the interactions (Bridges et al., 2015). This presentation focuses on how language issue was oriented to by participants at the beginning of the consultations, as from the observations throughout the data corpus, language is always the first thing that participants negotiate. Findings of the analysis show that the choice of language was oriented to by all participants both directly and indirectly during the first turn construction unit (TCU) of the opening sequence. The patterns identified include both ‘preferred’ and ‘dispreferred’ formulations (Sacks 1987; Heritage 2013). Non-verbal actions such as gesture, eye gaze and proxemics were examined as complementary to preference formulations. Practice implications indicate how video-analysis may enhance clinician and allied health professions education.