Encounters Online Magazine
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become easily frustrated when a patient tries
to add contextual information. Such is the case
when a patient answers the question, “What
medication are you currently taking?” with a
detailed description of all medication he has
ever taken as well as other medications that
have helped his friends with similar complaints.
He feels that adding context is needed for his
case to be understood. She feels the information
is superfluous. He is looking for a personal
solution; she is looking for a rational one. The
ground rumbles.
There are three basic kinds of faults that form
when two tectonic plates interact. The reaction
to the conflicting forces at play between the
plates determines the result. With this in mind,
let’s analyze how a savvy interpreter can prevent
three common faults that may easily occur when
a low context medical communicator interacts
with a patient who uses a high context style.
“Normal Faults”
In geological terms, Normal Faults occur when
the two sides of the fault pull apart and one
side drops down in relation to the other. Often,
when there is a disconnect between patient and
provider, the patient becomes disempowered,
feeling misunderstood. He pulls away in the
sense that he takes whatever the provider has to
say into account, but feels that she, the provider,
does not truly understand his situation. His own
personal solution will likely involve only partially
following medical advice and only providing
partial information for the provider to work with.
What can the interpreter do to avert the “Normal
Fault” situation?
1
Interpret everything, even if the patient seems
to be repeating information. The more context
the patient can give in the early stages of
the interaction, the shorter the subsequent
interactions will be.
2
When there is implied meaning that may
be missed by either side, interpret it
explicitly. Interpret what was said (intended
to be understood) not simply the words that
were spoken.
3
Verbally interpret nonverbal communication
from the high context communicator that the
provider may miss. Facial expression, tone,
and gestures are much more important in high
context than low context communication. Trust
between the provider and the patient may be
lost if the patient doesn’t feel like he is being
“listened” to.
“Reverse Faults”
As two tectonic plates collide and experience
colossal compressive forces, one will have the
tendency to move up and over the other. This is
termed a reverse fault. The biomedical culture
can be seen as cold and machine-like to many
LEP patients. Low context communication is task-
centered, designed to be systematic, with the
goal of working towards a rational solution. Many
times questions and statements from providers
come across as too direct, lacking attention to
cultural and personal values. The majority of LEP
patients, being high context communicators, are
looking for a
personal solution
. When there
is no bridging this gap, the powerful figure of
a doctor can overpower the patient and seem
dismissive, almost oppressive at times.
What can the interpreter do to avert the “Reverse
Fault” situation?
1
Interpret everything the provider says, giving
just as much importance to questions they may
ask that may seem to be unimportant at first.
Savvy providers are now asking questions
like,
“What do you think is wrong? What do
you think caused the problem? What have
you done to try and make it better? Who
else have you seen about the problem? What
complications do you fear?”
They are doing
this in order to help increase buy-in from the
patient in the treatment by making the solution
seem more personal in nature.
2
When necessary, due to a serious cultural
misunderstanding, provide both parties with
the necessary contextual information quickly
and transparently. An interpreter should never
talk to one party without addressing the other.
3
Be sure to reflect the provider’s caring tone
in your interpretation, including the facial
expressions and gestures you may use.
“Strike-slip Faults”
Strike-slip faults are faults in the earth’s crust in
which the walls on either side slide against each
other horizontally, not up or down. In a scenario
where the patient does not feel disempowered
but rather conspired against or in some way
wronged, the friction caused reduces the
likelihood that the patient will follow through on
the treatment plan suggested by the provider.
Many times these disagreements are based on
cultural misunderstandings rather than true mal
intent on one side or the other. After all, both
parties are there for the same reason: to address
the illness.
What can the interpreter do to avert the “Strike-
slip Fault” situation?
1
Be prepared to re-interpret messages that
may have been misunderstood, maintaining
transparency by letting the other party know
that a reinterpretation is about to happen.
Interpreters are not perfect and should be
modest enough to make corrections as needed.
A misunderstanding could have occurred in
the case where the interpreter failed to make
explicit a key piece of information that was
implied in the source message.
2
Remember to interpret disagreements in
structures in the target language that match
the intent of the speaker. Disagreement is
personalized much more readily among
high context communicators. If the provider
disagrees with the patient on a matter and
intends no disrespect, this must be reflected in
the interpretation.
3
Make sure the tone, facial expressions and
gestures that you use match the intent of the
provider. Many LEP patients are sensitive
to conflict expressed through nonverbal
communication. A poor interpretation can
create a basis for conflict that may be absent
in the original message.
Geologists tell us that centimeter by centimeter
the continents are drifting together once again,
but the crossing of borders and mixing of
peoples from all over the world is happening
at a lightening pace. Communication fault lines
crisscross every health care system in the United
States, raising the threat and number of dangerous
miscommunications. Unlike the physical forces at
work on Earth’s tectonic plates, these cultural
rumblings can be minimized. The more physicians
and interpreters are aware of cultural differences,
especially between high context (LEP patient) and
low context (biomedical staff) communication
styles and apply corrective strategies, the safer
and more productive an environment we create
in health care.
