Download Examining discourse in healthcare

Examining discourse in healthcare:
Pedagogy, practice, and research in
ASL-English interpreting
AMPHL
April 5-7-2013
Laurie Swabey, PhD
St. Catherine University
Brenda Nicodemus, PhD
Gallaudet University
Video Scenario: Acid Reflux
Impetus for our study
•  The critical importance of the medical interview
•  The growing number of Deaf healthcare
professionals
•  Ultimately, to provide better access to Deaf
patients specifically in the intake process
Questions
•  What linguistic features of ASL are used in direct
and mediated discourse in healthcare settings?
•  How can this knowledge inform our practice?
Research design
Interpreters
Deaf Physicians
–  Interviews
–  Background Info
– Medical concepts
– Medical concepts
– Medical questions
and dosages
– Video simulations of
Deaf patients
English
Translations
– Medical questions
and dosages
– Video simulations of
Deaf patients
Research design
Interpreters
Deaf Physicians
–  Interviews
–  Background Info
– Medical concepts
– Medical concepts
– Medical questions
and dosages
– Video simulations of
Deaf patients
English
Translations
– Medical questions
and dosages
– Video simulations of
Deaf patients
Medical
questions
Questions
1. Are you allergic to any medications?
2. Do you have a history of glaucoma in your family?
3. Do you take any over-the-counter medications?
4. Are you sexually active?
Are you allergic to any medications?
Discuss with another person:
- What is the purpose of this question?
- What challenges are faced when interpreting
this question? Why?
Are you allergic to any medications?
Purpose of the question
•  Ascertain which medications should not be given
to patients
Are you allergic to any medications?
Purpose of the question
•  Ascertain which medications should not be given
to patients
•  Learn relationship between allergies and other
physical illnesses, e.g., asthma, ezcema, and
lupus (Strom, et al, 1994)
Are you allergic to any medications?
Linguistic challenges?
•  Temporal quality of allergies
•  Emphasizing “any”
•  To contextualize or not?
- allergic reactions
- medication
Physician: Are you allergic to any medications?
Interpreter: Are you allergic to any medications?
Chris Moreland
Physician: Are you allergic to any medications?
Amy
Interpreter: Are you allergic to any medications?
Contextualization: Allergic reaction
Contextualization Items
DP1
REACT, NOT AGREE
DP2
No contextualization
DP3
NAUSEA, FLUSH, RASH-on-arm, R-A-S-H
INT1
RASH-on-chest, RASH-on-cheeks,
THROAT-SWELL, CAN’T-BREATHE
INT2
MAKE-SICK, RASH-on-arm
INT3
THROAT-SWELL, RASH-on-face-and-body
Do you have a history of
glaucoma in your family?
Discuss with another person:
- What is the purpose of this question?
- What challenges are faced when interpreting
this question? Why?
Do you have a history of
glaucoma in your family?
Purpose of question?
•  Gauging genetic factors, possible chronic conditions,
present and future
•  Identifying high risk individuals who may need
additional screening (Orlando et al, 2011)
Do you have a history of
glaucoma in your family?
Linguistic challenges?
•  Patients’ knowledge of family health history
(Kaufmann and Hedding, 2012; Qureshi, et al, 2009)
•  History in your family” and “glaucoma” do not have
standard translations in ASL
Different Orientation
Interpreters
Physicians
HAVE G-L-A-U-C-O-M-A
EYE+, PRESSURE EYE+
EYE DISEASE CALL
G-L-A-U-C-O-M-A
CALL G-L-A-U-C-O-M-A
EYE PRESSURE++
EYE PROBLEM CALL
G-L-A-U-C-O-M-A
Different Focus
Interpreters
Two interpreters
included four
examples of family
members
Physicians
Two physicians signed
only FAMILY (no
examples of family
members)
Fingerspelling: Glaucoma
Misspellings
Emphasis*
DP1
no
yes
DP2
yes
yes
DP3
no
yes
INT1
no
yes
INT2
yes
yes
INT3
no
yes
•  Mouthing, careful fingerspelling, eye gaze, reduced body,
movement, indexing, use of eyes, duration, lexical marking
MIKE MCKEE
Physician: Do you have a history of glaucoma in your family?
Interpreter: Do you have a history of glaucoma in your family?
Do you take any over-the-counter
medications?
Discuss with another person:
- What is the purpose of this question?
- What challenges are faced when interpreting
this question? Why?
Do you take any over-the-counter
medications?
Purpose of question
•  Identify possible reactions with prescription
medications
•  Look for misuse or abuse of self-medication
(Wazaifya, et al 2005)
Do you take any over-the-counter
medications?
Linguistic challenges
•  There is no 1:1 corresponding phrase for OTC
in ASL
•  The phrase OTC may or may not be familiar
to patient
•  There are many over-the-counter items
Length
(in sec)
Contextualization
OTC type
Contextualization
OTC place
Compare
Rx vs
OTC
DP1
40
MOTRIN, TYLENOL
STORE, PHARMACY
yes
DP2
6
__
STORE, COUNTER
no
DP3
5
__
DRUGSTORE
no
INT1
27
TYLENOL, ADVIL,
PRESCRIPTION
PHARMACY
yes
INT2
40
__
INT3
41
ASPIRIN, IBUPROFEN
CVS, WALGREENS,
DRUGSTORE
PHARMACY, STORE
yes
yes
Physician: Do you take any over-the-counter medications?
Interpreter: Do you take any over-the-counter medications?
Are you sexually active?
Discuss with another person:
- What is the purpose of this question?
- What challenges are faced when
interpreting this question? Why?
Are you sexually active?
Purpose of question
•  Discussion of sexual history with patients in
an important part of a physical and emotional
health assessment (Lewis, 1990)
•  Inform provider about certain risks, including
STDs and pregnancy
Are you sexually active?
Linguistic challenge
•  No standard translation in ASL
•  To explicate or not? If yes, what to explicate?
•  Social and cultural challenges
Contextualization: sexual activity & partners
Sexual Activity
Partners
DP1
INTERCOURSE, SLEEP, INTERCOURSE,
SEX, DIFFERENT KINDS OF SEX,
INTERCOURSE, ORAL, SEX, ALL-LIST
PARTNER, MAN,
WOMAN
DP2
INTERCOURSE, ORAL SEX, ETCETERA
OTHER PERSON
DP3
SEX ACTIVE, INTERCOURSE, ANAL,
ORAL, ACTIVE
--
INT1
Sex, intercourse, etcetera
--
INT2
SLEEP TOGETHER, SEX, SEX
PARTNER, HUSBAND,
GIRLFRIEND, ANYONE
INT3
INTERCOURSE, MASTURBATION
PARTNER, MAN,
WOMAN, OTHER
PERSON
Physician: Are you sexually active?
SUSAN
Interpreter: Are you sexually active?
Summary of results
•  No standard ASL translations emerged for common
medical questions in this data set
•  Explication is a prominently used linguistic feature in
both direct and interpreted discourse
•  Judicious use of explication by physicians and
interpreters
•  Other linguistic features employed: comparison,
fingerspelling, orientation, and emphatic markers
Conclusion
•  Develop and teach a range of standard translations
from English into ASL for common medical questions.
•  How? Community-based participatory research – a
collaborative process between researchers and
community partners, deaf and hearing.
•  Enhancing the dialogue between interpreters, deaf
bilingual healthcare providers, and Deaf patients.
Acknowledgements
The physicians and interpreters
who graciously participated
in this study