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Patients' experiences of communication support in Japanese-English medical encounters

机译：患者在日英医疗交流中的交流支持经验

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摘要

This thesis explores patients' experiences of cross-linguistic medical encounters, with a particular focus on encounters by Japanese speakers in the Australian health care system. It aims to identify the views and practices of Japanese speakers when negotiating communication, and their views on preferred communication supports. The thesis identifies gaps between the perceptions of health care interpreters held by patients through their real experiences and the idealised model of interpreter-mediated health communication which underpins the Australian language service industry and quality improvement in interpreter practice.;Language barriers are a major obstacle to accessing health care. In Australia, language service agencies send credentialed, professional interpreters to health care facilities. However, the uptake of their services is low, even in Australia which provides fee-free, rapid-access telephone interpreters to doctors in private practice, and where interpreter provision is an accreditation requirement for hospitals. The barriers are generally assumed to be lack of knowledge by clinicians, lack of supportive systems, or insufficient interpreters. There is little research on the perspectives of patients towards interpreters.;Australia and Japan are highly monolingual countries; thus visitors from each country to the other frequently need language support. Australia differs from Japan in that it has a highly developed, government-funded interpreter system which has been promoted to clinicians. I interviewed thirty-one adults who have experienced Japanese-English medical consultations, four doctors with extensive experience in cross-linguistic communication; attended as a participant observer seminars and workshops on health care interpreting in Japan and Australia, and a seminar for Japanese residents in Australia on how to access Australian health services; and analysed technical documents in English and Japanese used in the interpreting and health communication fields.;Most Japanese-speaking interviewees were reluctant to use interpreters. The socially constructed meanings which Japanese patients attach to the English language suggests that Japanese patients may feel humiliated if they find a professional interpreter has been arranged for them, leading them to further avoid interpreting services. The interpreter's flexibility to adopt different roles and their emotional proximity to the patient helped dismantle boundaries which patients draw to exclude outsiders. Preference for relationship-centred communication interventions over professional interpreting services was particularly prominent among Japanese women who have English-speaking partners, irrespective of how fluent the partner's Japanese was.;The ideal model promoted in the Australian code of ethics for interpreters emphasises accurate rendition of verbal statements and detachment of the interpreter from the speakers. There is a discrepancy between this ideal model held by the interpreting profession and the expectations of interpreters' engagement in communication held by patients and medical practitioners. Japanese patients often expect an interpreter to render their tacit messages which often carry culturally nuanced connotations. Doctors often assume that interpreters are able to recognise these tacit messages, too.;Many multicultural health policies in Australia warn health professionals of the risks of using interpreters who do not have professional credentials. Findings from this study suggest the necessity for revisiting this position and focusing on relationship-based care in cross-linguistic medical encounters, incorporating interpreters and other language support.
机译：本文探讨了患者在跨语言医疗方面的经历，特别关注了日本人在澳大利亚医疗体系中的遭遇。它旨在确定日语使用者在交流时的观点和做法，以及他们对首选交流支持的看法。论文确定了患者通过他们的真实经历对口译员的看法与口译员介导的健康交流的理想模型之间的差距，后者是澳大利亚语言服务行业和口译员实践质量提高的基础。语言障碍是阻碍口译员学习的主要障碍获得医疗保健。在澳大利亚，语言服务机构将经过认证的专业口译员送到医疗机构。但是，即使在澳大利亚，私人诊所的医生都可以免费获得快速访问的电话口译员，并且那里的医院必须提供口译员，因此他们的服务使用率较低。通常认为这些障碍是临床医生缺乏知识，缺乏支持系统或口译人员不足。很少有关于患者对口译人员观点的研究。因此，来自每个国家/地区的游客经常需要语言支持。澳大利亚与日本的不同之处在于，澳大利亚拥有高度发展的，政府资助的口译系统，并已推广给临床医生。我采访了三十一位经历过日英医学咨询的成年人，四位在跨语言交流方面具有丰富经验的医生；作为参与者参加了在日本和澳大利亚进行的有关医疗口译的观察员讨论会和讲习班，以及针对如何在澳大利亚获得日本医疗服务的澳大利亚日本居民的讨论会；并分析了口译和健康交流领域中使用的英语和日语技术文档。大多数说日语的受访者不愿使用口译员。日本患者对英语的依附于社会建构的含义表明，如果日本患者发现为他们安排了专业的口译员，他们可能会感到羞辱，从而导致他们进一步避免口译服务。口译员灵活地担当不同的角色，以及他们与患者的情感亲密感，有助于消除患者为排除外界因素而划定的界限。在拥有英语伴侣的日本女性中，无论是伴侣的日语流利程度如何，在以英语为中心的交流干预措施中，偏重于专业口译服务的人尤为突出。；澳大利亚口译员道德守则中倡导的理想模式强调准确翻译口头陈述和口译员与演讲者的分离。口译专业人士所持有的理想模式与患者和医生之间的口译人员参与交流的期望之间存在差异。日本患者通常希望口译员提供他们的隐性信息，这些信息通常带有文化上的细微差别。医生通常认为口译员也能够识别这些隐性信息。；澳大利亚的许多多元文化卫生政策警告卫生专业人员，要使用没有专业证书的口译员存在风险。这项研究的结果表明，有必要重新确立这一立场，并在跨语言医学交流中将重点放在基于关系的护理上，并结合口译人员和其他语言支持。

著录项

  • 作者

    Matsumoto, Nami.;

  • 作者单位

    The Australian National University (Australia).;

  • 授予单位 The Australian National University (Australia).;
  • 学科 Communication.;Linguistics.;Medicine.
  • 学位 Ph.D.
  • 年度 2017
  • 页码 283 p.
  • 总页数 283
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 生理学;
  • 关键词

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