Doing their best : strategies used by South African clinicians in working with psychiatric inpatients across a language barrier
Date
2015-10-26
Journal Title
Journal ISSN
Volume Title
Publisher
Co-Action Publishing
Abstract
Background and objectives: South Africa has 11 official languages, but most psychiatrists can speak only
English and Afrikaans and there are no formal interpreter posts in the mental healthcare system. As a result
clinicians communicate with patients who have limited English language proficiency (LEP) without the use of
interpreters. We present case material, constituting recordings of interactions between clinicians and LEP
patients in a public psychiatric institution. The aim is to have a better understanding of how these clinical
encounters operated and what communicative strategies clinicians used.
Design: We used the Roter interaction analysis system (RIAS) to evaluate clinicians’ conversational strategies
and to analyze interactions between clinicians and patients.
Results: Clinicians showed a high degree of tenacity in trying to engage patients in the clinical conversation,
build rapport, and gather crucial diagnostic information. However, patients often responded briefly and
monosyllabically, or kept quiet. In psychiatry where commonality of language cannot be assumed, it is not
possible to determine the clinical significance of these responses.
Discussion: Clinicians went to great lengths to understand LEP patients. It is also clear that patients
were often not optimally understood. Clinicians would try to gain valid information in a polite manner,
but would abandon these attempts repeatedly as it became clear that proper communication was not
possible.
Conclusions: Our findings suggest that in the absence of interpreter services, the communication between
clinicians and LEP patients is sparse and yields limited clinical information. The lack of proper language
services stands in the way of optimal clinical care and requires urgent attention.
Description
CITATION: Kilian, S., Swartz, L. & Chiliza, B. 2015. Doing their best: strategies used by South African clinicians in working with psychiatric inpatients across a language barrier. Global Health Action, 8:28155, doi:10.3402/gha.v8.28155.
The original publication is available at http://www.globalhealthaction.net
The original publication is available at http://www.globalhealthaction.net
Keywords
Language barriers -- South Africa, Communication in psychiatry -- South Africa, Therapist and patient -- South Africa, Psychiatrists -- Language -- South Africa
Citation
Kilian, S., Swartz, L. & Chiliza, B. 2015. Doing their best: strategies used by South African clinicians in working with psychiatric inpatients across a language barrier. Global Health Action, 8:28155, doi:10.3402/gha.v8.28155.