醫療口譯員與醫護人員如何建構、協調彼此的溝通語意及專業權威

Constructing Meanings and Authority in Bilingual Health Care

10.29786/STI.200907.0003

謝怡玲(Elaine Hsieh)；孔海英(Hai-Ying Kong)；Eric Mark Kramer

醫療口譯 ； 雙語醫療 ； 社會建構 ； 語言意識 ； Medical Interpreting ； Bilingual Health Care ； Social Construction ； Language Ideology

翻譯學研究集刊

12輯（2009 / 07 / 01）

87 - 123

繁體中文

本研究透過實證方式檢視口譯員和醫護人員如何使用各種溝通方式建立、協調、爭取在醫病互動過程中的專業地位（包括權力及權威）。本研究採用深度訪談及焦點團體訪問26位來自17個不同語言的專業醫療口譯員及32位來自4個專業（婦產科、護理科、精神科、腫瘤科）的醫護人員。我們認為醫療口譯是複雜的溝通模式，並進一步檢視（一）醫護人員及口譯員在互動過程中，如何建構語意並溝通協調其專業範疇及專業權威；（二）醫護人員及口譯員如何彼此合作並相互競爭，以建構醫病互動過程中的溝通語意。本研究指出幾個重要發現。第一，口譯員使用特定、專業語法及各種符號資源（如：語言、空間、非語言資源）來積極建立溝通情境及語意。這些溝通方式會進一步影響醫護人員在醫病互動過程的溝通行為。第二，醫護人員和口譯員用以建立權威或語意的詮釋框架，並不盡然相同，而彼此認知的差異會造成口譯過程中的溝通障礙。口譯員使用的語言策略並非一般人使用語言常態，故容易造成醫護人員及病患對溝通情境及語意的誤解。此外，醫護人員往往就其本身專業考量病患的語意；但口譯員則視病患的論述為一完整語意，不特意考量醫療專業是否影響其語意或溝通目的。第三，雙語醫病互動過程中，語意及專業權威的建構是及時、動態的溝通活動，所有活動參與者必須了解、善用彼此的符號資源及詮釋框架以有效溝通。當醫護人員與病患不使用同一語言時，醫護人員必須能夠信賴口譯員可以完整呈現他們的聲音，同時維持其醫療品質。儘管醫護人員在醫療體系裡有較高地位、正當性、和醫學專業權威，他們需要依賴口譯員表達他們的聲音，包括其身份和情緒。口譯員透過對他人的聲音的建構掌控溝通語意，進以建構口譯過程中其他參與者的身份及彼此關係。口譯員據此實質掌握溝通過程的詮釋能力，此一能力實為溝通語境中的重要權力。但醫護人員並非全然信任口譯員的表現，他們透過各種方式、管道（如：口譯時間長短、是否使用相對應辭彙、情緒表現）評估口譯員是否值得信賴，並積極介入、影響口譯人員的溝通表現。而口譯員則強調他們在語言、文化上的專業，重新詮釋病患的聲音，以掌控傳播內容及過程。<BR>本研究指出在醫療口譯過程中，無人可以完整掌控自己的聲音呈現。醫護人員（及病患）的聲音須透過口譯員來呈現。而口譯員的聲音儘管隱藏於整個溝通情境，卻也不時受到醫護人員的監控及修正。口譯員與醫護人員對以下兩點有不同的認知和溝通模式：（一）如何透過各種不同符號管道（如語言、非語言、空間及情緒資訊）建構語意；（二）醫病溝通的功能（如強化彼此關係、治療目的及身份建構）。本文最後探討溝通語意如何影響醫護人員和口譯員的互動，並對臨床醫病互動及學術理論發展提供建議。

This study examines interpreters' and health care providers' understanding and negotiation of authority and trust in bilingual health care. Twenty-six professional interpreters (of 17 languages) were recruited for in-depth interviews. In addition, 32 health care providers from 4 specialties (i.e., mental health, nursing, oncology, and OB/GYN) were recruited to participate in in-depth interviews and focus groups. By recognizing interpreter-mediated medical encounters as a complex phenomenon, we investigate (a) providers' and interpreters' understanding and negotiation of their authority in constructing meanings, and (b) providers' and interpreters' competition and collaboration in constructing meanings in medical encounters.<BR>The findings highlight several issues that are critical to the construction of authority in bilingual medical encounters. First, interpreters utilize a specialized speech genre and various semiotic resources (e.g., linguistic, spatial, nonverbal resources) to construct meanings during bilingual medical encounters. Interpreters actively influence the process and content of the medical discourse. In addition, providers may change their communicative behaviors in response to the interpreters' management of communicative contexts. Second, the frames of references (i.e., frames that are used to derive meanings and construct authority) for individuals involved in a bilingual medical encounter may not be consistent or compatible with each other. Interpreters utilize the genre of interpreter-mediated talk to derive meanings, whereas other participants often are not familiar with such a frame and use their own cultural norms and monolingual talk to derive meanings. In addition, health care providers may filter a patient's talk through their expertise-specific frame, whereas interpreters manage the medical discourse as a holistic event. Third, the construction of meanings and authority in bilingual medical encounter is an interactive process, requiring individuals to negotiate the appropriate and effective use of semiotic resources and frames of references. Although health care providers have the institutional status and medical expertise to assert legitimate power in the medical encounter, interpreters are the ones who decide how providers’ voices are told or heard. By means of their communicative strategies, interpreters construct meanings through the identity of others. Their construction also involves relational and informational management, a power that is de facto to the very process of mediation. Mediation is a form of power. In addition, interpreters may assert their expertise in cultural and linguistic issues, and thus, claim legitimate power in asserting control over the information exchanged in the medical discourse.<BR>No one has the sole authorship to his or her own voice in interpreter-mediated encounter. The provider's (and the patient's) voice is mediated through the interpreter’s performance. The interpreter's voice remains hidden while being constantly monitored, supervised, and rectified by the provider. Interpreters and Providers differentiate their understanding of and response to (a) meanings across various semiotic resources, such as verbal, nonverbal, spatial, and emotional information, and (b) functions of the provider-patient conversations, such as relationship building, therapeutic purposes, and identity management.

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