Plurilingual communication in healthcare: Interlinguistic and intercultural mediation

In a multilingual and multicultural society, the need to achieve linguistic understanding between migrant patients and healthcare staff intersects with that of promoting inclusive and patient-centred healthcare services. As linguistic diversity can go along with differences in the cultural meaning of health and illness and in the expectations towards the social roles played in medical encounters, mediation is required to bridge both linguistic and cultural differences that may hinder effective communication, and hence pose problems for the course of treatment. While most research on mediation analyses triadic exchanges between a doctor, a migrant patient and a mediator, this article focuses on interactions where the triadic format alternates with dyadic sequences from which one of the participants is temporally excluded. Combining notions from Conversation Analysis, medical sociology and dialogue interpreting studies, this paper investigates a corpus of about 100 minutes of French-Italian medical interactions, collected in three different local health services of the Emilia-Romagna region (Italy). A qualitative approach is taken to the analysis of two types of dyadic sequences: (1) Mediator-patient dyads, when the healthcare staff delegates the mediator to offer explanations or instructions to the patient; (2) Patient-healthcare staff dyads, when they try to communicate directly, relying on a minimum degree of mutual understanding. The results suggest that, notwithstanding the temporary exclusion of an interlocutor, dyadic sequences may support the participation of both the patient and the healthcare staff, thus improving the quality of multilingual communication in healthcare settings. Results also suggest that the presence of the mediator may be functional even in medical encounters where healthcare staff and migrant patients are able to communicate directly. In these situations, mediation appears to promote multilingualism and the expression of cultural diversities, by making them recognized and managed in the course of treatment.