Doing Empathy in Multilingual Healthcare Communication Through Interpreters: an Evidence-based Perspective

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Welcome to our guest presenter!
Dr. Demi Krystallidou

The professional interpreter’s effect
on empathic communication in
medical consultations
@demi_krystallid

7
What we already
knew
What we did
not know
What we know
now
What it means
Empathy

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What we already
knew
What we did
not know
What we know
now
What it means
Empathy
Empathic Communication in Interpreter-Mediated Consultations
in times of COVID-19
(video consultations)
+

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What we already
knew
What we did
not know
What we know
now
What it means
Empathy

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What we already
knew
Empathy

11
What we already
knew
(Jones 2017)

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What we already
knew
(Jones 2017)

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What we already
knew
(Jones 2017)

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Empathy in healthcare
• to understand another’s experience
• to communicate & confirm understanding
• to act in a helpful manner
Mercer & Reynolds (2002) Empathy and quality of care. Br J Gen Pract 52, 9-12
What we already
knew
What we did
not know
What we know
now
What it means
What we already
knew

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• transactional process
What we already
knew
What we did
not know
What we know
now
What it means
What we already
knew

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• jointly co-constructed
What we already
knew
What we did
not know
What we know
now
What it means
What we already
knew

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• meaning
&
understanding
What we already
knew
What we did
not know
What we know
now
What it means
What we already
knew

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• meaning
&
understanding
negotiated
What we already
knew
What we did
not know
What we know
now
What it means
What we already
knew

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• transactional process
• jointly co-constructed
• meaning / understanding negotiated
Empathic Communication
What we already
knew
What we did
not know
What we know
now
What it means
What we already
knew

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intricacies of the communicative process
• how meaning / understanding
are negotiated
What we already
knew
What we did
not know
What we know
now
What it means

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intricacies of the communicative process
• how EC is co-constructed
What we already
knew
What we did
not know
What we know
now
What it means

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• the interpreter’s effect on
the co-construction of EC
What we already
knew
What we did
not know
What we know
now
What it means

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What we already
knew
What we did
not know
What we know
now
What it means

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What we already
knew
What we did
not know
What we know
now
What it means
“Empathic Communication in interpreter-mediated
consultations is largely dependent on
the interpreter’s interpreting performance, and
ability to correctly detect, assess and render
patients’ empathic opportunities and healthcare professionals’
empathic responses to them.”
Krystallidou et al 2019

Faculteit Letteren Campus Sint-Andries Antwerpen25
The evidence

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Data
Participants n Male Female Mean
age
Language
Doctors 20 15 5 47.6 Dutch
Patients 20 13 7 52.65 Russian
Turkish
Arabic
Interpreters 8 2 6 41.6 native
speakers
Russian
Turkish
Arabic
Hospital department Video recorded
consultations n=
Gastroenterology 2
Urology 2
General and hepatobilary
surgery
1
General internal medicine,
infectious diseases and
psychosomatics
3
Haematology 1
Cardiology 2
Paediatrics 6
Endocrinology and metabolic
diseases
3
Total number of video
recorded consultations
20

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Method
Empathic Communication Coding System (ECCS)
C.L. Bylund, G. Makoul (2005)
Coders: 2 independent (MD + CC trainer, IMCC trainer) + calibration (ECCS developer)
Multimodal Interaction Analysis
D. Krystallidou (2014, 2016, 2018)
Coders: 3 pairs of independent coders (TIS scholars + MD & CC trainer + IMCC trainer)
+
VSR Qualitative Content Analysis
INTERVIEW U.H. Graneheim, B. Lundman (2004)
PERCEPTIONS Coders: 3 pairs of independent coders (TIS scholars + MD & CC trainer + IMCC trainer)
C
O
N
S
U
L
T
A
T
I
O
N
S

Question:
In your view, what is the percentage of empathic communication rendered
perfectly by professional interpreters?
A. > 80%
B. > 50%
C. about 50%
D. < 50%
E. < 10%
F. None of the above

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=
What we already
knew
What we did
not know
What we know
now
What it means
co-construction of
Empathic
Communication
=
complex interactional
phenomenon Emotion
0/44
Progress
08/44
Challenge
36/44

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=
What we already
knew
What we did
not know
What we know
now
What it means
co-construction of
Empathic
Communication
=
phenomenon
Emotion
EMOTION
explicitly expressed by the Patient
0% 100% 200% 300% 400%
0%

31
=
What we already
knew
What we did
not know
What we know
now
What it means
co-construction of
Empathic
Communication
=
phenomenon
Progress
PROGRESS
responded by the doctor without interpretation
not passed on to the doctor 75%
25%

32
=
What we already
knew
What we did
not know
What we know
now
What it means
co-construction of
Empathic
Communication
=
phenomenon
Challenge
CHALLENGE
shift in intensity
shift in meaning
not passed on to the doctor
without change in meaning or intensity 5.55%
38.80%
44.40%
11.11%

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=
What we already
knew
What we did
not know
What we know
now
What it means
co-construction of
Empathic
Communication
=
phenomenon
PATIENT
EMPATHIC
OPPORTUNITIES
NOT passed on to the doctor
passed on to the doctor 50%
50%
Challenge
Progress
Emotion

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The organization of empathic communication in medical consultations
mediated by
professional interpreters
Empathic Communication Coding System
(Bylund & Makoul 2002,2005; Krystallidou et al. 2018)

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Box 1
PAT: patient, DOC: doctor, I: interpreter
53 PAT: ‫منيح‬ ‫ننعسش‬ ‫ما‬ ‫ديما‬ ‫ناخدها‬ ‫اال‬
if I always take it (medication), then I cannot sleep well
54 INT: hij zegt als hij dat neemt hij voelt dat hij slaapt niet goed
he says that if he takes it (medication) he feels that he does not sleep well
55 DOC: hij slaapt niet goed?
he doesn’t sleep well?
56 INT: ‫منيح؟‬ ‫تنعسش‬ ‫ما‬
slaap je niet goed?
you don’t sleep well?
57 PAT: [ ‫مفهوم‬ ‫غير‬ ]
(inaudible)
EO passed to the DOC without significant change in meaning or intensity

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mediated by

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EO not passed to the DOC due to INT’s intervention
Box 2
PAT: patient, DOC: doctor, INT: interpreter
82 DOC: is de mutualiteit in orde?
is the insurance all right?
83 INT: Мутуалитет в порядке?
is the insurance all right?
84 PAT: (.) Сейчас не совсем, после работы ещё не совсем наладился
not entirely yet, since I’ve stopped working it is not entirely all right
85 DOC: ((typing))
86 INT: Это важно потому что если он просит осмoтры, это большая сумма для вас
it is important if he requests examination that is very expensive for you
87 PAT: Надо немношко тогда подождать
then we have to wait a little
88 DOC: dus ze kan niet zeggen of haar medische verzekering nu in orde is?
so she cannot tell whether her medical insurance now is all right?
89 INT: То есть вы не можете сказать что ваша медицинская страховка пока в порядке?
So you cannot tell whether your medical insurance now is all right?
90 PAT: (inaudible) ((the P is saying something but both the DOC and the INT ignore the P))

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mediated by

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Box 3
PAT: patient, DOC: doctor, INT: interpreter
73 DOC: heeft mevrouw gezwollen voeten?
does the lady have swollen feet?
74 INT: У вас ноги опухшие?
do you have swollen feet?
75 PAT: Сейчас больше нет, а вообще каждый день у меня опухшие ноги
not now anymore, but normally my feet are swollen every day.
76 INT: Хорошо
good
77 D: (( the D interrupts the I and rushes to claim the next turn at talk)) nu haar bloeddruk nog eens meten
now I’ll measure her blood pressure
78 INT: Сейчас проверит кровь
he is now going to measure your blood
EO not passed to the DOC due to DOC’s intervention

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Shifts in the meaning of the PAT’s empathic opportunity

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mediated by

Box 4
178 PAT: Нет у него euh проблема первая появились когда его отца забирали, он euh был на
руках моей средней дочери и тогда они ее в панике столкнули с лестницы она стояла не лестнице ну (.) и не зайти не выйти она не
догадалась а я была ну мне и зайти да не -не было потому что там человек 20 солдатов было. И они их столкнули в панике (.) ну
короче покатились. Тогда у него первая проблема было с ногами.
No the first time the problem appeared was when his father was arrested. He was in the arms of my middle daughter
and then there was panic and they pushed her off the staircase… and we could not go in or out and she did not know
what she had to do, I could not get in because there was a bunch of 20 soldiers. And so they pushed her and him out
of panic. In short, they rolled down the staircase. Then his first problem with the leg appeared.
179 INT: Euh neen 't is eigenlijk niet ... euh zijn vader werd opgepakt hij werd weggevoerd van thuis uit, en toen die soldaten binnenkwamen dus er
waren ja een man of 20 euh 't was nogal euh ja er was nogal paniek in het huis en mijn tweede dochter stond euh aan de trap en euh ja ze wist
niet goed wat ze moest doen binnengaan of buitengaan, en z'is dan euh ze –ja ze droeg hem eigenlijk. En ze zijn dan gevallen van de trap euh
ze zijn gerold eigenlijk van de trap.
Ehm no actually not…ehm his father was arrested he was taken away from home and when the soldiers came in so
there were yeah approximately 20 there was ehm yeah there was panic in the house and my second daughter was
standing at the staircase and ehm yeah she did not quite know what she had to do to go inside or outside, and she’s
then ehm –yes she was carrying him actually. And then they fell off the staircase ehm they actually rolled down the
staircase. OMISSION
180 DOC: Ja, de zus en hem.
Yes, the sister and him.
181 INT: сестра и он у нее в руках был.
the sister and he was in her arms
182 PAT: mhm
hmm
183 INT: ja
yes
184 DOC: ja? en hoe oud was –was hij toen?
yes? and how old was - was he then?
The INT draws attention to peripheral aspects of the PAT’s empathic opportunity

43
mediated by

Box 5
127 PAT: Да, потому, что это, сейчас я хотела сказать, что начала чуть чуть покаловать сердце, как будто уколы
what I also wanted to say is that now I started feeling a stabbing pain in my chest, it is as if needles are
being inserted
128 INT: //mevrouw zegt
// the lady is saying
129 DOC: // ik zal een keer e:
// i will eh:
130 INT: bij mij is er hartpijn opgetreden en soms heb ik het gevoel dat af en toe mijn hart stopt op dit moment
in me heartache has appeared and sometimes I have the feeling that once in a while my heart
stops at this moment PARAPHRASING / ADDITION
131 DOC: ja, kijk e:: wij gaan, ja ik ga moeten kijken. Het probleem is dat ik vast zit hé? Dus e: ik wil haar niet onderzoeken om haar niet
onnodige kosten te ( ) ook als je een cardiografie e: kost een paar duizenden Belgische francs. Ik kan dat onmogelijk aandoen
als zij totaal niet in orde is met de ziekteverzekering. Dus ik zal EERST een keer contact opnemen met de Sociale
Dienst, ok?
yes, look. eh: we’ll, I’ll have to check. The problem is that my hands are tied yeah? So ehm I do not want
to examine her not to (cause) her unnecessary costs ( ) also if you (do) a cardiography eh it costs a couple
of thousands of Belgian francs. I cannot possibly do that if she is not entirely okay with the insurance. So
FIRST I will get in touch with the Social Services department, okay?
132 INT: То есть сейчас он не может не какие осмотры вам делать, потому что это (ххх) стоимость таких
осмотров. Если будет кардиологию вам делать, это стоит пару тысяч бельгийских франков, которые
вы сами должны будете заплатить. Поэтому он свяжется с социальной службой на счёт этого
so he cannot do any examinations now because that is too expensive. A cardiology costs for instance a
few thousands of Belgian francs, which you’d have to pay yourself. Therefore he will get in touch with the
Social Services department about it.
The INT expands / elaborates on the PAT’s empathic opportunity

45
Shifts in the intensity of the PAT’s empathic opportunity

46
mediated by

47
Box 6
123 PAT: // Нет // я сердце ( ) Прсото часто была у меня боль в голове, и сейчас это обследуют
//not // my heart. I simply had often headaches and that is now being looked into
124 DOC: // neen //
// no //
125 INT a:ah met mijn hart is alles perfect in orde maar ik heb wel last van regelmatige hoofdpijn =
aah: with my heart everything perfectly okay but I do suffer from regular headaches =
126 DOC: = maar dat komt subiet, dat komt subiet.. Ja ja
= but that’s for later, that’s for later. Yes yes
127 INT: Сейчас
in a moment (we’ll talk about it)
128 DOC: heeft ze ooit problemen gehad van maagzweren of maagbloedingen
has she ever had any problems with stomach ulcers or stomach bleeding
The INT intensifies the PAT’s empathic opportunity

48
mediated by

49
Box 7
114 PAT: yok, titreme yok da (.) kalp atışı (.) Hızlanıyor o durumda.Ama titreme yok
no, I don’t have any tremor when I’m angry, but my heart does beat faster
115 INT: ik heb beven maar als ik nerveus ben zal mijn hart waarschijnlijk sneller kloppen
I have tremor but when I am nervous my heart will probably beat faster
The INT downplays the PAT’s empathic opportunity

50
mediated by

51
Box 8
285 PAT: Şimdi tekrar okula dönüyorum
now I am going back to school
286 DOC: aah, da’s goed!
aah, that’s good!
The DOC recognizes the PAT’s empathic opportunity and responds to it
before this is interpreted by the INT

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➢ How is empathic communication expressed in consultations mediated by
professional interpreters?
Patients:
• refrain from describing themselves feeling an emotion (EMO EOs).
• are more likely to describe a negative effect a physical or psychosocial problem is
having on their quality of life, or a recent, devastating, life-changing event (CHALL
EOs).
• are less likely to describe a positive development in physical condition that has
improved their quality of life, a positive development in the psychosocial aspect of
their life, or a recent, very positive, life changing event (PROG EOs).
Findings

53
Patients:
EOs).
Findings

54
Patients:
EOs).
Findings

55
Patients:
EOs).
Findings

56
Findings
CHALLENGE
shift in intensity
shift in meaning
not passed on to the doctor
without change in meaning or intensity 5.55%
38.80%
44.40%
11.11%

57
Findings
PROGRESS
responded by the doctor without interpretation
not passed on to the doctor 75%
25%

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➢ What is the professional interpreter’s effect on the expression of empathic
communication in interpreter-mediated consultations?
Findings

59
• 3 shift categories:
i) EOs not passed to the DOC
EOs when passed to the DOC: ii) intensity
iii) meaning
Findings

60
no change in the Level of the Doctor’s empathy
Findings

61
50% (n= 22/44) of the Patients’ EOs were not responded by the Doctor
(L0 or - )
Findings

62
Method
D. Krystallidou (2014, 2016, 2018)
C
O
N
S
U
L
T
A
T
I
O
N
S

63
PATIENTS INTERPRETERS DOCTORS
speaker hearer hearer speaker hearer speaker
fully ratify INT
(speech + gaze)
adopt middle position
• body oriented between
DOC + P
• neutral gaze between
DOC and P
• gaze to P (relevance)
integrate their
assessment
into their
renditions
adopt middle
position
(body oriented to
DOC, gaze mostly
to INT)
are responsive to relevant
information (display
engagement)
use
embodied
semiotic
resources to
signpost
relevance in
P’s utterance
do not always provide
a verbal response to
P’s EOs
assess the weight of the
P’s utterance
(of which EOs are part)
adopt middle
position
(body
oriented to
DOC, neutral/
no gaze or
gaze to P)
might use embodied
resources to
compensate for lack
of verbal-response

64
fully ratify INT
(speech + gaze)
DOC + P
DOC and P
integrate their
assessment
into their
renditions
adopt middle
position
(body oriented to
DOC, gaze mostly
to INT)
adopt
middle
position
(body
oriented to
DOC, gaze
between
INT and
DOC)
engagement)
use
embodied
semiotic
resources to
signpost
relevance in
P’s utterance
P’s EOs
P’s utterance
adopt middle
position
(body
oriented to
DOC, neutral/
no gaze or
gaze to P)
might use embodied
resources to
compensate for lack
of verbal-response

65
fully ratify INT
(speech + gaze)
DOC + P
DOC and P
integrate their
assessment
into their
renditions
disengaged /performing
non-collaborative tasks
(e.g. typing)
➔
respond to relevant
information as
assessed and rendered
by the INT
adopt middle
position
(body oriented to
DOC, gaze mostly
to INT)
engagement)
use
embodied
semiotic
resources to
signpost
relevance in
P’s utterance
P’s EOs
P’s utterance
adopt middle
position
(body
oriented to
DOC, neutral/
no gaze or
gaze to P)
might use embodied
resources to
compensate for lack
of verbal-response

66
fully ratify INT
(speech + gaze)
integrate their
assessment
into their
renditions
(e.g. typing)
➔
respond to relevant
information as
by the INT
adopt middle
position
(body oriented to
DOC, gaze mostly
to INT)
use
embodied
semiotic
resources to
signpost
relevance in
P’s utterance
P’s EOs
adopt middle
position
(body
oriented to
DOC, neutral/
no gaze or
gaze to P)
might use embodied
resources to
compensate for lack
of verbal-response
(e.g. gaze)

67
fully ratify INT
(speech + gaze)
DOC + P
DOC and P
integrate their
assessment
into their
renditions
(e.g. typing)
➔
respond to relevant
information as
by the INT
adopt middle
position
(body oriented to
DOC, gaze mostly
to INT)
engagement)
use
embodied
semiotic
resources to
signpost
relevance in
P’s utterance
P’s EOs
P’s utterance
adopt middle
position
(body
oriented to
DOC, neutral/
no gaze or
gaze to P)
might use embodied
resources to
compensate for lack
of verbal-response
(e.g. gaze)

68
fully ratify INT
(speech + gaze)
DOC + P
DOC and P
integrate their
assessment
into their
renditions
(e.g. typing)
➔
respond to relevant
information as
by the INT
adopt middle
position
(body oriented to
DOC, gaze mostly
to INT)
adopt
middle
position
(body
oriented to
DOC, gaze
between
INT and
DOC)
engagement)
use
embodied
semiotic
resources to
signpost
relevance in
P’s utterance
P’s EOs
P’s utterance
adopt middle
position
(body
oriented to
DOC, neutral/
no gaze or
gaze to P)
might use embodied
resources to
compensate for lack
of verbal-response
(e.g. gaze)

69
Method
D. Krystallidou (2014, 2016, 2018)
VSR Qualitative Content Analysis
INTERVIEWS U.H. Graneheim, B. Lundman (2004)
C
O
N
S
U
L
T
A
T
I
O
N
S

70
The INT’s assessment of the PAT’s empathic opportunity “and then I started to worry”

71
284. D dus (.) de patiënte zegt toen begon ik me zorgen te maken
so (.) the patient said “then I started to worry”
285. INT hmhm (0.9)
hmhm (0.9)
287. D en (0.6) hebt u het (.) ook zo begrepen dat de patiënt echt angstig was op dat moment of?
and (0.6) did you (.) also understand that the patient was really worried at that moment or?
288. INT euhm
ehm
289. D want ik begi toen begon ik me zorgen te maken is echt euh sterk e dus
because I started then i started to worry is really strong so
290. INT ja dus euh ze zeg euh (.) dus mevrouw is geopereerd [drie] maanden eind vant jaar of zo drie
yes so she says ehm (.) so the lady underwent surgery (three) months at the end of the year so three
months
291. D [ja]
(yes)
292 INT maanden ging het to tot mei ging het goed [dus] bijna half jaar ging het [goed] (.) en in mei
for months until until May it was good (so) almost half a year it went (well) (.) and in May
293. D [hmhm] [ja]
(hmm) (yes)
294 INT kreeg zij (.) maandstonden (.) zo euh verschillende keren na elkaar dus ze kreeg eigenlijk constant bloedingen twintig dagen
she got (.) her periods (.) so ehm multiple times so she was actually having constant bleeding twenty days
long
295. D hmhm
hmhm

72
296. INT dus [ze] kreeg in het begin van de maand maandstonden dan was het nog een beetje aan het
so (she) got her periods at the beginning of the month then she was still having blood
297. D [ja]
(yes)
298. INT doorbloeden dan weer maandstonden en ze en toen begin ik mij zorgen te maken [(.) ja] dus
then again her periods and she and then “I started to worry” ((.) yes) so
299. D [hmhm]
(hmmm)
300. INT toen dacht ik oei zouden weer teruggekomen zijn en zo dus ze was echt euh (.) ze hee ja ik ben echt mij
then I thought oh they must have been back then and so she was ehm (.) she (said) “yes I really started to
zorgen aan het maken (.) of of nu met mij alles ok is en toen heb ik toen heeft ze ook twintigste direct
worry” (.) or or now it’s all fine with me and then I then she made immediately
afspraak gemaakt bij de dokter om (1.1) euh dat met dokter te bespreken en die heeft ze pas gekregen na een
an appointment with the doctor in order to (1.1) ehm to discuss with the doctor and she got them (periods)
just after
maand
a month
301. D hmhm
hmhm

73
The DOC’s understanding of the PAT’s empathic opportunity “and then I started to worry”
based on the INT’s delivery…

74
184. L ja (.) en u zei zelf ook al dat de euh dat de patiënt eigenlijk veel aan het spreken was over de problemen die ze had en over de
yes (.) and you also said yourself that the eh that the patient was actually talking a lot about the problems she had and about
klachten die ze had (.) had u misschien ooit het gevoel da ze zich zorgen maakte of da ze ongerust was?
the symptoms she had (.) did you ever perhaps have the feeling that she was worried or that she was anxious?
185. DOC ja ik denk wel dat dat iemand was die ongerust was omdat ze (.) ja tis daarom da ze kwam omda ze nie wist wat er iets aan de
yes I think it was someone who was anxious because she (.) yes that’s why she came here because she did not know what was
hand was e
wrong eh
186. L ja
yes
187 DOC ze heeft waarschijnlijk een voorgeschiedenis van endometriose en dan weet je van ja zolang dak mijn maandstonden heb kan da wel eens terugkomen
most likely she has a history of endometriosis and then you know that yes as long as I am having my periods it can still come back
(0.8) en dan euh (.) [ja]
(0.8) and then ehm (.) (yes)
188. L [ja]
(yes)
189. DOC dan heeft ze die klachten gehad (1.2) dus ja is die ongerust da weet ik wel e
then she has had these symptoms (1.2) so yes she is anxious that is something I know hey

75
The actual reason behind the PAT’s empathic opportunity
“and then I started to worry”
as meant by the PAT herself…

76
130.
131.
132.
130. D en de bezorgdheid (.) want u zei hier toen begon ik me zorgen te maken (.) ja? wat bedoeld u precies?
and the concerns (.) because you said here “then I started to worry” (.) yes? what exactly do you mean?
130.
131 PAT да я не мог видеть доктора (.) мне пришлось ждать слишком долго
yes I could not see the doctor (.) I had to wait too long
132 D was DIT eigenlijk het probleem (.) omdat u geen afspraak kon maken? (0.2) of omdat u
was THIS actually the problem (.) because you could not make an appointment? (0.2) or because you
133 PAT да я не мог видеть доктора
yes I could not see the doctor

77
= • to detect, assess, render Patient cues
What we already
knew
What we did
not know
What it means
Interpreters require new set of skills
co-construction of
Empathic
Communication
=
phenomenon
What it means

78
• aware of the implications arising from their renditions and
their effect on EC
• aware of the communicative goals attached to
Ptn EOs and the D’s empathic responses
What we already
knew
What we did
not know
What it means
co-construction of
Empathic
Communication
=
phenomenon
What it means

79
• implications arising from shifts in
meaning
intensity
order of information
paraphrasing
What we already
knew
What we did
not know
What it means
co-construction of
Empathic
Communication
=
phenomenon
What it means

80
• to display communicative behaviours that facilitate
each other’s communicative goals
What we already
knew
What we did
not know
What it means
Interpreters & doctors require new set of skills
co-construction of
Empathic
Communication
=
phenomenon
What it means

81
• interactional complexity of
interpreter-mediated consultations
(e.g. power & knowledge asymmetries, time-lag, …)
• pitfalls arising from inferencing / bypassing
the INT’s turn
What we already
knew
What we did
not know
What it means
Doctors require new sets of skills
co-construction of
Empathic
Communication
=
phenomenon
What it means

82
What we already
knew
What we did
not know
What it means
Interpreters and Doctors
require new sets of skills
that enable and facilitate
inter-professional collaboration
co-construction of
Empathic
Communication
=
phenomenon
What it means

83
What we already
knew
What we did
not know
What it means
co-construction of
Empathic
Communication
=
phenomenon
What it means
Inter-Professional Education
Collaborative Practice
Empathic Communication in IMCs

84

85
• Introduce yourself to the HCP and the patient.
• Ensure you interpret the informed-consent procedure for a video consultation (if
applicable)
• The HCP might introduce everyone in the room (even off camera) and might ask
the patient to do the same or confirm that they are alone. Interpret.
• The HCP might reassure the patient that the consultation is likely to be very
similar to a standard one, and that the call is confidential/ secure. Interpret.
Starting the consultation
Adapted from:
Greenhalgh, T. (2020) Video consultations: information for GPs. Oxford www.rcgp.org.uk/policy/rcgp-policy-areas/-/media/B2ED99A2DBEE424788E12D17FF73A55F.ashx

86
Adapted from:
Having a consultation
• Alert the patient & HCP to potential glitches (e.g. blurry picture) and ask them to
repeat their last utterance.
• Ask the patient & HCP to try to look as much as possible at the screen (so you can
observe their facial expressions).
• Inform both the patient & HCP that video communication is a bit harder for the
patient and that they might feel less inclined to express emotions. The HCP should
explore further. You should be alert to indirect expressions of emotion.
• Ensure you pass the patient’s emotions/concerns/progress on to the HCP. When
in doubt, seek clarification and interpret.

87
Adapted from:
Closing the consultation
• The HCP might be particularly careful to summarize key points, since it’s possible
something could have been missed due to technical interference. Interpret. When
in doubt, seek clarification and interpret.
• The HCP might ask the patient if they need anything clarified. Interpret.
• The HCP might confirm (and record) if the patient is happy to use video again.
Interpret.
• To end, the HCP will tell the patient they are going to close the call now, and say
goodbye (before actually closing the connection). Interpret.
• Thank the patient and HCP and close the connection.

The professional interpreter’s effect
on empathic communication in
medical consultations
demi.krystallidou@kuleuven.be
@demi_krystallid

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Doing Empathy in Multilingual Healthcare Communication Through Interpreters: an Evidence-based Perspective

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