Considering mono- and multilingual interactions on a continuum: an analysis of interactions in medical settings

Changing geo-political scenarios, especially in Europe, Northern Africa and the Middle East, are displacing populations and reshaping societies. In this context, the provision of health care becomes even more challenging as the cultural and linguistic gaps add challenges to the highly complex interactions taking place within clinical settings. In this contribution, we analyze the main issues regarding effective communication in multilingual medical settings and propose to adopt a theoretical framework that allows to consider mono- and multi-lingual settings on a continuum, thus offering homogeneous tools for the analysis of misunderstandings and ineffective communication. We propose, first, to consider doctor-patient interactions by using the concept of activity type. We argue that, from this perspective, the most challenging aspect of this kind of interaction is not so much the quantitative knowledge disparity between the parties (somewhat foreseen by the preconditions of existence of the activity type itself), but rather the qualitative knowledge disparity. With ‘qualitative knowledge disparity’ we refer to two specific conditions that characterize this activity type: 1. The fact that at least one of the parties involved is defined by having a technical knowledge the other(s) do not share (or share only up to a certain degree); 2. As a consequence of point 1., the fact that the parties often do not share the criteria for the interpretation/assessment of the objective facts (symptoms and clinical parameters), which should constitute the starting point for decisions and actions. The problems that arise in real-life interactions as a consequence of these characteristics have been explored by using theoretical constructs such as ‘asymmetry’, ‘power relations’, ‘medical world vs life world’, ‘voices’, etc. What seems lacking is a dialogical perspective on the issue, allowing the description of the phenomena and of possible solutions that can be tested empirically. In order to fill this gap, as a second step, we propose to observe clinical interactions – both mono- and multi-lingual – under the lenses of the ‘socio-cognitive approach’ (SCA) outlined by Kecskes (2008, 2010) and Kecskes and Zhang (2009). The model describes the process of meaning construction and comprehension as it develops around three different types of knowledge: ‘collective prior knowledge’, ‘individual prior knowledge’, and ‘actual situationally created knowledge’. It also highlights the dynamics between intention and attention in the process of meaning production and the role of salience and relevance for the interpretation of meaning (Kecskes, 2014). The reframing of the issue of effective communication in medical settings proposed in this contribution shifts the attention from the specific challenges posed by multilingual settings by adopting a more overarching perspective encompassing both mono- and multi-lingual interactions. By considering mono- and multi-lingual interactions on a continuum, we believe it will be easier to identify the dialogical processes that may allow the parties to build a common ground starting from the salient aspects of two worlds that are very different but not therefore irreconcilable.