Table 2.

Quotations for Interactional Impact of Varied Terminology

Terminology Misalignment			Some Analytic Points
Excerpt 1a: Cantonese-preference Female patient; Cantonese-speaking Research Assistant.
Languag Used: Cantonese
32	RA:	Do you overly worry about different things? I think you do
33	Pt:	yes, I am extremely depressed [jauwat 憂鬱]	Patient openly uses ‘depression’
[Lines removed discussing other screening questions]
110	RA:	your family doctor is
111	Pt:	I can’t get an appointment with him, I want to get a consultation for a psychologist now	Patient states purpose openly – to see psychologist
Excerpt 1b: Cantonese-preference Female patient; Mandarin-speaking Physician. Language Used: Mandarin
124	Dr:	that’s okay. How is your mood [xinqing 心情] lately?	Doctor uses term ‘mood’
125	Pt:	I can’t sleep well at night, I always wake up during my sleep. Now, I also doze off. My heart/mind [xinnao 心腦 ] is not good, I always get chest tightness. My arms are not good, and now it’s even painful in my legs.	Chinese term in response to ‘mood’
		They are only looking at my arms now, but not my legs and waist yet. It is very tight, right here. Very uncomfortable, it’s so painful that I wake up in the middle of the night.	Move to somatic symptoms
126	Dr:	waking up because of pain…is that just at night, or you have other sleeping problems as well?
127	Pt:	pain, or sometimes just can’t sleep well
[50 lines removed: discussion about sleep and “medication for your mood”]			Doctor raises the point about the therapist – uses this term.
177	Dr:	you have seen a therapist in Chinatown before, is that correct?
178	Pt:	yes
179	Dr:	so did you like that therapist then? No? You would like to have another therapist?	Patient mirrors with ‘therapist’
180	Pt:	I would like to see a therapist from [this hospital]
Interpretation Misalignment			Some Analytic Points
Excerpt 2: Spanish-preference Latino patient; English-speaking Doctor; Professional Interpreter. Language spoken in (parentheses)
136	Dr:	(Eng) Mm-hm, ok. Ok, thank you for sharing that with me. Um, ok, and how, um, how is your — I mean a transition out of talking about your mood, cause I, I want to make sure that you’re uh depression is not getting worse. So can you tell me about your mood please?	Doctor starts with ‘mood’, says ‘depression’, but then reverts back to “mood”.
137	Int:	(Sp) Great sir, great, thank you very much for sharing. Now we are going to change topic, we are going to talk about another topic which is, is your mood [su humor]….how are you feeling [como se siente]. How are you feeling with all of this? We were talking about — we are going to talk about the depression [la depresión]. We have seen that the depression [la depresión] hasn’t gotten worse, but we would like to know how you’re feeling? What are you feeling?	‘Humor’ is not an accurate translation of ‘mood’, later interpreter uses ‘feeling’
138	Pt:	(Sp) Well, the depression [la depresión], mm. If I see a child cry, I cry. The depression [la depresión], is quite.. I have to be careful about what TV programs that I see. Nothing dramatic, because that, how can I say it? If I see a drama, it’s like I participate in the drama.	Of the various terms, the patient uses ‘depression’
[21 lines removed: talk about changing the TV channel to avoid sadness/upset]			Despite the patient’s term, which the doctor may not have recognized in Spanish, doctor uses ‘mood’ again
158	Dr:	(Eng) Yeah. So compared to uhm. Because I don’t know you that well, I’m not your primary care doctor, so um, I’m gonna ask you about how your mood now compares to how your mood was let’s say one to two months ago. So if you think back to one to two months ago, do you think your mood today is better, worse, or the same as a couple of months ago?
159	Pt:	(Sp) Yes, it’s better now
160	Int:	(Eng) It’s better now
161	Dr:	(Eng) Ok. And, and why do you think that is?
162	Int:	(Sp) And why do you think that is sir?
163	Pt:	(Sp) Mm, well now I can go to the bathroom, I can eat, and I can sleep early	Patient’s proof of improvement is based on physical things, less about feelings
164	Dr:	(Eng) Mm-hm
165	Int:	(Eng) Yeah, you know, it is because now I can, I go to the bathroom, I can eat, and I can sleep mostly early
Misalignments in Use of Medical Terminology			Some Analytic Points
Excerpt 3: English-preference Latina patient; English-speaking physician. Language used: English
16	Dr:	How are you?
17	Pt:	I’m fair.
18	Dr:	Yeah, what’s going on?
19	Pt:	I think I’m suffering from depression again	Patient openly uses ‘depression.’
20	Dr:	Yeah. Why is that?
21	Pt:	Oh, a series of things and then ( ) is just making me more depressed
22	Dr:	What’s happening with your work? Are you still working?	Doctor clarifies
23	Pt:	I am. It’s crazy.
24	Dr:	Yeah?
25	Pt:	I negotiated to have a flex schedule. I get three hours off in the middle of the day, so I go to the gym
26	Dr:	Okay. Good for you!
[165 Lines removed: discussion about exercise]
191	Dr:	You said that you’re feeling down?
192	Pt:	I am.	Doctor downgrades and defines patient’s experience away from ‘depression’ to “feeling down”
193	Dr:	Yeah?
194	Pt:	Because I don’t even want to stay here anymore. I mean, staying here in the United States.
195	Dr:	Why is that?
196	Pt:	Well, it’s because it’s not so quiet. It wasn’t for dog baby, I would’ve gone and my parents are no longer alive, so I remain here
197	Dr:	Where would you want to go?
198	Pt:	Back to Jamaica
199	Dr:	Uh-huh (affirmative) Uh-huh (affirmative)
200	Pt:	It’s just that health wise I’m not really sure how that would work because in terms of I do need to be monitored on a regular basis. I can’t believe people can be so xenophobic and so … Yeah.
201	Dr:	Yeah. Oh, I know. I would say at least a couple times a day I have patients who come here and say that they’re really anxious about what’s going on.	Doctor relates and describes similar other patients as ‘anxious’ and that it is ‘distressing’ but not ‘depressing’
202	Pt:	It makes me sick to my stomach. It really does
203	Dr:	Yeah. It’s distressing
Excerpt 4 Cantonese-preference female patient; Mandarin-speaking resident physician (Res); Cantonese-speaking attending/supervising physician (AP). Languages spoken: Cantonese with some English
510	AP:	hello! So you are using your husband’s sleeping pills right now?
511	Pt:	yes.
512	AP:	and it’s effective?
513	Pt:	yes, it’s been a while already
514	AP:	okay, got it, got it. He prescribed more for you. It doesn’t interact with your blood pressure medicine, and not much side effect, no dependency, so it’s good?
515	Pt:	yes
516	AP:	And for you had your gallbladder removed, right?
517	Pt:	yes
518	AP:	hoping there won’t be more problems, haha
519	Pt:	me too
520	AP:	haha, good good. (Eng directed to Res) she’s up to date on her immunizations and stuff? Okay.
521	Pt:	he said everything is (Eng) normal (Can) for me, but I feel like I’m foggy/not stable [wanwan zanzan 瘟瘟陣陣]	Patient differentiates between doctor’s diagnosis of normal and patient’s feeling of being foggy and unstable, a term the supervising physician doesn’t actually recognize. Patient explains that it’s a way to measure health, which she deems as ‘bad’-openly discussing mental health
522	AP:	foggy/not stable [wanwan zanzan 瘟瘟陣陣]? What do you mean by foggy/not stable [wanwan zanzan 瘟瘟陣陣]?
523	Pt:	it’s like, my health is very bad, kind of like that
524	AP:	mmm it’s not a proble:::m and now that things are taken care of. Like let’s hope that the problems will become stable[wanding 穩定] for a while don’t be too worried. (Eng) she’s saying everything looks normal, she’s just like she’s si::ck=
525	Res:	=(Eng) yeah haha=
526	AP:	=(Eng) I said yeah she’s been through a lot. (Can) I hope. With luck that you won’t have other problems.	Doctors continue to reassure patient Patient then suggests ‘stress’ but discloses stopping the psychologist
527	Pt:	maybe it’s just stress, maybe, I have to, I have a lot of stress. I even stopped my psychologist [samlei jisang 心理醫生], too. Ever since I got admitted to the hospital and did these things. I haven’t had much time, so stopped.
528	AP:	(Eng) she said she stopped seeing her psychiatrist. (Can) Do you feel your mood [samcing 心情] is still depressed?	Attending changes to ‘psychiatrist’, then asks specifically about the ‘mood being depressed’. Patient responds about ‘stress.’ Attending switches to ‘psychologist’. In talking to the Resident, switches to therapist.
529	Pt:	a lot of stress lately. A lot of things going on.
530	AP:	I think you should see the psychologist [samlei jisang 心理醫生] again.
531	Pt:	I will do so, too.
532	AP:	okay so you should go see him again. (Eng) she said she’s having a lot of stress, and pressure, so she’s going to see the therapist again.
533	Res:	(Eng) okay.
534	AP:	okay, so see you!
Complex Misalignment: Interpretation and Lay/Medical Terms			Some Analytic Points
Excerpt 5 Cantonese-preference female patient; Mandarin-speaking physician. Language used: Mandarin
65	Dr:	So you didn’t go anymore
66	Pt:	yes
67	Dr:	so you, may I ask after the passing of your daughter, how is you mood [jingshen 精神] now?	Doctor uses ‘mood’
68	Pt:	It’s a little better. Because what should I think, she passed away already
69	Dr:	yes
70	Pt:	she is not here already, it is useless for me to think. But don’t think ( ), I always think about it in the middle of the night as I am sleeping, about the process, when she was younger, studying, and what I did wrong. I think, would it be that I did something wrong, that’s why she left, sometimes I will blame myself.
[typing sounds throughout]
71	Dr:	Yes, this is normal. Especially someone in the family passed away, I will too, think about them once in a while. But I think that it is important that as long as your spirit [jingshen 精神] is not especially, you know, spirit [jingshen 精神] especially like, like, the dimensions of your heart [xinwei 心位] are not especially serious/extreme, as long as it’s not like this, then that’s considered a little better.	Despite the patient’s seriousness, doctor focuses on this being a normal response to grief. There are multiple Mandarin words to discuss ‘mood/spirit/heart’ which doctor includes
[14 lines removed discussing sleep and whether the patient communicated/talked to the psychiatrist]
85	Dr:	Yes. No, its, what I’m saying is, is, to, with your psychiatric doctor [jingshen 精神 doctor], does the you know the psychology [xinli 心裡], you know, like psychology[xinli 心裡] treatment. It’s the, you know, not the eat medicine, you know, to control your that, how should I put it, uh.	Many terms are included but the doctor seems to be trying to find the word for talk therapy or not-eating-medicine-treatment, which the patient understands and correctly identifies as psychologist. This is a concrete action (therapy) that doctor suggests to patient.
86	Pt:	He called me. He said if you don’t eat medicine, you can see us. We will find a psychologist [xinli 心裡 doctor] to talk with you
87	Dr:	yes just like this
88	Pt:	He asked me. Later I said, I said, because I have a family friend. She’s in the same situation. That person, her ( ) husband, later her son last time it was on the newspaper, that when a person went fishing, and a wave pulled him away that person. He is my sister’s husband’s brother.
89	Pt:	She said to me, her mother could get through it, why couldn’t you. She said it is testing me, if I could, I could get through this challenge, I think I should figure something to get over it.
90	Dr:	I think you should too, you should, there should be some ways to. But if you want to go back to you know and talk with a doctor
91	Pt:	yes
92	Dr:	talk thoroughly about this, and do a psychology plus this kind of therapy, it can help you in this situation.	Doctor suggests talking as a possible treatment, uses the terms psychology + therapy Patient explaining that the only option she is offered is medication, therefore, she’s not taking it Doctor shifts gears to social support
93	Pt:	He told me, he said, I told him this situation with taking medicine, and how I think. Later he said, he has to put it in a file, he said, we will keep a file in the hospital, if you need it then you will have to come back to us. If you don’t need it then no need to reach us, it’s been a month already
94	Dr:	already a month
95	Pt:	hence I am not going to him.
96	Dr:	Never mind then. That’s with, if, anyway in this important period of time, you need someone for support, if family and friends can support you, your ( ) will be the best.