由醫師觀點探討臺灣醫療通譯現況

Abstract

醫師在臨床工作中，面對語言能力有限的外籍病人時，必須思考如何解決和病人之間的語言溝通障礙。在相關文獻中，醫療通譯是一個相當重要的研究主題，但對台灣醫療情境中之語言障礙和醫療通譯的研究則相對缺乏。本文採用混合型研究方法，透過問卷調查和訪談，探討台灣醫師在面對中文能力有限之外籍病人時，如何解決與病人之間的語言溝通障礙，同時也試圖了解台灣醫師認為醫療通譯員需具備哪些特質。 研究結果發現，醫師在面對中文能力有限之外籍病人時，傾向先用英文溝通，而不是先尋求通譯服務協助。醫師之所以選擇先用英文，可能是基於普遍存在於醫師間的共同信念，即英語可用來作為與外籍病人溝通的通用語言，但其實這不見得適用於所有醫療情境。此外，研究結果也指出，醫師之所以選擇不使用通譯服務協助醫病溝通，可能是基於一個對通譯員的錯誤刻板印象，即醫療場域中的通譯員都是仲介，再加上醫師普遍對仲介無法信任，以至於他們也無法相信醫療場域中的通譯服務品質，進而降低通譯服務的使用頻率。問卷結果的量化分析顯示，通譯協助無法顯著提升醫病溝通品質，進一步透過訪談結果的分析，試圖解釋這個令人意外的結果，可發現醫師因不懂外語，無法判斷通譯品質好壞，這時如果又看到通譯員以不專業、不可靠的方式提供通譯協助時，就有可能對通譯品質產生懷疑，因而導致醫病溝通品質無法有效提升。根據此發現，本研究得以強調，專業醫療通譯服務的發展在台灣確實有其重要性。 基於上述研究結果，本研究對專業醫療通譯服務在台灣的未來發展以及新移民醫療照護均有重要啟發。 Physicians have to address the language barrier when meeting foreign patients with limited language proficiency, and there is a great abundance of literature on strategies for bridging language and cultural gaps between physicians and patients. Among the strategies, medical interpreting is a principal research topic. There is little research, however, on the language barrier and medical interpreting in Taiwan’s healthcare settings. Using the mixed methods design—that is, a questionnaire survey complemented by follow-up interviews, the researcher attempted to explore how Taiwan’s physicians addressed the language barrier in the context of meeting a foreign patient with limited Mandarin proficiency. Their attitudes toward the characteristics of the medical interpreter were examined as well. The findings suggested that the participants appeared to try speaking English first, instead of using the interpreting service, in the context of communicating with foreign patients with limited Mandarin proficiency. Although the physicians appeared to share a common belief that English can serve as a lingua franca in communication with foreign patients, such an idea may not necessarily work in all clinical contexts. Besides, the results also indicated that the participants were likely to refrain from employing the interpreting assistance because of their common presupposition about the medical interpreter that the interpreter in the medical context is always the agent. Such presupposition, as well as the physicians’ mistrust toward the agent, might inevitably lead to their mistrust toward the medical interpreter and consequently decrease the utilization of the interpreting service. Another remarkable finding was that there was no significant positive effect of the interpreting assistance on the quality of doctor-patient communication according to the quantitative data. Using the qualitative data collected by the interview, the researcher argued that the physicians were likely to develop doubt about the quality of interpretation when seeing the interpreting service being conducted by an unprofessional, unreliable way by the interpreter. As a result, concern about the poor quality of communication would possibly emerge based on the suspicious interpretation, leading to unsatisfying quality of care. From this critical finding, the study highlighted the value of developing professional medical interpreting service. To conclude, this study had important implications for the development of professional medical interpreting and the new immigrants’ health care as well in Taiwan.