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Intercultural communication in healthcare settings 243

12. Intercultural communication in
healthcare settings

Celia Roberts

1. Introduction

Most of the literature on cultural issues in healthcare settings stems from medi-
cal anthropology and does not focus on the details of interaction. The sociologi-
cal and sociolinguistic studies take a more interactional perspective but are con-
cerned with asymmetrical encounters generally rather than with intercultural
communication. The applied linguistic literature on intercultural communi-
cation in healthcare would make up only a slim volume, although it is growing.
It is important, therefore, to make connections with the wider literature, not
least because of the contributions anthropology and sociology have made to an
understanding of discourse, identity and equality in healthcare settings. The
work on healthcare discourse has concentrated on the health professional – pa-
tient interaction. Following Goffman, this is the “front stage” work of profes-
sionals. However, hospitals and other healthcare institutions are held together as
much by “backstage” work: the talk and text between health professionals, man-
agers and other staff in healthcare organizations (Atkinson 1995). And the insti-
tution of medicine and the professions within it are largely maintained by the
education, training and selection work that prepares and develops health profes-
sionals. Much of this is carried out in high stakes gate-keeping encounters. So,
this “backstage” work is also included in this chapter.
Migration and the diaspora continue to produce a changing communicative
ecology in public life. Stable ethnic minority populations co-exist alongside
relatively new groups of migrants and asylum seekers. As with other caring and
social services, both the research and policies in the health arena chart the
changes in practices produced as a result of multilingual and culturally diverse
client populations. These include changes in the medical and nursing under-
graduate curriculum and postgraduate training, concerns about fairness and
equal opportunities in assessment and selection processes, and research and pol-
icies around interpreter mediated consultations.

2. Professional–patient communication

It is estimated that over ten thousand articles have been written about healthcare
professional–patient communication. Most of these are written either by health-