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Intercultural communication in healthcare settings 245

Iedema (in press) describes the “interactive volatility” where there is increasing
amount of talk in what might broadly be conceived of as intercultural en-
counters where professionals and others who inhabit different professional and
organizational cultures now have to negotiate meanings together. This volatility
is the result of new sites and practices where there are stuggles over how to in-
teract, as professional roles and relationships have to be rethought. Research on
the detailed interactional strategies of the consultation has been dominated by
Conversation Analysis (CA). Although not addressed explicitly, Conversation
Analysis looks at the differences in how professionals and patients communi-
cate with each other. By looking at relatively large numbers of a particular phase
of the consultation, CA has shown the patterns of turn design and their conse-
quences for health professionals and their patients. CA studies in the USA, Fin-
land and the UK, to name some of the main contributions to this tradition, have
focused on particular phases such as openings, history taking and making a di-
agnosis (see Drew, Chatwin and Collins 2001 for an overview of CA in health-
care settings). CA, in pursuing the quest for general patterns, has not focused on
ethnic/linguistic diversity in communication and so the unpredictable and less
determinate qualities of consultations when patient and doctor draw on different
ethno-linguistic resources (see Gumperz and Cook-Gumperz in this volume).
However, CA methodology has influenced the interactional sociolinguistic re-
search in healthcare settings described below.
It is not possible to look at all aspects of what Sarangi calls a developing
“communicative mentality” (Sarangi 2004) in healthcare settings, nor to look at
all the ways in which “diversity” affects interpretation in health encounters
where diversity includes, as mentioned above, any difference in health profes-
sionals’ and patients’ perspectives.
The rest of the chapter will, therefore, focus on language and ethnicities in
intercultural communication.

4. Cultural differences and medical anthropology

Just as there are fuzzy boundaries between what is ethnically constituted as cul-
tural difference and what is socially/institutionally constituted, as suggested, so
the notion of “intercultural” is problematic. In other words “culture” can be con-
ceived of too narrowly as only accounting for linguistic/ethnic differences or
overused to explain any interaction where participants’ ethnic/national origins
differ. As Auer and Kern argue, an encounter is not intercultural just because
people originate from different parts of the world and belong to different races
and ethnicities. “Culture” can only be understood as part of action and interac-
tion rather than standing outside it. Differences, difficulties and misunderstand-
ings cannot be easily accounted for because people come from these different