The challenge of tetradic relationships in medically interpreted pediatric primary care visits: A descriptive study of communication practices

•We recorded interactions between adolescents, parents, clinicians and interpreters.•Examples show how intended messages may not be conveyed or understood.•Shifts in power may mask sources of inaccuracy, limiting parents and interpreters.•Findings provide insight to upgrade skills of community interpreters and clinicians.

ObjectiveTo examine spoken interactions between pediatricians and community-based interpreters speaking with adolescents and parents with Limited English proficiency (LEP) in primary care to identify the challenges of interpreting in a four-person or tetradic visit, its sources of co-constructed errors, and specific practices for educational intervention.MethodsAs part of a larger study of vaccine decision-making at six clinical sites in two states, this descriptive study used discourse analysis to examine 20 routine primary care visits in a Latino Clinic in interactions between adolescents, parents, community-based interpreters, and pediatricians. Specific patterns of communication practices were identified that contributed to inaccuracies in medical interpretationResultsPractices needing improvement were tallied for simple frequencies and included: omissions; false fluency; substitutions; editorializing; added clarification, information, or questions; medical terminology; extra explanation to mother; and, cultural additions. Of these speaking practices, omissions were the most common (123 out of 292 total) and the most affected by pediatricians.ConclusionThe dynamics of both pediatricians and interpreters contributed to identification of areas for improvement, with more adolescent participation in bilingual than monolingual visits.Practice implicationsThese observations provide opportunities for mapping a communication skills training intervention based on observations for future testing of an evidence-based curriculum.