Explanations, explanations, explanations: how do patients with limited English construct narrative accounts in multi-lingual, multi-ethnic settings, and how can GPs interpret them?

BACKGROUND: The gap is widening between understanding the subtle ways patients and GPs manage their talk, and superficial discussion of the 'language barrier' among linguistic minority patients. All patients have to explain themselves, not just those for whom English is their first or main language. Patients' explanations reflect how they want the doctor to perceive them as a patient and as a person: they reveal patients' identities. Yet interpretations are not easy when patients' style of talking English is influenced by their first language and cultural background.
OBJECTIVE: To explore in detail how patients with limited English and GPs jointly overcome misunderstandings in explanations.
METHODS: Using discourse analysis and conversation analysis, we examine how GPs and their patients with limited English negotiate explanations and collaborate to manage, repair or prevent understanding problems.
RESULTS: 31% of patients said English was not their first language. Misunderstandings arise owing to a range of linguistic and cultural factors, including stress and intonation patterns, vocabulary, the way a patient sequences their narrative, and patient and GP pursuing different agendas.
CONCLUSION: When talk itself is the problem, patients' explanations can lead to misunderstandings, which GPs have to repair if they cannot prevent. Careful interpretation by skillful GPs can reveal patients' knowledge, experience and perspective.