A frequent source of difficulty in medical encounters is the marked differences between staff and patients in 'wait time' or the length of pause taken between turns in an interaction.
According to Scollon and Scollon (1995, p.60) 'very small differences in the timing of interturn pauses can lead conversationalists to develop negative attitudes toward each other'. They explain that:
if two speakers (or more) differ in the length of the pauses they take between turns, the speaker with the shorter pauses will come to dominate the conversation. This is because at each point where turns might be exchanged, the faster speaker recaptures the conversational floor.(p.78)
The lengthy pauses which are common in Yolŋu discourse are often a source
of confusion for Balanda in their encounters with Yol\u. Without an awareness
of the need to wait for what feels like an unnatural length of time the
Balanda will inevitably come to dominate the conversation and the opportunity
for the Yol\u to participate will increasingly diminish. Obtaining information
which may be crucial to effective care therefore becomes impossible.
In the renal study, some of the more experienced staff waited for relatively
lengthy periods before either repeating or rephrasing their question.
For example, one of the physicians waited for 12 seconds before rephrasing
his question (the Yol\u researcher said if he waited a little longer he
probably would have got an answer). Less experienced staff assumed that
a lengthy pause indicated some kind of problem with the communication.
Click here for a typical example of the difficulties experienced due to differences in 'wait time' in a medical encounter.
In this interaction, the staff recognised that they had not allowed sufficient
wait time but only after having the opportunity to review the video-recording
of the interaction. As the physician explained:
probably..when you look at it now I hadn't waited all that long but I
probably felt that I needed to rephrase it to help her understand.. from
looking at it I probably thought she wasn't responding and thought how
can I rephrase it .. I didn't wait long..
Click here to watch another example from a role play from the "Just Scratching the Surface" Project.
In both these examples, the staff members utilised a range of good communication strategies - such as a good rate and plain English - but their 'wait time' following a question was typical of Balanda discourse. The Yol\u patients, neither of whom is a fluent English speaker, were unable to respond in the short pause between the questions. The question and answer routine was uncomfortable for them but it is likely both would still have attempted to respond to most of the questions if given sufficient time - but 'sufficient time' for the Yol\u patients is likely to have been very difficult for the staff members to endure. Even if they did allow sufficient time, without an interpreter, the potential in these interactions for effective communication was seriously limited. The best communication strategies cannot overcome so little shared cultural knowledge and language.
Click here to listen to Maratja explain more about these differences
in 'wait time'.
Even when working with an interpreter there may be long pauses - assume there will be a response eventually and encourage the interpreter to let you know if you need to repeat or rephrase your question.