“You have to cover up the words
of the doctor”
The mediation of trust in interpreted
consultations in primary care
Nadia Robb and Trisha Greenhalgh
Department of Primary Care and Population Sciences,
University College London, London, UK
Purpose – This article explores issues of trust in narratives of interpreted consultations in primary
Design/methodology/approach – The paper is based on empirical data from a qualitative study of
accounts of interpreted consultations in UK primary care, undertaken in three north London boroughs.
In a total of 69 individual interviews and two focus groups, narratives of interpreted consultations
were sought from 18 service users, 17 professional interpreters, nine family member interpreters, 13
general practitioners, 15 nurses, eight receptionists, and three practice managers. The study collected
and analysed these using a grounded theory approach and taking the story as the main unit of
analysis. It applies a theoretical model that draws on three key concepts: Greener’s taxonomy of trust
based on the different “faces” of power in medical consultations; Weber’s notion of bureaucratic vs
traditional social roles; and Habermas’ distinction between communicative and strategic action.
Findings – Trust was a prominent theme in almost all the narratives. The triadic nature of
interpreted consultations creates six linked trust relationships (patient-interpreter, patient-clinician,
interpreter-patient, interpreter-clinician, clinician-patient and clinician-interpreter). Three different
types of trust are evident in these different relationships – voluntary trust (based on either
kinship-like bonds and continuity of the interpersonal relationship over time, or on conﬁdence in the
institution and professional role that the individual represents), coercive trust (where one person
effectively has no choice but to trust the other, as when a health problem requires expert knowledge
that the patient does not have and cannot get) and hegemonic trust (where a person’s propensity to
trust, and awareness of alternatives, is shaped and constrained by the system so that people trust
without knowing there is an alternative). These different types of trust had important implications for
the nature of communication in the consultation and on patients’ subsequent action.
Research limitations/implications – The methodological and analytic approach, potentially, has
wider applications in the study of other trust relationships in health and social care.
Practical implications – Quality in the interpreted consultation cannot be judged purely in terms of
accuracy of translation. The critical importance of voluntary trust for open and effective
communication, and the dependence of the latter on a positive interpersonal relationship and
continuity of care, should be acknowledged in the design and funding of interpreting services and in
the training of both clinicians, interpreters and administrative staff.
Originality/value – This is the ﬁrst study in which interpreted consultations have been analysed
from a perspective of critical sociology with a particular focus on trust and power relations.
Keywords Ethnic minorities, Interpreters, Health services, Communications, Trust
Paper type Research paper
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The author would like to hank Professor Graham Scambler and the anonymous referees for
helpful comments on a previous draft of this paper.
Journal of Health Organization and
Vol. 20 No. 5, 2006
q Emerald Group Publishing Limited