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The purpose of this paper is to examine the role of the computer in medical consultations in which English- Spanish-bilingual medical providers interact with Spanish-monolingual patients. Following previous studies that have revealed that the presence of the computer in consultations detracts from direct provider- patient communication, we pay specific attention to how the use of the computer in Spanishlanguage medical consultations can complement or adversely affect the co-construction of the patient's health narrative. The data for the present study consist of 36 Spanish-language medical consultations in Southern California. Applying a conversation analytical approach to the health narratives in the corpus, we argue that the computer is essentially a third interactant to which medical providers orient through lowered volume, minimal responses, bureaucratic side talk, and, most importantly, codeswitching to English - all of which strip the patients of control over the co-construction of their health narrative with their medical provider. Because the patient does not have access to the computational task and the language, we posit that this exacerbates the already existing adverse effects that the computer has on provider-patient interaction. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine patient-provider narrative co-construction of symptoms, diagnosis and treatment in the medical consultation. Narrative scholarship has demonstrated that conversational narratives, including those that take place in medical consultations, are typically co-constructed by all participants within the conversation. In the context of the medical consultation, this means that patient narratives are co-constructed with providers, and that at times, provider contributions to the patient narrative can hide patient contributions. The inherent power asymmetry that exists between patient and provider facilitates the possibility for provider contributions to obscure those of the patient. Based on audio-recorded data from medical consultations between two different nurse practitioners and one patient, findings from this study demonstrate that such narrative co-construction leads to differential information regarding the patient's symptoms, diagnosis and treatment. Implications include the need for providers to relinquish control over to the patient to allow the patient to fully articulate narrative accounts of their medical issues. [ABSTRACT FROM AUTHOR]

The purpose of this study is to demonstrate how individual experiences shape ideologies toward healthcare. To demonstrate, we analyze conversational narrative data about health and healthcare between a dominant Spanish-speaking Mexican immigrant woman, Maria, and the researcher, Caroline. Findings demonstrate that Maria's narrative about her experience receiving healthcare for a knee injury reveals her ideological stance toward healthcare in both the United States and Mexico. In particular, the narrative reflects an ideological position in which medical providers neglect patients and strip them of agency in making choices about their own healthcare. Cultural competence, then, is not only about gaining knowledge of patients' cultural groups but also about understanding how patients' life experiences shape them as autonomous individuals with socially constructed attitudes toward healthcare. [ABSTRACT FROM AUTHOR]