Language Choice and Accommodation Strategies in Pharmacist-Patient Interaction in Ambulatory Care Pharmacy Service Erwin Martinez Faller 1 , Francisco Perlas Dumanig 2 , Rami Maher Delli 2 , May Florence Dela Cruz-Bacayo 1 , Lai Siew Mei Pauline 3 1 School of Pharmacy, Management & Science University, Shah Alam, Malaysia 2 Faculty of Language and Linguistics, University of Malaya, Malaysia 3 Department of Primary Care Medicine, University of Malaya, Malaysia METHODOLOGY To carry out the study, 10 conversations between pharmacist and patient were recorded during counselling and dispensing of medication. All the conversations lasted for a minimum of 10 minutes and a maximum of 30 minutes over a one-month period from February 2, 2015 to February 27, 2015. The conversations were conducted after the pharmacists, doctors and patients agreed to participate in the study. A letter of consent was given to them as a proof that they agreed to take part in the study before the conversations were recorded. The data collection for this study is experimental since this study is an intervention in the ambulatory care. In this, the setting for data collection was not the normal practice in which the patient goes to the doctor’s room first for consolation then he went to the pharmacy for medication dispense. In this study, all the participants (pharmacists, doctors and patients) were instructed on how the procedures of the data collection would be. All the recorded conversations were transcribed using Dubois’ transcription convention. RESULTS AND DISCUSSION The findings of the study show that pharmacists and patients prefer to use English in most conversations. However, it is also evident that the use of other languages such as Malay, Chinese and Indian (Tamil) were used according to the ethnicity of the patient. Despite the choice of English and other local languages, one emerging language pattern was observed and it was through code switching from English to other languages. The occurrence of code switching happens because most medical terminologies have no translation in any local languages. The language choice of pharmacists and patients are seen to be effective when counselling the patient because they are able to understand each other. It also shows that patients become more interactive and have clearer understanding about the medication when local languages are used during the conversation. Therefore, accommodating the language of the patient helps in making the counselling successful and eventually minimizes the medication errors. It is also found that during the counselling and dispensing of medication both pharmacists and patients employ various accommodation strategies such as approximation, interpretability, interpersonal control and discourse management strategies. ABSTRACT Language choice and accommodation strategies are two essential elements in pharmacist-patient interaction in Ambulatory Care Pharmacy Service. This study argues that in pharmacist and patient interaction, the choice of a language contributes in setting a patient-centred care in achieving medication safety during counselling and dispensing of medication. However, this study further examines how the accommodation strategies are used during the conversations (counselling and dispensing session). This study uses the Communication Accommodation Theory (CAT) as its theoretical framework which explains that in pharmacist-patient conversation there is a tendency for both interlocutors to converge or diverge in conversation. Such convergence and divergence in conversation are seen to be influential in maintaining the medication safety and achieving optimum health outcome to patient. To carry out the study, 10 conversations between pharmacist and patient were recorded during counselling and dispensing of medication. All the conversations lasted for a minimum of 10 minutes up to 30 minutes. The findings of the study analyses the occurrence of language choice in conversation and the emergence of the various accommodation strategies used such as approximation, interpretability, interpersonal control and discourse management strategies. INTRODUCTION Language choice is a careful selection of a word, phrase, clause or sentence of another language within the speakers’ linguistic repertoire. For bilinguals, the occurrence of language choice seems natural, automatic, and unplanned (Coulmas, 2005). However, it happens to mono-dialectal speakers who also face a wide range of linguistic choices (Coulmas, 2005). Language choice also occurs even in the medical context particularly in multilingual countries like Malaysia where pharmacists frequently interact with patients who speak different languages. Therefore, being multilingual is beneficial but sometimes can cause of misunderstanding between the pharmacist and patient. Such misunderstanding may result to medication errors. Medication errors are considered to be one of the major problems that healthcare providers try to minimize or avoid (Johari, H. et al., 2013).Statistics reveals that 10% of the patients in the world reported that they experience medication errors (Rothschild et al., 2005). In Malaysia, there were 2,572 cases of medications errors reported and it created an adverse drug event (ADE) to the patients in 2009 (New Straits Times, 16 March 2010; Maziah, A., et al., 2012; Johari, H. et al., 2013). It is therefore the focus of this paper to examine how language choice contributes in achieving medication safety during counselling and dispensing of medication. Furthermore, this study analyzes the accommodation strategies used during the conversations (counselling and dispensing session). The Communication Accommodation Theory (CAT) is used as the theoretical framework of this study which explains that in pharmacist-patient conversation there is a tendency for both interlocutors to converge or diverge in conversation. Such convergence and divergence in conversation are seen to be influential in maintaining the medication safety and achieving optimum health outcome to patient. Convergence is an attempt to build solidarity and conformance with the other speaker while divergence is an attempt of not conforming to the speech partner. Other interlocutors are looking for differences in others. The concept of Communication Accommodation Theory (CAT) was expanded and applied to family communication. Harwood, Soliz, & Lin (2006) proposed that there are different strategies in family communication, i.e. approximation accommodation strategies, interpretability accommodation strategies, discourse management accommodation strategies and interpersonal control accommodation strategies. Harwood, Soliz, & Lin (2006) described these four strategies when analyzing different aspects of accommodation in communication. CONCLUSION AND RECOMMENDATION From the findings of the study, it can be said that language choice plays a crucial role in pharmacist and patient interaction particularly during counseling and dispensing of medication in order to maintain the medication safety. It is recommended in this study that pharmacists should be familiar with the mother tongue of the patients and must be able to speak the language so it would be easier for them to interact. However, in the case of those patients who are proficient in the English language, code switching is seen to be an effective tool in the conversation. In addition, it is also recommended that certain accommodation strategies must be employed by the pharmacists during the counseling and dispensing in order to make the conversation successful. REFERENCES American Academy of Orthopaedic Surgeons (AAOS). (2000).Patient-physician communication. Copyright December 2000 American Academy of Orthopaedic Surgeons. Academy of Managed Care Pharmacy (AMCP). (2010). Medication errors. The Academy of MaŶaged Care Pharŵacy’s CoŶcepts iŶ MaŶaged Care Pharŵacy http://www.amcp.org/WorkArea/DownloadAsset.aspx?id=9300 Bird, J., et al. (1993). Doctor-patient interaction and communication. World Health Organization (WHO), Geneva, 15-18 June. Byrne, P.S. and Long, B. (1976). Doctors Talking to Patients: a Study of the Verbal Behaviours of Doctors in the Consultation. London: Her Majesty’s StatioŶery Office. CE online (2010). Communication Skills for Effective Patient Counseling. [ONLINE] Available at: [Last Accessed 15th March 2014]. Chewning, B. a. (2011). Concordance between observer reports and patient survey reports of pharmacist communication behaviour. Research in Social and Administrative Pharmacy, 276. Retrieved from https://www.dropbox.com/sh/77a04oad14nglzd/jbaezngaiw/Observers%20report%20and%20p atient%20survey%20report%20of%20pharmacists.pdf. Correspondence: erwin_martinez@msu.edu.my View publication stats View publication stats