Patient Engagement

When Words Are Not Enough

Transcription is an almost inevitable part of qualitative research. Transcription (of a sort) is also an inevitability in patient care. Words are spoken and then translated from the live, animated practice of communication to a written, text-based representation of those words, a static version that can be easily shared, analyzed and archived. If it isn’t written down, it didn’t happen…right? That’s certainly what health care professionals are taught in their educational programs.

A few weeks ago, as part of our Queer, Queering and Questioning (QQQ) Project, we completed some supplemental individual interviews with a few healthcare providers that had participated in one of our focus groups. We interviewed Mary, a psychotherapist who provides mental health counseling to LGBTQ community members living in rural and remote areas. She counsels via SKYPE – an Internet-based video chat service that provides face-to-face communication between 2 (or more people).

According to the time signature on the video and audio recordings of Mary’s individual interview, we spent 17 minutes and 19 seconds chatting with Mary. About 3 minutes of that time was setting up and testing our equipment, and ending the session and saying goodbye. So the time we spent on the interview itself was about 14 minutes and 19 seconds. We loved Mary’s interview. We loved speaking with her; we loved the stories she told. We loved the way she animated what she said, her tone of voice, her facial expressions, and her hand gestures. It was a thick, rich interview. We instantly submitted her audio recording for transcription. We eagerly awaited the written version so we could deconstruct, analyze, savour, and digest Mary’s words even more deeply. We were looking forward to re-experiencing her stories of her own experiences of health care, the needs of her clients, the successes and the failures, and all the nuanced understandings of high quality healthcare provision that she shared with us.

When the transcription arrived, we were, well… flabbergasted. Only 2 and half pages, some 800 words, which included 100 words of questions from us to Mary. The stories seemed, short, flat, factual… not at all the way we remembered them. There must be an explanation…

Included in the transcription were notes from the transcriptionist indicating there were 5 – 6 places where there was an issue with the recording that made it difficult for them to decipher what was said. We were certain that due to these technical issues, the transcriptionist may have left out pieces of the stories or details of the experiences that Mary shared during our interview. Our faithful research assistant, Drew, compared the audio recording and the transcript for us and we were disappointed to find out that nothing significant was missing. The parts of the recording that the transcriber left out involved someone coughing, the two of us talking at the same time, a section of the recording that was muffled – and that seemed to say “let me think about that…”, a noise made when someone moved a chair… nothing related to the stories or information shared by Mary.

What Mary’s stories were missing in these transcripts, were… well… Mary. It was the feelings, emotions and connections that Mary shared through her non-verbal communication, through her tone and intonation, that made these stories so compelling. It was shocking to feel so let down by the text-based translation of Mary’s experiences. But it was also very affirming for us. One of the goals of our QQQ project is to use digital media as a means of sharing stories using a first voice perspective, allowing the people whose stories we were drawing on to remain firmly connected to these stories. These digital stories will be used to help create a digital narrative curriculum on LGBTQ healthcare to be used in a variety of healthcare education programs. We believed when we started this project that it was this affective dimension of the stories that would help learners truly learn about the needs of LGBTQ community members and the possibilities of providing effective, passionate and patient-centred care.

We still need the transcripts – they are helping us locate the most important pieces of these stories, but we feel like we have made a case for digital stories as not only an important piece of the puzzle, but an essential aspect of learning. Words are extremely important, but sometimes words are just not enough.

– Tara La Rose & Albina Veltman, October 2015

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