Medical Interpreting: What You Need to Know

What is medical interpreting? And why is it important?

Medical interpreters interpret conversations between doctors, caretakers, clinicians, and patients in a medical setting.

Medical interpreting is a specialized discipline. Having a casual understanding of both languages being spoken does not make someone a good medical interpreter. At a minimum, they also need a basic understanding of medical terminology in both languages, and an understanding of cultural factors that could influence communication between doctors and patients.

Study after study has found that “ad hoc” interpreters make more mistakes than professional medical interpreters.

For example:

• A 2012 study by the American College of Emergency Physicians found that the error rate was far lower for professional interpreters that ad hoc interpreters: 12 per cent versus 22 per cent.
• The same 2012 study found that the error rate dropped to 2 per cent amongst medical interpreters with over 100 hours of training.
• Ad hoc interpreters are not only more likely to make mistakes, but the mistakes they make are also more likely to compromise patient care. A 2003 study from the American Academy of Pediatrics found that 77% of errors committed by ad hoc interpreters were likely to be “errors of potential clinical consequence,” versus 53% for trained medical interpreters.
• According to a 2007 study published by the International Journal for Quality in Health Care, 52% of the “adverse events” experienced by low English proficiency patients in US hospitals were due to communication errors.
• According to the same study, 49.1% of those adverse events involved some physical harm.

These mistakes can and do affect the care patients receive. 8.5% of the U.S. population reported they were Limited English Proficient (LEP), which a 2011 study linked to difficulty communicating and comprehending medical information from providers, including challenges with written information at the doctor’s office, or reading prescription bottles.

Language access (or the lack of it) can impact the quality of care and patient health in a variety of ways, including the following:

• More frequent missed appointments.
• Less effective consultations.
• Poorer patient experience.

Or, the consequences may be even more dire.

For example, consider the most famous instance of medical interpreting gone awry: the case of Willie Ramirez.

In 1980, Willie Ramirez, a healthy 18-year-old, suddenly collapsed. An ambulance took him to the nearest emergency room. His family thought he might have had food poisoning. However, they were Cuban immigrants who primarily spoke Spanish.

There was no interpreter present. Instead, doctors relied on Ramirez’ 15-year-old girlfriend and his girlfriend’s mother, Concha, to interpret.

As Concha later explained to the Health Affairs journal,

“Since Iberia didn’t speak English, she spoke to the doctor – in English. She wanted to tell the doctor that the hamburger Willie ate made him sick: ‘I say him, doctor the amburger intoxiCAted him.’”

To native English speakers, that sounds like an odd turn of phrase. But as Health Affairs notes, it makes perfect sense if you grew up speaking Spanish in Cuba:

“Among Cubans, “intoxicado” is kind of an all-encompassing word that means there’s something wrong with you because of something you ate or drank. I ate something and now I have hives or an allergic reaction to the food or I’m nauseous.”

Unfortunately for everyone involved, “intoxicado” sounds like “intoxicated.” Willie was treated for a drug overdose, even though he was actually having a brain bleed.

By the time the mistake was discovered, Willie Ramirez was a quadriplegic. The family sued the hospital, which is now on the hook for his care, to the tune of $71 million.

But the money won’t give Willie his arms and legs back. And it can’t erase the unwarranted guilt of his family.

Children are little sponges, soaking up information of all sorts. Language is no exception, and in immigrant families, it’s not uncommon for children to speak English better than their parents. It’s also not uncommon for kids to act as interpreters for family members who are less fluent.

In casual situations, that’s fine. In medical situations, it’s not. Even routine appointments can involve sensitive or important information that children simply should not be responsible for translating.

And of course, in emergencies, the stakes are higher. It’s unrealistic to expect children to perform in a situation where even adults struggle. It’s also unfair.

That’s why Section 1557 of the Affordable Care Act prohibits the use of a patient’s children as interpreters except in “emergencies to prevent imminent patient harm”.

Fortunately, this situation is usually avoidable as long as appropriate language assistance procedures are in place.

Both US and international regulations require that patients with limited English proficiency have access to a medical interpreter as part of regulations that mandate equality of access to health services. Access is required in the following circumstances:

There are three federal laws – The Title VI of the Civil Rights Act of 1964, the Americans with Disabilities Act, and the Affordable Care Act – that require medical providers, including primary care services, to provide oral interpreters and written translated materials to LEP patients.

If there is a failure to meet their needs, LEP patients are well within their rights to sue.

Ethical medical research is based on the principle of informed consent. Trial subjects must understand the risks and benefits of participation.

Obviously, all patient-facing documents and written information about the trial must be made available in the patients’ language to ensure understanding. But interpreters should also be available to help trial staff answer questions, gather accurate data and discuss issues like side effects.

The same regulations that mandate access to interpreters during routine doctors’ visits also mandate access during hospital stays or specialist care.

Of course, during emergent situations hospitals may need to balance the need for timely treatment with the need for language access. However, providing patients and their families with as much language assistance as possible improves patient outcomes and keeps everyone safe.

There are a number of medical interpreting solutions available to help lighten the load of providing interpreting services.

Since telephone interpreters don’t have to travel, telephone interpreting is much cheaper than hiring an interpreter in person.

However, it’s not a panacea. Since interpreters can’t see the doctor or the patient, they miss out on nonverbal communication cues like body language. Also, the experience of using a telephone interpreter for an in-person visit can be confusing for patients, especially the elderly.

Finally, if you’re giving bad news to patients or their families, a disembodied voice on the phone is the wrong way to go about it. Some situations simply require a more personal touch.

Video interpreting is as cost-saving as telephone interpreting. However, the use of video means that interpreters can better understand the situation and better communicate with patients and clinicians alike.

Telephone interpreting and video interpreting both provide fast access to interpreters and a wide selection of languages. But an in-person interpreter is still often the best choice for difficult situations. Any medical interpreting solution worth its salt will make it as easy as possible to connect with an interpreter in whatever way clinicians and patients feel is best.

At K International, we make it easy to expand language access for your patients with a complete suite of medical interpreting options, including in-person appointments with qualified medical interpreters and ASL interpreters. Furthermore, our telephone interpreting and video interpreting service TalkLingua enables you to communicate in over 250 languages 24/7 through professional interpreters. No matter where you are in the world, we can connect you to an interpreter in less than a minute.

For more information, contact us about your interpreting needs today!