The English speaking world has a long tradition of immigration. Consequently, in the UK, USA and Australia, there are many residents who speak English less than fluently. This means that to access medical services they are in need of a specialised medical translator or interpreter. Most patients take it for granted that once they approach a doctor or hospital and describe their specific ailment or symptoms, a line of treatment that is appropriate to their condition is then prescribed. However, things are not always that simple: with non English speakers communication is a key element, and unexpected complications may arise if the patient or his family is unable to clearly explain the exact nature of the patient’s condition and the accompanying symptoms. The situation could be even more precarious if it happens to be an emergency. Setting up and running translating and interpreting services can be time-consuming and costly. However, there are potentially serious consequences when these services are not available or when professional, trained medical interpreters are not used.
There have been many high profile law suits in recent years that could have been avoided if a professional interpreter had been used. The following are examples of when spending a bit of money on an interpreter could have saved millions in settling a lawsuit:
1. The lack of an interpreter for a 3-year-old girl presenting to the emergency department with abdominal pain resulted in several hours’ delay in diagnosing appendicitis, which later perforated, resulting in peritonitis, a 30-day hospitalization, and two wound site infections;
2. A resident’s misinterpretation of two Spanish words (se pegó misinterpreted as “a girl was hit by someone else” instead of “the girl hit herself” when she fell off her tricycle) resulted in a 2-year-old girl with a clavicular fracture and her sibling mistakenly being placed in child protective custody for suspected abuse for 48 hours;
3. Misinterpretation of a single Spanish word (intoxicado misinterpreted in this case to mean “intoxicated” instead of its intended meaning of “feeling sick to the stomach”) led to a $71 million dollar malpractice settlement associated with a potentially preventable case of quadriplegia;
4. In the United States where Pharmaceutical Companies are required by law to translate prescription instructions, a recent study tested the translation programs (yes…programs) used by pharmacies and found that over half of the prescriptions produced contained serious errors. These errors pop up on real prescriptions all the time: “By mouth” is changed to “by little,” “two times” is changed to “two kiss,” and in one spectacularly disquieting case, the instructions for blood pressure medicine caused a man to take it 11 times a day instead of once because “once” in Spanish is “11.”
Another recent study, conducted at two American pediatric Emergency Rooms and published in the Annals of Emergency Medicine, found that potentially dangerous mistakes, like giving the wrong medication dose, were about twice as likely if there were no interpreters or if the translator was an amateur. Studies have found that patients prefer to have an interpreter available, and that it improves care and cuts costs by avoiding unnecessary tests and other mistakes. When an individual such as a family member or a bilingual member of the hospital staff was used (not a professional interpreter), 20 to 22 percent of their translation errors were potentially risky. Errors are least common when professional interpreters with 100 hours of training or more are used. In these cases, only two percent of their translation slips had the potential for doing the child harm.
The most common interpreter errors that were listed in the study were as follows:
1) Omission: (52%), in which the interpreter left out an important piece of information;
2) False fluency: (16%), in which the interpreter used words or phrases that didn’t exist in a specific language;
3) Substitution: (13%), in which a word or phrase is replaced with another word or phrase of a different meaning;
4) Editorialization: (10%), in which the interpreter’s opinion is added to the interpretation;
Addition: (8%), in which a word or phrase is added by the interpreter.
Omissions are almost always caused by the cognitive pressures and stress in interpreting. According to interpreting studies theorists, in virtually no other profession does one undertake a similar cognitive load as in interpreting. “Interpreters are under a considerable amount of pressure in their job and there are a number of areas of concern […] work could be organized to take many of them into account, although some are less amenable to change (Cooper et al. 1982: 104)”. When an interpreter is working simultaneously, it is possible to fall behind when trying to reformulate the message into the target language. Different languages have different structures, and interpreters working simultaneously often have to wait until the speaker has finished their sentence before they can start speaking. When an interpreter is working consecutively, they have to take notes and rely on their memory to remember everything that was said while they are interpreting the message into another language. In both modes of interpreting, this means that occasionally a part of the message is omitted. Professional interpreters are trained to deal with all of these issues. They have skills that allow them to anticipate what is going to be said in simultaneous interpreting and also have worked on their cognitive skills to be able to divide their attention between listening, translating and speaking. In consecutive interpreting, professional interpreters are equipped with note-taking skills as well as memory training.
In addition, vicarious trauma can affect interpreters as well. The part of the brain that controls emotions, the limbic system, temporarily overrides all other brain systems when an emotional event is taking place. The left side of the brain, which controls language, shuts down and the right side of the brain takes over. Therefore the interpreter may struggle with finding the appropriate words to interpret the client’s experience.
Therefore, to provide the best and safest services possible for patients, the following is recommended: always use a professional interpreter, preferably one that has been trained specifically for interpreting in a medical setting. This normally means that they will possess a DPSI (Diploma in Public Service Interpreting) in Health. Other DPSI certified interpreters or interpreters with a postgraduate degree are also well trained and professional.
We have some basic tips on how to get the best out of your interpreter. For a more in-depth look at how interpreters and medical professionals can work together more efficiently to provide excellent health care service for all, please wait for our next blog! If you have any tips or suggestions, we’d love to hear from you!