Miscommunication increases the risk of medical errors, inappropriate treatments, emergency room visits, and unintended consent. Ideally, whenever there are language barriers between patients/families and providers, a trained medical interpreter should be made available to assure the clearest possible exchange of important information. A medical interpreter is a trained healthcare specialist who works with spoken language, often mediating between two languages in both directions. Understanding the nuances of two languages requires understanding the culture behind each language. Qualified medical interpreters have extensive knowledge of medical terminology as well. It is common in hospital and clinic settings for telephone interpreter services to be used, but in emotionally-charged conversations it is usually best to use an in-person interpreter if one is available. Unfortunately, trained medical interpreters are unavailable in many private practice settings. The expense is prohibitive for these small businesses. When professional interpretation is not possible, arranging for the family to bring a relative or friend as an interpreter is the next best option. Keep in mind these key points:
In healthcare settings where interpretation services are available, it is surprising how often patients/families refuse interpreter services when it is clear to the provider that language barriers are going to hinder communication. It is important to offer interpreter services whenever a key decision maker is unable to understand English well enough to participate in a conversation. For example, the patient may be fluent in English, but the spouse speaks only their native language. There are many reasons interpreters may be refused by an individual, but often the refusal is a manifestation of shame. People don’t want to reveal a lack of necessary fluency. In some cases, there are privacy concerns at play if an ethnic community in a city is small and close knit. People do not want private family matters spread through their community, and anonymity may be very hard to protect. Patients are sometimes not comfortable with interpreters because of gender differences (women prefer female interpreters; men prefer male interpreters) or political/ethnic differences (for example, some Amharic- speaking Ethiopians are not comfortable with Oromo interpreters, some Oromos with Tigreans, and so forth). Because of these differences, patients often feel they cannot express all their needs and may not trust treatment plans and medications prescribed. (Molakign, 1996)
- The family should bring someone whom they can trust with confidential medical information. Be sure to explain this prior to the appointment.
- A representative from the community is sometimes more reliable during an exchange of medical information.
- Be sure parents understand that young children should not be used to interpret in medical settings.
Cultural Differences in “Truth Telling”
Relying on untrained interpreters has risks, and healthcare professionals need to take extra care to ensure clear communication.There are strong cultural preferences about giving patients “bad news.” Feeling protective, a family member may use their role as designated interpreter to prevent certain truths from being revealed. Similarly, it is not uncommon for family interpreters to withhold or change information to avoid conflicts. These are key reasons a representative from the community is sometimes a better choice for exchange of medical information.Refusing Available Interpreter Services
Vital Tip! In situations where it is obvious an interpreter will be needed, start by explaining: “Medical talk is complicated. Sometimes it is hard for me as the doctor to make sure I am being clear. Your English is very good, but an interpreter will help me!” (This approach helps people save face.)
Use Teach-Back
With or without the use of interpreter services, people should always be asked to explain what they have understood about a medical condition, prognosis, or course of treatment. This is usually called “teach-back.” Even with patient-centered care as the ideal in U. S. healthcare today, physicians may still be viewed as authority figures by people from societies that emphasize status differences. In some of these cultures, it is not acceptable to ask authority figures questions. Even when they do not understand or agree with what is being said, patients and family members may nod and smile to please a doctor. If someone can’t explain back what they have been told, it reveals a lack of real understanding. Teach back is also extremely important to help address low health literacy in patients and families from all cultures, including mainstream American culture. No matter how busy healthcare professionals may be, nothing is more important than creating a safe environment for honest discussion to unfold. Hurrying through conversations with patients too often leads to medical errors, ER visits, and patient dissatisfaction. Planning for ways to address language barriers effectively will save time in the long run and improve health outcomes. References 1. A. Molakign. (1996) EthnoMed. Retrieved 12/9/2014 at https://ethnomed.org/culture/ethiopian/copy_of_ethiopian-cultural-profileOvercoming Language Barriers and Resistance to Interpreter Services
Written by Marcia Carteret, M. Ed. © 2014. All rights reserved.
