Interpreters_in_the_Medical_Profession

Interpreters in the Medical Profession Debra L. Reed Rasmussen College ENC1101 English Composition Larkin Corvin May 21, 2010 Interpreters in the Medical Profession Who would you want translating for you in a medical emergency' Although it is becoming more commonplace to have in-house translators, not all medical facilities have them. Some hospitals still rely on relatives or bilingual staff but may have an interpreter on call. Not having an interpreter on call affects not only the doctors and patients but loved ones as well. Considering the cultural diversity of the population in the United States, trained interpreters must be used rather than relying on medical staff and family members who might be unreliable or inaccessible and may leave out important information needed for a correct diagnosis. When trained interpreters are not available, bilingual staff and family members may be called upon to translate. The chances that miscommunication will occur have now increased by using untrained, and therefore, unreliable translators. Since a correct diagnosis relies on accurate information, which might include personal and sensitive issues, it is critical that all information is relayed to the physician. If a family member is translating, the patient or the family member may be too embarrassed to relay that information to medical staff. In the some Asian cultures, they avoid embarrassment so as not to “lose face.” This includes embarrassment for others. Dignity and self esteem must be maintained. This point is illustrated when a nurse was explaining to a Filipino patient, using the patient’s husband as a translator, about her medication. The couple smiled and nodded like they understood. Luckily the nurse wasn’t convinced that they comprehended all of the information she said so she asked them to explain what she just told them. The Filipino couple was unable to explain what they had just heard. It seems the couple pretended to understand as not to embarrass the nurse for not explaining it well, as well as to preserve their own dignity for not understanding her instructions (Galanti, 1997). Complications like this are common according to a report by the Center for Community Health Research and Action at Brandeis University which stated that “more than one-fourth of limited-English patients without interpreters did not understand medication instructions” (Modern Healthcare, 2004). Luckily, they discussed the instructions and information until the nurse was sure they understood. An interpreter who spoke Filipino and was aware of their cultural values could have avoided the embarrassment for the couple. On the other hand, information may be omitted because the translating family member just refuses to translate. In this instance, an Arab woman was being informed on health teaching material and the mother- in-law was translating. But when the part concerning birth control was reached, the mother refused to translate. In her country, large families were important Galanti, 1997). Although this was not a medical emergency, situations like this do arise. The interpreter could just as well have pretended to relay information to her daughter in law. The health professional has no idea if the translator is accurately relaying the information or even if pertinent information is omitted on purpose. A trained interpreter will make sure that all information to the patient is communicated. Dealing with a medical situation is stressful enough, but having to maintain your demeanor while a loved one is in pain or dying adds additional pressure to both the patient and loved one. In one incident, “Eugenia Chien , who was 17 years old at the time, had to tell her grandfather in Mandarin that he was in the final stages of liver cancer. ‘If it was that traumatic for me then I wouldn’t want someone younger going through that,’ she said” (Associated Press, July 24, 2006). The patient should have been told the news first though a trained translator. There would then be no doubt that the correct information was given and the patient would then have time to adjust to the information before seeing loved ones. In another instance, the mother of a dying baby had to take time to translate for her husband. “It wasn’t my job to interpret; that was taking away the few moments of her life that I had with her,” said Rayes. “It was an unfair burden at a time of true crisis in our lives” (Associated Press, July 24, 2006). In this situation, added stressed was put upon a grieving mother. Having a translator present would have eased her burden so she could spend the last few moments bonding with her child. Situations like this arise and are avoidable if trained translators are available in all healthcare facilities. Not knowing the family dynamics can also cause difficulties when a family member translates. A patient was terminally ill who spoke no English, and one of her children offered to translate. Treatment continued although there was no hope for recovery. The doctor was concerned and called in someone who spoke the patient’s language. It was then revealed that the family’s decision to continue treatment was because an out of state family member was threatening to kick the interpreter out of the family. Once this family drama was uncovered, the husband and children were able to do what they thought was right for the patient. (Todays Hospitalist, 2010) Being aware that not all family members agree or get along should reinforce the need for trained and impartial translators. Since the prime function of the medical staff is to attend to their medical duties, they may not be available to translate. Even if they happen to be available, they might only be trained in English in regards to medical terminology and be unable to explain medical terms in the patient’s language. Also, the medical personnel may not be fluent in their second language. One way this might inadvertently cause difficulties for the patient is by using words that have different meanings in another region. One example of this is the incident of a Filipino nurse who cared for a premature Mexican baby. The mother of the ill infant got along well with the nurse. Inexpiably, one day the nurse requested to be replaced. The mother found another Spanish speaking nurse to find out what the reason for her nurse’s abrupt departure. The mother was told that she had been overheard talking about a “puto” which to her former nurse meant male prostitute. Her previous nurse thought the mother to be unfit and her visits with this prostitute to be a factor in the baby’s illness. In the mother’s country, puto means rice cake (Galanti, 1997). Once the situation was explained, the mothers former nurse came back to care for the mother and ill infant. The miscommunication between her and her nurse added stress to a mother whose primary concern is for her ill child. This situation could have been avoided if a trained translator had been present who was fluent in the mother’s language. Another important reason to have trained interpreters available is the lack of patient doctor confidentiality that happens when family or loved ones translate. Patients will hold back sensitive information which affects the quality of health care received. On the other hand, patients may be open and relay the personal information which is not information that the family member needs to know. By using trained translators, the patient’s right for privacy will be maintained. Not only is it important to have trained translators available in instances of physical health but also in the area of mental health. In many cultures having a mental illness is seen as shameful and private. Patients and family members may be unwilling to discuss their symptoms or diagnosis in front of each other. Maintaining patient confidentiality in this area is of utmost important. The use of trained interpreters in mental health issues, instead of family members, must be implemented. Diversity not only entails different languages but the deaf as well. Even though both the deaf person and untrained professional may speak English, miscommunication can occur. An incident occurred when a nurse told a young gay deaf man that his HIV-tests came back positive. The young man could read lips and understood, but the man didn’t return for his follow-up visit. The mix up was in the translation. In the hearing world, if the test for a disease is positive, then the disease is present. In the deaf world, positive means good meaning that the test results were good news (Galanti, 1997). A trained interpreter for the deaf would have known this and made sure the patient understood and would come back for treatment. Patient care is also affected when communication between the patient and doctor is inhibited by using loved ones or bilingual personnel. Some of these side effects include: * Decrease in follow up visits * Dissatisfaction with medical treatment * Improper use of medication * Substandard medical care * Misdiagnosis * Increased costs * Increase in diagnostic testing * Use in mainly conventional treatments * Increase in risk factors It has been shown that not having a trained interpreter available can cause miscommunication between the doctor and patient. Bilingual staff and relatives may not be fluent in their second language leaving room for error in their translations. Family members may leave out embarrassing information or have their own agenda in mind while translating. When family members are needed to translate during an extremely emotional situation, such as death, added stress is put on the loved one, leaving room for error. Even if the end result of miscommunication may be minor, such as hurt feelings, having untrained interpreters can negatively impact a patient’s quality of life. So, would you want a relative or loved one translating for you in an emergency' References Associated Press (2006). Doctors, patients struggle with language barrier, MSNBC. Retrieved from http://www.msnbc.msn.com/id/13924005/ Fitzgibbons, S. Say What' (March, 2010) Issues with hospital interpreters. Today’s Hospitalist. http://www.todayshospitalist.com/index.php'b=articles_read&cnt=972 Galanti, G. (1997) Caring for patients from different cultures: Case studies from American hospitals. Retrieved from http://www.netlibrary.com/Reader/ Greenbaum, M., & Flores, G. (2004, May 3). Lost in translation. Consumer Health Complete, 34(18), 21-21. Retrieved from http://search.ebscohost.com/ login.aspx'direct=true&db=cmh&AN=13164065&site=chc-live Jacobs, E. A., Shepard, D. S., Suaya, J. A., & Stone, E. (1994, May). Overcoming language barriers in health care: Costs and benefits of interpreter services. American Journal of Public Health, 94, 866-869. Retrieved from CINAHL Plus with Full Text database. (2004201261) Moreno, M., Otero-Sabogal, R., & Newman, J. (2007). Assessing Dual-Role Staff-Interpreter Linguistic Competency in an Integrated Healthcare System. JGIM: Journal of General Internal Medicine, 22331-335. doi:10.1007/s11606-007-0344-8.