Inside Medicine: A growing language barrier in medicine

For 90 minutes, Sylvia and her 16-year-old English-speaking daughter sat in the clinic exam room waiting for an official Farsi hospital interpreter to arrive.

This wait was despite the fact that one of the clerks at the check-in desk spoke Farsi fluently and gladly offered to translate for us. Every 20 minutes Sylvia would come out of her room and ask if the interpreter had arrived. The problem was with new federal rules: Only "certified" hospital translators can be used in patient care.

While the rules that require the use of officially trained translators are very clear, the data on their benefit is mixed. There are studies that show that more communication-related errors occur in non- English speaking patients, and their follow-up care is also poorer than for English speakers. There are also individual cases in which poor medical communication has made the news.

For example, Willie Ramirez came to a hospital complaining of "intoxicado" and the doctors diagnosed a drug overdose. In fact, he had a brain bleed. The problem is that in Spanish "intoxicado" can simply mean feeling dizzy and confused, not intoxicated. The Ramirez family sued and won $71 million.

One report claims that more than 3,000 deaths are the result of communications breakdowns. It's even worse for care involving children.

Since the creation of the first American hospitals 200 years ago, doctors have managed to provide care to those who spoke English poorly or not at all by using hospital staff members and family. Then came phone translation services and, more recently, video tele- medicine translation.

I find the phone and video services a hassle. Patient care is episodic and takes place in stages: check-in, history taking, the physical exam, then a wait for lab results, and finally termination and discharge with explanations of diagnoses and patient instructions.

The translator, on the other end of the phone or video, needs to be available for all phases. It is no surprise, then, that official translators require enormous hospital or clinic resources. It is also no surprise that this is an unfunded mandate, meaning that the rule is clear and must be followed, but there is no one to bill for the expense.

Do hospital-based translators allow for better care?

In some ways they certainly do. They allow clearer communication by having a trained person translate exactly what the doctor or patient says without paraphrasing or summarizing.

Translators also improve confidentiality by taking the family out of the middle of communications such as giving a patient bad news about a cancer or talking about topics such as a sexually transmitted disease or unwanted pregnancy.

But with patients at our hospitals speaking more than 60 different languages, it is not possible to provide translation services for everyone. In these cases telephone or telemedicine is the next best thing.

Finally the Farsi interpreter arrived and we could begin the clinic visit. At the end of the visit, Sylvia felt strongly that she would have preferred to use her daughter or the front desk clerk to save time.

But she acknowledged that for other people or other problems it is better to have translation services available.

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