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In an increasingly multi-ethnic society, virtually all doctors now treat patients with limited English. Google Translate is (as yet) only up to quite simple communication; using family members has serious limitations; and knowing how to say ‘Where does it hurt?’ in five languages won’t really cut it in an age of shared decision making, so inevitably we often end up relying on interpreters.
Every doctor probably has a few horror-stories of mistranslations, misunderstandings and mishaps. I remember the time I walked away from – as I fondly imagined – consenting a patient for a procedure only for the interpreter to say brightly, ‘And what is ‘anaesthetic’?’ Or the occasion when an interpreter fainted dead away at the moment of delivery of a sick baby, and had to be dragged out of the room to make way for the resus team.
One episode in particular made an impression on me. I was asked to go and talk to the parents of a child who’d had neurosurgery the preceding day. To be fair, the registrar who sent me didn’t know what they were dropping me into: they’d spoken to the family post-op and explained the outcome, not realising that the politely-nodding couple were struggling to follow.
Although they had some English it was far from fluent, so we got a telephone interpreter. And only then did it become apparent that among the things they hadn’t understood was that the surgery had failed, and their child was permanently blind.
This is not news you want to be giving unprepared, as a junior, through a telephone service, but there was nothing for it. Naturally the parents were devastated, and the father in particular became almost hysterical.
His speech grew faster and faster, with barely time for the interpreter to translate before he was shouting again. Why had we done this? Why hadn’t we taken more care? How could the baby ever have a decent life now?
In the middle of his tirade, the phone suddenly went dead. As if this encounter wasn’t enough of a disaster already, I thought.
Then a minor miracle happened. The father looked up and met my eyes for almost the first time since I’d entered the room. He took a deep, shuddering breath. And he calmed down. We continued to talk: taken slowly, and with plenty of checks of understanding, it turned out we could cover a good deal of ground in English. The parents were still desperately sad, but the tension and animosity had gone out of the room.
Good medical interpreters are hugely valuable and we couldn’t do without them. It’s worth remembering, though, that a third party – even a much-needed, highly-professional one – can drastically alter the dynamic of a consultation.
By the Secret Doctor. Read the blog and follow @TheSecretDr on Twitter and on Facebook
This is happening everywhere. I have recently seen a 40 something years old patient who is now wheelchair bound and incontinent due to unbelievable mismanagement when the patient with Cauda Equina syndrome was not operated on for 7 weeks . A dural tear happened during surgery and patient was not told about it and they found out few years later when I told them about this complication . Patient is now in severe neurogenic pain , incontinent , unemployed , financially ruined and has major psychological problems and on narcotic and neuropathic analgesia and no cure expected .
It all begs the question How much stress per day can a doctor take ?
This shows that high quality interpreting is needed for good communication. It may be extremely difficult to access in the appropriate language for emergencies. The Institute of Translation and Interpreting uphold a code of conduct for good standards.
As always there is no mention of the responsibility of the patient to speak the language of the country where he or she resides! Clearly it is putting them at a risk that they might be able to ameliorate.
Nor does this mention or refer to the difficulty that patients face who are native English speakers when being treated by doctors whose English language skills and or confidence in the colloquial and vernacular is inadequate.
These are both ‘Elephants in the room’
@ Anonymous “Anonymous
As always there is no mention of the responsibility of the patient to speak the language of the country where he or she resides! ”
It always makes me laugh when British people talk about learning the local language. Go to France and Spain and count how many brits speak the local language let alone ‘colloquialisms and vernacular.’
How about if they’ve just come into the country? Are they supposed to not seek medical treatment until they can write a phd level thesis in English?
You sound xenophobic and ignorant.
I agree with "As always there is no mention of the responsibility of the patient to speak the language of the country where he or she resides! Clearly it is putting them at a risk that they might be able to ameliorate."
I read one comment that it is the patient responsibility to speak English in America. They must have never been out of country to place that did not speak English. Wake up!! I have been there, both trying to get information from a patient who does not speak English and I have been in a foreign country dealing with people that feel that I should speak their language if I am in their country. I once experienced a gentleman that acted as I was dump for not speak his language and would not help with any translation situation. I later found out that he actually spoke 5 different languages fluently, including English and he would not help our struggling. All we can do is keep on trying and remember that the Art of Medicine is treating patients and other as if they are family. If you would not treat them like you would a family member, then you are not in the right profession.