Interpreters vs. own mediocre language skills

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LadyGrey

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In theoretical medical school world, we learn that it's always better to have a professional interpreter when a patient speaks another language. In practice, I've yet to see this. I've been in areas with a lot of patients who speak primarily or exclusively Spanish. Most of the doctors have learned some minimal amount of medical Spanish, or if not they grab a nurse or family member to interpret. Just curious if this is what other people have seen, or if in some places interpreters really are used regularly.

I found that much as I think my Spanish is horrible (and it is) it seems adequate enough to get a history, though not good enough to be as thorough in explaining things as I'd like. (Getting consents with a major language barrier is as even more questionable area, though one that as a student I'm not directly involved in, except for looking on and thinking hmm, this is not quite right).
 
I've seen a lot of use of interpreters and the blue phones in clinics and inpatient. On OB/gyn, I was one of the rounds interpreters for some of the students if we didn't have enough blue phones on the floor, and I usually picked up Spanish speaking patients.

I speak enough Spanish that I do fine on rounds, but I don't trust myself to do an entire H&P, so I get an interpreter if I think there's even a slight chance the problem could be complicated.
 
I spent two years in Mexico speaking Spanish. When I came back I had a doctor tell me that no matter how well I spoke Spanish, I would need to take alot of classes to help me communicate effectively in the the Spanish world. I figure that I will slowly pick up on the vocabulary.
 
In theoretical medical school world, we learn that it's always better to have a professional interpreter when a patient speaks another language. In practice, I've yet to see this. I've been in areas with a lot of patients who speak primarily or exclusively Spanish. Most of the doctors have learned some minimal amount of medical Spanish, or if not they grab a nurse or family member to interpret. Just curious if this is what other people have seen, or if in some places interpreters really are used regularly.

I found that much as I think my Spanish is horrible (and it is) it seems adequate enough to get a history, though not good enough to be as thorough in explaining things as I'd like. (Getting consents with a major language barrier is as even more questionable area, though one that as a student I'm not directly involved in, except for looking on and thinking hmm, this is not quite right).

I have minimal Spanish abilities, and try to us it whenever I can. Many hospitals I have worked at have an on-call interpreter who will come if paged. Others require you to use the translator phone.

In almost all cases, I will go in and try to take a history myself. If I don't get very far, I'll page the interpreter, but if I get enough info, I'll go ahead and present the patient.

I hate the translator phone, and will try to never use it if I have to.
 
I took Spanish in both high school and college, so I at least have a working knowledge of the language. Even though an interpreter probably could have communicated better to the patient, I usually did the H&P myself in Spanish just because it would have taken time for the interpreter to come down. We also didn't have any of the special translator phones in the clinics or hospitals I worked in.
 
My criteria is what is best and safest for the patient. If you believe that you can obtain an accurate history and physical exam with your skills, then do so. On the other hand, if you are doing something like obtaining an operative/procedural permit where you have to thoroughly explain the risks and benefits of an invasive procedure, you definitely need to use an approved interpretation service unless you can legally prove that your language skills are more than adequate. If something goes wrong, and you find yourself having to defend your actions in court, you can't defend "it took too much time for the interpreter to get there" or "we ran out of phones" etc.

I have some "pigeon spanish" skills but I always use an approved hospital interpretation service for anything that could have potential legal ramifications. Again, taking an accurate H & P could have this potential. If your skills are good, and you know that you can defend them in court, go for it. I also note on the chart the name of the service or the person who served as an interpreter. Again, with the high potential for litigation in these areas, you need to be sure that you protect yourself.
 
My criteria is what is best and safest for the patient. If you believe that you can obtain an accurate history and physical exam with your skills, then do so. On the other hand, if you are doing something like obtaining an operative/procedural permit where you have to thoroughly explain the risks and benefits of an invasive procedure, you definitely need to use an approved interpretation service unless you can legally prove that your language skills are more than adequate. If something goes wrong, and you find yourself having to defend your actions in court, you can't defend "it took too much time for the interpreter to get there" or "we ran out of phones" etc.

Be weary of judging this for yourself. In general, the law mandates that patients in acute care settings receiving either Emergency or Psychiatric services receive "competent interpreter services". This is defined as "". . . interpreter services performed by a person who is fluent in English and in the language of a non-English speaker, who is trained and proficient in the skill and ethics of interpreting and who is knowledgeable about the specialized terms and concepts that need to be interpreted for purposes of receiving emergency care or treatment."

Based on this, if you're using pigeon Spanish when explaining diagnoses and treatment options, you are violating the law. Yes, I know it's done a lot. Yes, I have done it myself. But eventually a smart lawyer is going to catch on to the pervasive disregard of this requirement and make a freakin' fortune by suing everyone and their momma.
 
For me, it really varies. For some patients, I have frequently been the person in the room with the best spanish skills and have actually felt quite useful. However, some days I am just off and can't coherently connect with a patient.

I personally hate the translator phones, the people on the other end are really variable. It is good if you know enough of the language to understand what is being said between the interpretor and the patient. On more than one occasion I have had the interpreter take significant liberties and dive in with their own medical advice...which I would never have known if I didn't know enough spanish. Kind of scary when using Swahili translators or something, especially when they seem to be saying A LOT more than I did or I hear back one word after a 2 minute dialogue.
 
I personally hate the translator phones, the people on the other end are really variable. It is good if you know enough of the language to understand what is being said between the interpretor and the patient. On more than one occasion I have had the interpreter take significant liberties and dive in with their own medical advice...which I would never have known if I didn't know enough spanish.

I definitely agree. What's even worse is when the interpreter clearly thinks that you're crazy.

On OB, we had a lot of non-English speaking patients. One of the Chinese-only postpartum patients didn't want to breast feed, but her breasts were painful because of retained milk. So I was told to tell her to put cabbage leaves in the fridge, and then put the cold leaves in her bra, to reduce swelling.

When I told this to the translator over the translator phone, there was a brief pause, then a clearly incredulous "Cabbage leaves???!!!"

He relayed the advice to her, but I don't know exactly what he said. I wonder what he told her, because she just sat there and didn't seem surprised or put off by this cabbage leaves thing. 😕

On more than one occasion I have had the interpreter take significant liberties and dive in with their own medical advice...which I would never have known if I didn't know enough spanish.

What do you do on these occasions? Do you jump in and say, "Uh, that's not exactly what I told you...."?
 
What do you do on these occasions? Do you jump in and say, "Uh, that's not exactly what I told you...."?

I usually say something along the lines of "I'm sorry, I need you to translate exactly what I am saying and what she is saying." Most interpreters are professionals and respond to redirection.

If an interpreter was injecting their own medical advice I would terminate the interview and speak to a supervisor -- that's completely inappropriate and dangerous. Indeed, that's why we dont' use family members.

Anka
 
Do you ever notice that, depending on the language, the phone translators can take 20 minutes to conduct what should be a 1 minute translation, whereas with other languages, it really only takes them 1 minute? Whenever I call the Chinese line, I have no idea what they're talking about for all those minutes! I'll ask them to ask the patient "How they're feeling?" and five minutes later, the translator will say, "fine."

I did peds at a hospital where the vast majority of patients spoke only Spanish. The residents were native Spanish speakers mostly too, and I never saw anyone use a translator. Our school makes us fill out a lot of "communication skills" forms where we're observed dealing with patients and then our skills are evaluated. I speak Spanish but I'm no Don Quixote in that respect. Anyway, during peds I did all my own H&Ps in Spanish with some backup from residents when needed. Because of this, they expected me to do all my "communication skills" exams in Spanish! Ok, I'm a good sport, but that's a little unfair! I'm a LOT more nervous and embarrassed around patients when I know I've just mangled their grammar.

I've never even SEEN a real live translator appear on the scene. Do they exist?
 
In theoretical medical school world, we learn that it's always better to have a professional interpreter when a patient speaks another language. In practice, I've yet to see this. I've been in areas with a lot of patients who speak primarily or exclusively Spanish. Most of the doctors have learned some minimal amount of medical Spanish, or if not they grab a nurse or family member to interpret. Just curious if this is what other people have seen, or if in some places interpreters really are used regularly.

I found that much as I think my Spanish is horrible (and it is) it seems adequate enough to get a history, though not good enough to be as thorough in explaining things as I'd like. (Getting consents with a major language barrier is as even more questionable area, though one that as a student I'm not directly involved in, except for looking on and thinking hmm, this is not quite right).

This is an excellent question and I'm really glad you brought it up.

We were in fact talking about this at one of our ethical work shops the other day. My personal experience has been that 99% of the time when an interpreter is not available, the doctor uses the family member. This is just another example (to me) of how our school teaches high and mighty ethics, yet fails to set the proper example. It basically makes it seem like it's just something we say but give little actual emphasis to in real life.

However, I am probably about the equivalent of a 4 or 5 year old in Spanish speaking abilities (my main problem is the lack of vocabulary at the moment, but I'm working at that), and I also have doubts about whether or not I should interpret. At the hospital I work at, for Spanish speaking patients there are phones the patient can call and have someone interpret/translate for them. However, sometimes even that doesn't go well, as there are huge dialectical differences, and quite frankly I don't think the interpreters always have a vested interest in the patient. I have interpreted before, but I make it clear to who I'm interpreting for that I don't understand something if it so happens. I can take an H &P, but when the patient uses words I don't know, I'm up a creek. So it's probably better overall if the patient uses the phone. I really do think the most important thing is their care, and if I am going to be hindering it (no matter how much I'd like the chance to speak Spanish with them), I probably shouldn't be trying to translate.

This is making me a little nervous, because I will be going to Latin America for a fourth year rotation, and for the first time I will be seeing patients on my own. If we are short on interpreters, I've already been informed that I'm the first person to lose one, so then I will be on my own. I'm just going to practice a lot of Spanish before I go, and then make it clear to the patient that my Spanish is not on the same level as theirs, and if there is something I don't understand, we need to try and put it in different words or else wait for them to see the doctor with an interpreter.
 
We were in fact talking about this at one of our ethical work shops the other day. My personal experience has been that 99% of the time when an interpreter is not available, the doctor uses the family member. This is just another example (to me) of how our school teaches high and mighty ethics, yet fails to set the proper example. It basically makes it seem like it's just something we say but give little actual emphasis to in real life.

To me it just seemed like another example of how people with little clinical experience (but a lot of fluffy ideas about "high and mighty ethics") make blanket rules that do not apply to real life.

I used to translate for my mother all the time, even at doctor's offices. I wouldn't want a stranger to do it for her, when I could do it just as well. Granted, she never forced me to do it, and certainly didn't make me translate for her at the gynecologist, but still - I just wouldn't feel good letting a total stranger translate for her.

Is having a real live translator feasible anyway? We're right next to a Chinatown, so many of our patients on L&D spoke only Chinese (Cantonese or Mandarin) or Vietnamese. If you were a 20 year old woman FOB from China, would you want a strange man translating for you in the delivery room? Heck, if you were a translator, would you want to be "on call" on L&D every night (or every other night if you're lucky) of the week?

This is why I hated those bioethics courses in first year. I wish some of those professors for that class could spend a few shifts in the ED or on L&D. They'd probably change their ideas REAL quick. 🙄

At the hospital I work at, for Spanish speaking patients there are phones the patient can call and have someone interpret/translate for them. However, sometimes even that doesn't go well, as there are huge dialectical differences, and quite frankly I don't think the interpreters always have a vested interest in the patient.

How big are the dialectical differences? 😕 My first Spanish teacher was from Ecuador, I did an internship in Madrid, one of my best friends (non-English speaking) is Mexican, I've met a lot of Colombians, and I've had numerous Mexican and Puerto Rican patients. I could understand pretty much all of them - the Puerto Rican accent is a little hard to understand at times, though.

But I agree - the telephone interpreters have mastered that "detached and objective" thing really well. I hate the translator phone because it must be frustrating to receive instructions and diagnoses in such a detached, emotionless voice.

This is making me a little nervous, because I will be going to Latin America for a fourth year rotation, and for the first time I will be seeing patients on my own. If we are short on interpreters, I've already been informed that I'm the first person to lose one, so then I will be on my own.

Why are you going to be the first person to lose one? 😕
 
To me it just seemed like another example of how people with little clinical experience (but a lot of fluffy ideas about "high and mighty ethics") make blanket rules that do not apply to real life.

I used to translate for my mother all the time, even at doctor's offices. I wouldn't want a stranger to do it for her, when I could do it just as well. Granted, she never forced me to do it, and certainly didn't make me translate for her at the gynecologist, but still - I just wouldn't feel good letting a total stranger translate for her.

So, let me ask you a question. Would you rather have someone who really cares about a patient but has a 5 yr old's vocab translate (but a doctor's intellect, lol) translate or would you rather have the complete stranger over the phone do it?


This is why I hated those bioethics courses in first year. I wish some of those professors for that class could spend a few shifts in the ED or on L&D. They'd probably change their ideas REAL quick. 🙄

Word. I was getting very irritated during a recent "are pelvic exams under anesthesia ethical" discussion the other day. LISTEN, if I'm going to have to pull their uterus out through their vagina, I think a pelvic exam might be warranted.



How big are the dialectical differences? 😕 My first Spanish teacher was from Ecuador, I did an internship in Madrid, one of my best friends (non-English speaking) is Mexican, I've met a lot of Colombians, and I've had numerous Mexican and Puerto Rican patients. I could understand pretty much all of them - the Puerto Rican accent is a little hard to understand at times, though.

It's not the accent, but the vocab differences. Patients use different words for the same meaning, you know? For example, my friend was in Peru last year and she knows Mexico Spanish and they did not understand the word she was using for sweatshirt.


Why are you going to be the first person to lose one? 😕

Just because I will be the only person with any Spanish proficiency seeing patients. The other doctors all have no Spanish skills, so they get the priority for interpreters. Last year we had a shortage of interpreters and I actually had to interpret for a little bit. LOL I remember once I was interpreting for a Gyn complaint and I didn't know how to say "discharge" so I ended up saying "líquido de la vagina?"
But actually one of our regular male interpreters refuses to interpret any female related complaints anyways (he just leaves the room, sigh...), so I guess I was better than him. Cultural boundaries can be a problem...
 
So, let me ask you a question. Would you rather have someone who really cares about a patient but has a 5 yr old's vocab translate (but a doctor's intellect, lol) translate or would you rather have the complete stranger over the phone do it?

I suppose I should be practical and say "complete stranger over the phone," but, in all honesty, I'd probably prefer the person who really cares about the patient.

Using a translator phone never seems to make the patients more vocal and they seem just as quiet as when you were bumbling through the interview.

In any case, the point about my mother was that I hated it when they told us in class that "family members should NEVER translate for you!" I used to do it all the time, and I never felt bad about it. I mean, I understand the concern and all that, but it's not a hard-and-fast rule.

It's not the accent, but the vocab differences. Patients use different words for the same meaning, you know? For example, my friend was in Peru last year and she knows Mexico Spanish and they did not understand the word she was using for sweatshirt.

That's true - although I've encountered that problem generally only in informal settings. In terms of formal, medical settings, the vocabulary is pretty similar, and I haven't had much of a problem.

In any case, a lot of the vocab differences are "inside jokes" among Spanish-speakers anyway, and they tend to know when they're using a local phrase that other people are unlikely to understand. It's like the fact that most Americans know some British words and their American equivalents (ex: cookie = biscuit, elevator = lift, etc.)

It's not much of an impediment, and it should almost certainly not be an impediment to a telephone translator (who is usually a native speaker).

😉 The only word that I avoid using is "coger" since I can never be sure how it will be received by others. In some countries, it means "to catch" - as in catching a bus or a cab. In other countries, it means...something else. Something that might cause you to end up on L&D. 😀

Just because I will be the only person with any Spanish proficiency seeing patients. The other doctors all have no Spanish skills, so they get the priority for interpreters.

Ohhh...eek. That's tough. Good luck on the trip - I hope you have fun! :luck:

But actually one of our regular male interpreters refuses to interpret any female related complaints anyways (he just leaves the room, sigh...), so I guess I was better than him. Cultural boundaries can be a problem...

Exactly. Which is why it irritates me when the medical Spanish club at my school hired an American to teach Spanish. She might speak it well - but can she teach anything about the cultural nuances, and the differences between the Mexican vs. Puerto Rican vs. Colombian cultures? That's just as important.
 
Is having a real live translator feasible anyway? We're right next to a Chinatown, so many of our patients on L&D spoke only Chinese (Cantonese or Mandarin) or Vietnamese. If you were a 20 year old woman FOB from China, would you want a strange man translating for you in the delivery room? Heck, if you were a translator, would you want to be "on call" on L&D every night (or every other night if you're lucky) of the week?

Pff. I could have translated two of the three languages listed above! 🙂
 
Pff. I could have translated two of the three languages listed above! 🙂

Which is why you should come to my hospital...you like to teach med students AND you speak Chinese! 😀

The first delivery I saw on L&D was with a Vietnamese woman, who didn't speak English. Her husband, who was with her, said that he would translate.

Intern: Okay, I see the baby's head! Tell your wife to push!
Husband: Push! Push!
Intern: No, say it in Vietnamese! Tell her to bear down and push!
Husband: Push harder! Push! Push!
Me: No, in Vietnamese! Say it IN VIETNAMESE!
Husband: Keep pushing!
Intern: In Vietna...oh, never mind.

The MFM fellow, who was supervising, was shaking with laughter the whole time.
 
Right now I'm on L&D, so it's a pretty standard set of questions and answers that I'm dealing with. I'd have a lot harder time if I were dealing with more open-ended questions than "When did your contractions start?" I wouldn't trust my level of skill in something like ER.

The legal stuff is a good point, Tired. I had a resident ask me to translate for her to get consent the other day, and that I will not do.
 
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