A patient is hurried into Liverpool Royal emergencies at 3am. She is originally from Hong Kong and attempts to describe her agonizing symptoms in Cantonese but only receives blank faces from the medical staff. No medical interpreter is available until 9 am and so a Mandarin speaking Chinese nurse is instead quickly called upon to interpret. The patient, now desperate for urgent medical attention, struggles to explain what has happened to her and where she feels the pain. However, the nurse shrugs again apologetically to the doctor, and replies, “I’m so sorry, I’m really not sure what’s wrong; I don’t understand Cantonese.’’
Language can be a huge obstacle to the provision of health care. However, no country or health system is linguistically homogeneous. According to the 2011 consensus held in the United Kingdom, some 4 million – or 8% – reported speaking a different main language other than English or Welsh. Several studies have shown that language barriers lead to poorer health care and follow-up.
A medical nterpreter is fundamental to a country’s health system. He or she ist not only an essential communicator but also an advocator and cultural negotiator between doctor and patient. There is no doubt that a professional medical interpreter improves the quality of healthcare treatment. Furthermore, a medical interpreter alleviates the burden placed on staff in the medical field. A non-English speaking patient’s right to a medical interpreter varies from country to country. However, the Disability Discrimination Act and the Human Rights Act do help guide health experts in the UK.
Choosing a medical interpreter
Determining the most appropriate interpreter for each medical case involves a careful selection process. This may come down to whether the medical interpreter is male or female and not only speaks the same language but also the same dialect. For example, there are many varieties of the Arabic language (dialects or otherwise) in existence within five regional forms. Some varieties of Arabic in North Africa, for example, are incomprehensible to an Arabic speaker from the Levant or the Persian Gulf. Another important factor to check in advance is that the interpreter has had no previous contact with the patient: in certain close-knit Somalian communities, patients will fear disclosing any facts to a medical interpreter, who turns out to be his neighbour, in case they become widely known in their communities.
Professional interpreters must also be non-judgmental and confidential, as well as respect confidentiality and communicate information in a sensitive, subtle, and culturally acceptable manner. A patient involved in, for example, a personal injury compensation case may be physically and psychologically traumatised and need to be treated with great care.
Top tips for working with a medical interpreter
1. Greet the patient first, then the interpreter.
2. Focus on and speak to the patient, not the interpreter.
3. Speak at an even pace and pause often to allow the interpreter to interpret effectively.
4. Pay attention to the patient’s body language.
5. Ask one question at a time.
6. Use plain English; avoid slang, jargon, over-complicated medical/technical terminology and acronyms.
7. Be sensitive to cultural issues.
8. Assume that everything said by you and the patient will be interpreted.
9. Do not hold the interpreter responsible for what the patient does or doesn’t say; the interpreter is only the medium of communication.
10. Understand that the interpreter may need longer to interpret the terms than in your original speech. Many concepts do not have an exact equivalent translation in other languages.
11. If your patient is focusing excessively on the interpreter, you can use the following methods to ensure the patient focuses on you:
• Use the patient’s name. People respond to their name regardless of the language in which it is said.
• Move your chair closer to the patient.
• Make sure you are making eye contact with the patient as often as possible.
• Remember that facial expressions and body language can also communicate your interest and concern
12. Make no assumptions about the patient’s educational level. A patient’s inability to speak English does not necessarily signify a lack of education.
13. Respect the professional interpreter: his or her area of expertise is cross-lingual communication.