Veronica Larouche, MA, CMI-Russian, medical interpreter
As a medical interpreter, I am frequently asked questions such as, “Isn’t medical interpreting easy, since all you do is talk?” “Do you just interpret the medical terms or whole sentences?” or, “Why are you needed if bilingual family members are present?”
Such questions help us better describe our role. Medical interpreters contribute to creating a common language between care providers and patients, making better communication possible. After all, without proper communication, all of the great science we can offer is inaccessible, creating gaps in the care we provide to patients and their families.
An interpreter’s first step in bridging a language gap involves understanding medical information in the proper context. The interpreter must turn complete and often complex phrases into a totally different syntax, grammar, vocabulary and idiom, without compromising on pronunciation and vocal register—quickly and accurately.
For example, a Russian patient may say, “Нет боли в покое.” Word for word, that phrase means, “no pain in peace.” However, a seasoned interpreter knows to focus on the context rather than the literal translation. This patient does not mean that life is fine when there is peace in the world; rather, she is telling her orthopedist that she has no pain when her arm is at rest. The interpreter’s understanding of the context is vital and ultimately allows the care team to prescribe the correct treatment.
Equally challenging and significant are the split-second judgment calls that interpreters must make daily involving ethics, culture, body language and seemingly incomprehensible behavior.
For example, an elderly Russian speaker was recently hospitalized multiple times for complications stemming from a chronic illness. It would be tempting to assume that the only challenges she faced were related to her treatment, as the patient was not delirious, was quite mobile, had a very supportive family member who spoke excellent English and had no financial or insurance issues. However, it became clear over time that the patient and her family member were determined to keep the patient in the hospital for as long as possible, dwelling on minutiae and rebelling against the plan of care. The care team could not get clarity from the patient on these issues while the English-speaking family member served as the interpreter.
I gently asked the team to consider a mental health consult, since the patient‘s overall disposition, affect and focus on minutiae were things I was better able to pick up on in Russian. Only a psychiatrist could give a diagnosis, but our job as interpreters is to politely and respectfully plant the seed when it comes to cultural and behavioral nuances that defy explanation.
The most serious ethical challenge with this patient was the frequent use of the family member for interpretation. Regardless of how well a family member may speak English, he or she is not an impartial party. There are liability issues here, as well, as it is very difficult to interpret for a loved one in an objective manner and without expressing one’s personal emotions and opinions, all of which could compromise the accuracy of the interpretation.
There will always be communication challenges when caring for patients and families under the stress of illness—even when the patient and the provider speak the same language. However, at BWH, we work with a large number of patients who cannot use English adequately. These vulnerable patients deserve proper care, and central to their care is always an experienced interpreter who knows the right questions to ask to bridge the language gap, better ensuring they have the very best patient experience possible.