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Knowledge of language is no guarantee of accuracy
Medical interpreters require special training
With 45 million people in the United States speaking a language other than English and another 19 million people with limited proficiency in English,1 it is more important than ever for same-day surgery programs to make sure that interpreters are available and qualified to translate pre-op and discharge instructions.
In a study conducted in outpatient settings by physicians and staff at the Medical College of Wisconsin in Milwaukee, an average of 31 interpretation errors per pediatric clinical encounter was observed.1 The study also showed that many of the interpretation errors had potential clinical consequences such as omitting questions about drug allergies before a procedure or prescription or misinterpreting instructions on dose and frequency of medication. The researchers discovered that errors committed by ad hoc interpreters such as family members or friends are more likely to have potential clinical consequences than errors committed by hospital interpreters.
For these reasons, family members and friends are interpreters of last resort for the same-day surgery staff at Gwinnett Health System in Lawrenceville, GA.
"We have five patient representatives who are interpreters," says Paula Martin, spokeswoman for Gwinnett Health System.
"These employees are native-speakers, so they know the language well, but they’ve also taken a course offered through a local immigration services organization that prepares them to translate medical information," she explains. (See "resources" at end of article.)
The course reviews the role of the interpreter as well as techniques for interpreting in addition to making sure the interpreter knows words specific to health care that ensure accurate translation, such as units of measure used for dose, suppository, and orally.
"When one of our patient representatives is not available, or if the patient speaks a language not spoken by the patient representatives, we do have a list of employees throughout the health system who speak different languages," Martin explains.
The employees included on this list also take the medical interpretation class, even though interpretation services are not officially part of their job, she says.
"We want to make sure that the day-surgery nurse who offers to interpret when the patient representative is not available will offer the same quality interpretation service," Martin adds.
Another backup for interpreting information for a patient is a telephone interpreting service to which the health system subscribes, she notes. (See "resources" at end of article.)
"If you choose a service that offers a wide range of languages and certifies that the interpreters are trained for medical interpretation, this is an excellent backup," she adds. "We’ve even used the service to identify the language being spoken by the patient."
Staff at Gwinnett also document the interpretation, Martin points out. "If the interpreter is one of our employees who has interpreted face to face, the employee signs the discharge papers stating that interpretation was provided by the health system and that the patient has demonstrated that they understand the instructions," she says. "If we use a telephone interpretation service, the patient’s nurse writes the interpreter’s name on the form and states that the telephone interpreter has verified that the patient understood the instructions."
Family members may be used to translate simple questions and directions until an interpreter arrives, but they don’t translate medical instructions, Martin says. "We also never use children to translate information to their parents," she adds.
Although the children frequently are fluent in English because they pick up the language so quickly, it is inappropriate for a child to convey personal health information to their parents because it might be uncomfortable for the adult or the child to discuss the timing of their mother’s last menstrual period, for example, Martin says. "A child also does not understand the importance of accuracy in medication instructions and may inadvertently convey the wrong information," she adds.
1. Flores M, Laws B, Mayo SJ, et al. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics 2003; 111:6-14.
Source and Resources
For more on medical interpreters, contact:
For information on medical interpreter training programs, contact:
For information on telephone interpretation as well as document translation services, contact the following companies. Each company charges for telephone interpretation with a per minute charge that varies according to each organization’s contract: