Lost in translation: Best practices for working with medical interpreters

In a hospital hallway in south Florida, Aadil Vora, OMS III, was preparing for a follow-up visit with a woman who spoke limited English. But when he introduced himself, the woman stared at him blankly. During her first visit, she’d focused entirely on the interpreter, so she didn’t recognize Vora, who’d helped conduct the exam.

Working with medical interpreters is a vitally important part of caring for patients with limited English proficiency, and physicians who treat Medicare patients are required to let patients know that language assistance is available. But being unable to speak directly to patients also poses unique challenges.

Family medicine physician Mary Brigandi, DO, and Aadil Vora, OMS III, who attends the Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, have both worked at hospitals with large populations of patients who require interpreters.

Dr. Brigandi practices at Reading Hospital in Reading, Pennsylvania, and Vora, who wrote an essay about his experience, is completing clinical rotations at Palmetto General Hospital in Hialeah, Florida. Here are their tips for working effectively with interpreters.

Team communication

At Reading Hospital, where Dr. Brigandi practices, a dozen full- and part-time trained interpreters provide in-person language services.

For less common languages, the hospital uses a telephone-based interpreting service. Although the service bridges crucial language gaps, Dr. Brigandi notes that such encounters tend to take longer, partly because telephone interpreters don’t always have specialized training in medical interpreting.

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Even when interpreters are physically present, physicians’ body language is a key part of the patient encounter, so it’s important that the patient be able to see you clearly. After introducing yourself and the interpreter, explain that you’ll be speaking directly to the patient.

At times, this dynamic can feel awkward, Vora says: “Even though there are three people in the room, you sort of have to act like the interpreter isn’t there.” Maintaining eye contact with the patient can help bridge the communication gap.

Physicians should also be aware that body language can vary across cultures, which can cause misunderstandings. While caring for a Latina patient who’d just given birth to a son, a colleague of Dr. Brigandi’s asked the new mother if she wanted her son to be circumcised.

“The mother was nodding throughout the explanation,” Dr. Brigandi says. “But when she responded through the interpreter, my colleague learned she actually didn’t want the procedure. She was nodding to show she was listening, not to show agreement.”

Safety considerations

The legal and safety ramifications of inadequate interpreting can be significant. In one case, a nine-year-old girl died from a prescription drug reaction. Her parents spoke limited English and the patient and her teenage brother had served as interpreters during her hospital visits. The case resulted in a $200,000 settlement.

“Many physicians have been in situations where we had to pull in family members or colleagues who spoke the patient’s language,” Dr. Brigandi says. “But you are risking liability every time you rely on someone who isn’t trained to be a medical interpreter.” Notably, children should never be asked to interpret, except in emergencies.

Broader lessons

Dr. Brigandi has found that the tactics she uses when working with patients who speak limited English lend themselves to most patient encounters.

“Respecting each patient’s cultural background, speaking directly to him or her and keeping your language simple are concepts that apply to all patient visits,” she says. “Speaking through an interpreter can feel like a bit of a disconnect, but when you convey warmth and sincerity, patients see that, no matter the language.”