How to avoid the pitfalls when a patient needs the help of an interpreter
Why language and communication should not be barriers to a patient receiving quality care
Patients' language and communication requirements should not prevent them from receiving quality care
Good interpreters can clarify issues that might otherwise be lost in translation
Differences between interpreting and translating explained
‘Patients should be able to access primary care services in a way that ensures their language and communication requirements do not prevent them receiving the same quality of healthcare as others.’
So states the first principle in guidance on interpreting and translation services set out by NHS England.
The guidance sets out best practice and warns that ‘not being able to communicate well with health professionals can impact on health outcomes, the effectiveness of consultations and patient experience’.
Good interpreters are impartial and can clarify many issues that might otherwise be lost in translation. This means explaining nuances that may only be apparent if you know the culture.
The issues concern not just words, but are also about a bridging of cultural expectations, cultural practice of medicine and the way the health system works – all those aspects need to be mediated, and a good interpreter will be aware of them.
Difference between translating and interpreting
Translation is written, and includes patient leaflets, website text and information about treatments. Sometimes personal information needs to be translated, such as a patient’s medical notes and documents they bring with them about their health and medication they have been taking.
Interpreting covers the spoken word. It is the exchange between people that occurs in any consultation or nursing visit. This is an area that can become problematic for many healthcare professionals because it is ‘live’ and is customised to each person. Interpreting can be done in different ways: by bringing in an interpreter to do it face-to-face or by phone or video link.
Other options are bilingual nurses or using family and friends. Use of family and friends is not considered good practice, and NHS England guidance on the use of interpreting and translation services in primary care states that ‘patients should always be offered a registered interpreter’.
Many personal, cultural and medical issues are involved. Apart from the question of the patient’s right to privacy, healthcare interpreting is a specific skill, explains Kavita Parmar of Word360, a provider of NHS interpreting care in the West Midlands.
‘Even with the best intentions, someone who is a native speaker may still not understand the terminology. When using an interpreter you have a guarantee that the person knows the nuances and how to explain terms, including ones that may not be easy to translate.
Conflicts of interest
‘Then there’s a whole issue of bias and conflicts of interest. In many cultures and languages there are issues around, for example, a man explaining treatment to a woman. There are potential conflicts of interest. Family members may give their own advice.’
Ewa Jasinska-Davidson, a member of the Institute of Translation and Interpreting, says: ‘Relatives or friends are emotionally involved and may sometimes omit or add some parts of the conversation in good faith, for example when they do not want to upset the patient who does not understand English.’
Association of District Nurse Educators chair Julie Bliss says her colleagues report that availability and access to interpreters is a major challenge, especially when patients require daily visits, and interpreters are more likely to be used for case conferences.
Timing and expense
Booking a professional interpreter is expensive and arranging timings can be a problem. Phone services are not always easy to negotiate either. In some areas healthcare professionals are predominantly communicating via a translation website, with each party typing in their own language.
Ms Bliss says her colleagues recognise the difficulties, and they cannot always be sure the information has been transmitted properly.
Lost in online translation
Websites offering translation are not a complete solution. Machine translation is becoming increasingly accurate but it still requires post-editing – checking by humans to ensure it is accurate.
In a situation where accuracy is essential there is no room for error, and machine translation does not guarantee this.
Ms Parmar believes using registered interpreters is worth the expense: ‘We live in a society that is multicultural and diverse, and having that extra layer of support for patients enables them to get the help that they need. Interpreters are an efficient way of getting information across at the right time, and ultimately this reduces the burden on the local community.’
Tips for good practice
- Remember that the interpreter is the means of communicating with the patient
- If interpreters are physically present they should sit with the healthcare professional in the patient’s line of sight – this is called the ‘interpreter triangle’
- Speak to the patient, not to the interpreter
- Check that patients have understood by asking them to repeat back to you their understanding of what has been said
‘She just needed to talk’
Queens’ Nurse Jane Cook is a specialist working with excluded communities.
‘I’ve worked on projects where we trained up people with language skills to become accredited interpreters. It meant that they came out with a qualification – and indeed some were already trained clinicians who could use their new language skills to requalify in the UK – and it also meant that as a health worker I could have an interpreter with me.
‘I could brief them in advance, and they would clarify exactly what patients had said and ensure they understood any instructions. Afterwards we could also have a debriefing session and think about the interpreter’s well-being too.
‘On one occasion, a GP referred a young woman to our clinic. He didn’t know what was wrong, but she kept crying. She spoke English, but he couldn’t get through to her and he hadn’t thought to book an interpreter for her session with him.
‘We knew that culturally a female interpreter would be appropriate, so I arranged one and briefed her in advance. The woman came in and sat down with us. She explained in some detail that she had had a traumatic journey from her home country, with a family member who died in front of her.
‘The GP had been suggesting medication, but what she needed was to be signposted to intercultural therapy – she needed to be able to talk. If she hadn’t been referred to us and been able to communicate, her whole scenario would have continued and her mental state would probably have continued to deteriorate.’
Radhika Holmström is a health writer
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