Lost in translation

Ha. What a stereotypical, overused title. Oh well.

Our previous hospital was predominantly of Anglo-Saxon background, and throughout the whole year we saw less than a handful of patients who couldn't speak fluent English. This hospital, similar to other metropolitan public hospitals, has migrants from everywhere, Italian, Serbian, Vietnamese, Chinese, Greek, you name it. This time there was an elderly Asian gentleman in the wards.

"He speaks Chinese, anyone speaks Chinese here?" the consultant looked around.

I hesitated, remembering the disapproving tones we had from our tutors at the mention of students being used as interpreters. Plus the last time I spoke in Chinese was an awkward international call to organise my elective. I had said "hello", instead of "喂", and the lady handed phone to someone else saying, "她在说外国话".

But since the Asian intern didn't volunteer herself, I said, I can speak it, to some extent. They wanted to know if he knew where he was, and the day and month. Okay.

"你知道你在哪里吗？今天是星期几？现在是几月份？

Ask him if he's coping at home. That's tricky, I had to think hard, and came up with a half formed phrase (can't remember the exact wording) which he understood and replied that for small things he could handle it, but some of the more strenuous activities were difficult. He seemed happy to be able to converse and be understood properly. And we moved on to the next patient, and I reflected on the experience.

We've had many HP/EP/PD tutorials about using interpreters, and speaking to people from different backgrounds. We're always told, you should always use a trained, professional interpreter. Really? Yes I'm totally far from fluent but if you're asking about which day and month on ward round, how essential is it to find an interpreter. Or, the man in ED with his chest pain who was brought in by his daughter, are you going to wait for who knows how many hours for the only Serbian interpreter in the region, or are you going to ask the daughter who is also able to give good collateral history?

Our teaching has always focused on what can go wrong. The classic dilemma is the scenario where children are used as the interpreter, then they tell you that in their culture, it's better not to tell their terminally ill parent what is going on. See, they say, the children should never have been used to interpret in the first place. Or the example of awkward interviews, and misunderstandings with a doctor who speaks the patient's language as a second language. So the blanket rule is, always use an interpreter. Oh of course, how could people not understand that, I thought.

But now I disagree. Why do the tutors shake their heads when our classmates say they themselves, or the patient's family, were interpreting for a patient? True, there's lots of things that can go wrong in using non professionals, but there's also lots of things that can work better. It's impractical to call an interpreter for everyone who has some difficulty with English and clinician know it. If you work on those principals, how about calling an interpreter for every doctor who finds it difficult to communicate fluently in English?

In our society, it seems that having a certificate is a tick of excellence (and not having one, equals being inadequate). After working in hospitality, I realised that in some places, it's compulsory to have a food handling certificate. Before my hospital placement last holidays, I had to have a "hand hygiene certificate". Our hospital never provided one, so I searched online, answered a few MCQ's and printed myself one from the website. Do you really think there was any difference between my hand hygiene practices before and after the certificate? The point I'm making is that having a professional with a certificate every time doesn't mean you've optimised communication. Look at the interpreter who was called in, only to discover he spoke the same language but in a different dialect to that of our patient. Hmm, (nice man he was but) very useful? Or my friend's experience where the professional interpreter was interrupting the flow of the interview by cutting in, when the patient began to express herself in English. On the other hand, professionals can be great - I saw an age care assessment, and mini mental performed by an experienced interpreter, and it flowed seamlessly.

Consent for surgery, yes you wouldn't want to use someone who fumbled with the language, or emotionally involved, as an interpreter. On the other hand, ward rounds every day with basic questions, the family member can probably do a better job of helping you out with history (since they are often involved in the care too) than the professional.