Just because you can, doesn’t mean you should. That phrase comes to my mind when thinking about the all-too-common practice of relying on the patient’s family member(s) to act as the interpreter.
There are many good reasons why family members should not serve as the interpreter in an encounter.* These reasons include things such as:
1) Proficiency limitations. Does the family member know the terminology – medical or otherwise – in both languages?
2) Communication accuracy. Even if the family member has excellent language proficiency, will they convey the messages impartially and without changing the meaning to suit their own agenda?
3) Confidentiality. Will the patient’s right to privacy be jeopardized because the family member is the means of communication with the care team? Furthermore, will the medical team have limited information due to the patient withholding or changing information they don’t want the family member to know?
When addressing this topic, these tend to be the primary reasons why family members should not serve as interpreters. They are good reasons. But I’d like to add another reason to the list.
4) It skews the speaker’s voice and messes with the listener’s perception. I’ll elaborate with a scenario…
Imagine that your spouse has been trying to convince you for months that you’ve been displaying symptoms of a serious health problem that, if left untreated, could lead to devastating health consequences down the line. You do not agree with your spouse and believe that your so-called “symptoms” are normal and can be attributed to lifestyle circumstances, not a physiological anomaly. You are also skeptical of the medical community and believe that doctors regularly diagnose and treat patients for things that aren’t really health problems because that’s how doctors earn their living – by seeing and treating patients.
Still, you grow tired of the topic continually coming up. You even describe it as nagging. So, you finally agree to consult a doctor to get an official medical opinion. And with any luck put the matter to rest.
At the doctor’s office both you and your spouse are surprised to learn that the clinic has arranged an interpreter for the appointment. Your spouse has excellent proficiency in both languages and usually provides linguistic support when needed. Your spouse is glad to have an interpreter because some medical terms are unfamiliar. (Oh, and now might be a good time to mention that your English skills are pretty good for everyday communications, but not strong enough for specialized settings, like the doctor’s office, or for stressful settings, also like the doctor’s office.)
The usual phases of a clinic encounter unfold as one would expect. The doctor enters the exam room, does the usual introductions, and is a bit unsure why the interpreter is necessary since she won’t be using any technical medical terms and your spouse speaks both languages very well. But since the interpreter is present already, might as well keep on with the interpreter.
The doctor addresses you directly – asking questions, explaining the process for diagnosing the suspected condition, etc. Naturally, the doctor and your spouse also have a number of direct exchanges – talking about history, lifestyle, understanding of the condition and its implications (thanks to Google), etc.
With each utterance, the interpreter is repeating and replicating the voice of both your spouse and the doctor essentially converting these messages into your dominant language. The interpreter is managing the flow of communication ensuring that you truly receive an authentic rendition of what your spouse and doctor are saying and ensuring that you can also interject, interrupt, and correct anything that someone says about you or on your behalf. What’s more, you are hearing everyone’s words through a neutral voice. This last point is critical, especially in the context of what the doctor is saying. Because guess what? The doctor’s professional medical opinion – exam findings, suspected diagnosis, testing recommendations and anticipated treatment plan – aligns with what your spouse has been saying all along. Figures. So much for convincing your spouse that there is no need for concern.
Still, you heard the doctor’s words through the voice of the interpreter. You did not hear the doctor’s words through the voice of your spouse. Let’s be honest. The sound of your spouse’s voice is a distinctive factor in the communication. You associate your spouse’s voice with your spouse. Shocking? Of course not. So, the fact that you heard the doctor’s and your spouse’s messages through the voice of someone who has no stake in the matter had a significant impact on how you processed the communication and engaged in the encounter. Ultimately, it had a significant impact on achieving the entire point of the encounter: hearing the opinion of a medical professional, not your spouse’s take on the matter.
You still think that doctors are out to earn a buck and doubt there is anything wrong with your physical health. You know your spouse truly desires what is best for you, but you don’t always agree on what that is, regardless of an expert’s input. But you were able to have unfiltered, authentic communication, so that’s something. You’ll give it some more thought now that you have the resources and information to make an informed decision.
So, consider that even if the answers to points 1, 2, and 3 are satisfactory, you still must contend with point 4. Communicating through an interpreter is much more than achieving accurate communication. It is also about achieving effective communication, or at the very least striving to achieve the conditions that make effective communication possible.
How things are communicated can be just as important as what is communicated.
Interpreters, keep this in mind when valuing the importance of your role and contribution to the encounter.
Medical professionals, keep this in mind when working to establish meaningful and effective communication with your patients.
Patients and family members, you focus on you and let the professionals focus on providing optimal care. Because if you’re spending your time at the doctor’s office, you’ve got enough to deal with.
Postscript:
I’m not going to say that a family member should never be involved in communicating on behalf of the patient. But I will say that we should not equate that type of communication with interpreting and furthermore, we should acknowledge that that type of communication most likely falls into the category of advocating for the patient. Advocating for the patient or even speaking on their behalf is not automatically a bad thing. But, again, it is not interpreting. Therefore, it cannot provide the type and quality of communication among participants that one can expect when a real-deal interpreter does the interpreting. #BonaFide
*I’d like to take this opportunity to point out that an “encounter” is not limited to a scheduled medical appointment. It also includes phone calls to convey test results or adjust treatment plans, morning rounds on the inpatient unit, and any other point of contact. #JustSaying