The Problem of Medical Miscommunication

Medical translation and interpretation is a context where the words you choose can literally mean life or death for someone. As we consider legislation to change the U.S. health care system, I’m concerned with orienting our decisions toward the increasingly multilingual patient base. How will it be provided? How will it be guaranteed? Who is qualified to interpret? Who will pay for it? As someone who has worked as a medical interpreter, I can vouch for the fact that its availability  and quality is not consistent across different health care settings.

There was a super sobering NPR story on the growing problem and how it figures into the larger health care debate:

“Every day there are thousands of patients whose English is not very good who have a faltering ability to talk to their doctor or nurse,” says Leighton Ku, who teaches health policy at George Washington University.

Ku says most insurance companies do not pay for medical interpreters, so many health care providers don’t have them.

“There’s no serious monitoring or enforcement of the law,” he says. “Clearly it’s the nature of the health care system that health care providers work in response to payment.”

This often leaves family members or friends to interpret, and Ku says that leads to confusion and medical error. Doctors order unnecessary tests, wasting money. Children can be scarred when they have to interpret things like a parent’s cancer diagnosis or a consent form for surgery. And then there is the list of horror stories…

I’ll let you continue reading/hearing those. (Yikes.) I highly recommend reading/hearing it in its entirety.

To begin with, translating English to English is usually a necessity, because medical jargon is not always understandable to the normal patient. From an NPR story on transitional care:

“Mr. and Mrs. Rogers, I would consider very smart and savvy people — and assertive,” says [transitional care nurse Jessica] MacLeod. “And even having those skills, health care is complex, and we have a health care system that is increasingly complicated. And, you know, if you’ve ever been to the doctor’s office yourself, you are hearing words for the first time and they’re maybe said once and it’s hard to get a word in edgewise sometimes and say, ‘Wait, what is atrial fibrillation, Doc?’ You know, what does that mean? So part of my job is a translator, really, and I translate the language of health care to a layperson’s language.

Imagine if you you weren’t as savvy or assertive or didn’t speak English fluently. How much more difficult would it be for you to understand health care instructions? I could go on and on, but the bottom line is, nowhere does language and policy mean more than when people’s lives are on the line.

What are your thoughts on language issues in health care? What policies do you think are good to foster better communication and better health outcomes? Are there any implicit assumptions I have about language that you take issue with?

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One response to “The Problem of Medical Miscommunication

  1. Medical interpreting is protected under the Patient’s Bill of Rights, as well as the Civil Rights Act of 1964 (Title VI) and the CLAS standards 4 and 6 of the Office of Minority Health, however it is up to the states to enforce these provisions. Yet, quality interpretation is vital to ensuring quality care. We passed a bill last session that establishes voluntary incentives to improve the quality of medical interpretation in Utah. A small step forward
    http://www.healthpolicyproject.org/Publications_files/Dispariteis/HB144factsheet2-19-09Update.pdf

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