Errors in medical translation can be a real pain
by Andis Robeznieks , 18th November, 2004
Language barriers are seen as a huge potential source of medical errors for the 19 million English-deficient residents of the United States.
Patient-safety literature repeats over and over again how important it is to maintain open communication in the doctor-patient relationship, highlighting that miscommunication can lead to medical errors. But Glenn Flores, MD, believes that a key topic has been missing from the discussion: errors made in language translation. "This is a previously unrecognized root cause of medical errors," said Dr. Flores, an associate professor of paediatrics, epidemiology and health policy at the Medical College of Wisconsin in Milwaukee. "I think it's a huge quality issue." Translation errors were not mentioned in "To Err is Human," the Institute of Medicine's 1999 report on medical errors, Dr. Flores noted. But he said the potential for harm in this area is enormous given U.S. Census reports estimating that the United States has 19 million residents with limited command of the English language. According to a report by Dr. Flores and colleagues published in the January Paediatrics, translation errors occurred more frequently than one might expect, and a majority of these errors had the potential for clinical consequences. Researchers analyzed 474 pages of transcripts generated from 13 encounters where interpreters were used at the outpatient clinic of a Boston hospital. A mean of 31 translation errors occurred per patient visit, with a mean of 19 of these errors (63%) having potential clinical consequences. Errors committed by "ad hoc" interpreters (nurses, social workers, siblings) had potential clinical consequences 77% of the time compared with 53% of the time with professional translators. These errors included: * Omitting questions about drug allergies, medical histories and symptoms. * Omitting instructions on the dose, frequency and duration for antibiotic prescriptions. * Adding that hydrocortisone cream must be applied to the entire body instead of just on a facial rash. * Instructing a mother to put amoxicillin in both ears for treatment of otitis media. Dr. Flores said better training of medical translators is necessary as well as fluency screening to ensure that "people who say they are fluent actually are." Fluency screening, training necessary "You would want interpreters to undergo a pretty extensive training program," he said, explaining that the training would include learning about medical terms, confidentiality issues and principles of informed consent. The study revealed the importance of training. In one instance, Dr. Flores said an interpreter used a Puerto Rican colloquialism for "mumps" that was not understood by a patient from El Salvador. In another, the interpreter did not know the correct Spanish words for "level," "results" and "medicine." When professional interpreters are not around, Dr. Flores said, hospital clinicians often recruit anyone who is available. This can include strangers in the waiting room, custodians and children. He noted how this can be particularly inappropriate and awkward if a patient's problems involve mental illness, drug use or sexually transmitted disease. Tips for practising physicians To help primary care physicians manage the expense of translation services, Dr. Flores suggests: * Scheduling non-English-speaking patients to come in on specific days when translators are available. * Working with community groups to provide volunteer translators. * Working with local colleges to recruit students majoring in foreign languages to donate their time. He said telephone translation services are acceptable -- especially when the language being interpreted is rare -- but they are "not optimal," because nonverbal cues are missed. The optimum solution, he said, would be for professional translators to be paid by a third party such as Medicaid or the State Children's Health Insurance Program. "It's a beautiful solution to this, and it's already going on in five states: Hawaii, Maine, Minnesota, Utah and Washington," Dr. Flores said, but he added that Minnesota's program has some unnecessary "complexity" because it requires physicians to pay up front for translation services and then be reimbursed later. Other long-term solutions he proposes include: making "medical Spanish" a required course at medical schools in states with large Latino populations, giving bonuses to physicians who can demonstrate proficiency in another language, and directing patients with language difficulties to community English classes. In the long run, Dr. Flores said, having trained translators on hand could lower health care costs because language barriers can lead to unnecessary hospitalization or extra diagnostic tests as physicians compensate by being overly cautious. "They're doing the right thing [by being cautious], but they probably could be saving thousands of dollars if they had an interpreter," he said. http://www.ama-assn.org/amednews/2003/01/27/prsb0127.htm
© Amednews - American Medical Association - 27 January 2003
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