Many Physicians Ignore This Rule

It is often easier to ignore the rule about having a qualified medical interpreter in the room for non-English speaking patients. What do you do?


Finding a qualified interpreter often isn't easy

What is one of the rules that medical people comply with the least?

My vote goes to "translation." The rule is that you must use a qualified medical interpreter for any interview or discussion with a patient who does not understand English.

How is "lack of understanding" defined? It is usually fairly obvious. If you aren't sure whether the patient gets it, he probably doesn't.

Why can't family members act as translators?

There is no guarantee that they will understand what is said or transmit it accurately to the patient.

What are the options?

You can summon a translator from the list of hospital personnel who have volunteered to translate. This works if the language in question is Spanish or maybe French. It's not often useful for Bengali or for most of the 13 or so national languages spoken in Mali.

The Joint Commission says if hospital employees are used, they must be qualified as translators. They suggest ways employees can become qualified: language proficiency testing, training in the practice of interpreting, interpreting experience in a healthcare setting, and knowledge of medical terminology.

A website I found while researching this subject claims that the Joint Commission (JC) says all on-site interpreters must undergo an FBI background check. I could not verify this with the JC, because its standards are only available if you pay. [Digression: If this is true, it is very interesting. Doctors and nurses do not have to undergo FBI background checks.]

Many hospitals do not have formal training for interpreters, nor are interpreters always available around the clock.

Sometimes, hospital administrators take things too literally. In one hospital I know of, a fully bilingual surgeon was told he could not obtain an operative consent in Spanish -- his native language -- because he had not been trained as an interpreter.

There also are times when the hospital employee is not up to the task either because of education or attitude.

A hospital can contract with a service to provide interpreters via telephone. The advantages are that the interpreters are qualified and speak many different languages, far more than you might find among hospital personnel.

Among the disadvantages is the awkward nature of these conversations. If you use only one handset, you have to keep passing the phone back and forth and you can't hear what the interpreter is saying.

A two-handset phone setup is somewhat better, but you have to find it. It is always stored in a different place on each floor of the hospital.

Accessing the service can be time-consuming. You must make an 800 call, log in, wait for the interpreter to join and so on.

Either in person or by telephone, the conversation can be frustrating.

I have had occasion to say something to the interpreter that took 2 minutes, only to have the interpreter talk to the patient for 10 seconds. Here's a video example.

But the real problem is lack of true physician-patient interaction. You are both talking to someone else. Telling a patient she has cancer, or what the risks and benefits of a procedure are, is often accompanied by stunned silence from the patient. You really can't tell how much has been understood.

Also worth noting is that whatever the language, most of the time we then have the patient sign a consent form that is written in English.

You may have figured this out by now -- many hospitals don't do any of this very well.

What do you do with a patient who speaks a language that even the telephone interpreter service doesn't provide?

We simply do the best we can. I'm not sure that any interpreter, phone or in person, can really communicate with some of these patients.

Now that I think of it, I'm not sure how many English-speaking patients understand us either.

Skeptical Scalpel" is a surgeon who blogs at his self-titled site, Skeptical Scalpel. This post appeared on

This article was first published on MedPage Today and reprinted with permission from UBM Medica. Free registration is required.

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