Standard 6

Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff.   Family and friends should not be used to provide interpretation services (except on request by the patient/consumer)

In 1980, eighteen-year-old Willie Ramirez was taken to South Florida hospital.  With limited English skills, the teen’s mother and girlfriend told paramedics he was intoxicado (a Cuban term meaning “feeling sick due to something you ate or drank).  The paramedics and doctors took the term to mean “intoxicated” and treated Willie’s condition as an overdose.  This miscommunication resulted in a misdiagnosed intracerebellar hemorrhage.  This incident left Willie a quadriplegic and resulted in a  $71 million lawsuit. Read more about Willie’s case at http://healthaffairs.org/blog/2008/11/19/language-culture-and-medical-tragedy-the-case-of-willie-ramirez/.

(Image by A.D.A.M., Inc.) Had Willie’s intracerebellar hemorrhage been diagnosed correctly, he would have successfully walked out the hospital.   

Willie’s case illustrates how easily miscommunications may arise and their effects on patients and healthcare providers.  To avoid miscommunication, misdiagnoses, patient dissatisfaction, and improper treatment, it is important for health care providers to evaluate and ensure efficient language services. Bilingual staff who communicate with patients must be fluent in both English and the target language, including fluency in medical terms and concepts. 

Formal training and testing are two methods of ensuring bilingual staff and interpreters are equipped to communicate with patients.  According to the HHS, the National Council on Interpretation in Health Care recommends a minimum of 40 hours of formal training for working interpreters. 

Image by UC Davis

Although some patients may want to use family members as translators, providers should discourage such practices and inform the patient of free, qualified interpreter services.  Reasons patients’ family members and friends should not be used as interpreters include:

1.     Although family members and friends may feel confident speaking a language conversationally, they may not be able to accurately grasp medical terms and concepts.

2.     Family members and friends may withhold vital information from patients due to embarrassment or fear. 

3.     Some cultures disapprove of children discussing certain topics with parents such as sex and reproductive systems. 

4.     It is unfair to expect a child or a minor to take the responsibility of translating for his/her parents.

It is understandable that not every health care clinic or provider may have the resources to provide translation services. However, it is vital that health care providers find a way to do so.  Accurate and clear information to patients is critical to delivering care of services and reducing unnecessary duplication of services.