For example, in private practice and when dealing with less common languages, a phone service that translates information for patients may be the first available choice. “Some find the phone system comforting. I find it difficult,” says Ellen M. Ginzler, MD, MPH, chief of rheumatology at State University of New York (SUNY)-Downstate Medical Center in Brooklyn, N.Y. She says that while phone-based translations can be helpful for obtaining a patient history, she never feels quite comfortable that the phone-based translation accurately conveys what the patient needs to know.
“The jury is still out on phone banks,” says Laura Robbins, DSW, associate scientist and vice president of education and academic affairs at the Hospital for Special Surgery in New York. “It’s better than nothing, but translation is not just about language. It’s also about nuances.”
The next common solution is translation with the help of a family member, another option that many say is an all-too-easy solution. Although having a family member translate is better than no interpretation at all, it can put relatives in touchy situations.
“It raises ethical issues,” says Dharma E. Cortés, Ph.D., clinical instructor in sociology at the Cambridge Health Alliance, Harvard Medical School, and senior research associate at the Mauricio Gastón Institute of the University of Massachusetts-Boston. “First, you have someone who is not trained in interpretation managing the flow between the doctor and the patient. Second, you have the issue of multiple roles.” For example, family members may not know how much or how little to interpret; underage children who are interpreting for their parents are placed in the unfair position of decoding medical information and taking on a parental role, Dr. Cortés adds. The role of the child as the translator happens all too often in pediatric rheumatology, Dr. Onel says.
There may also be situations where a family member intentionally does not translate what the physician has said because of cultural mores or for fear of the patient’s reaction, Dr. Onel says.
Hospitals in diverse areas are more accustomed to the use of onsite translators. For example, at hospitals like SUNY-Downstate, Creole, Spanish, Chinese, Russian, and Eastern European languages are just some of the languages for which the hospital often obtains translation help, Dr. Ginzler says. At places like Parc Nicollet, translators must help immigrants and refugees who come from various parts of the world, including a variety of African, Latin American, and Asian countries, Dr. Schned says. In fact, at his organization, interpreters are required to be present even if a family member who can interpret is already there, he says.