Language a Barrier to Child's Health

Translation errors translate into poor medical care

MONDAY, Jan. 6, 2003 (HealthDayNews) -- When a mother doesn't speak English and a pediatrician does, the child's health can get lost in the translation.

A new study that detailed 13 visits between pediatricians and non-English speaking mothers, all of which relied on interpreters, found an average of 31 medical mistranslations per visit.

The misinterpretations, such as omitting words from the doctors' instructions or substituting other words, caused varying degrees of poor clinical consequences -- from taking the wrong dose of medicine to, in one case, causing a mother to temporarily lose custody of her child. Further, when informal interpreters were used -- such as family members or people called in to help -- there were significantly more serious clinical errors.

"These disturbances are more common than we want to admit. Just because of a single word being misinterpreted, there can be very bad outcomes," says Dr. Glenn Flores, an associate professor of pediatrics at the Medical College of Wisconsin and lead author of the study. The results appear in the January issue of Pediatrics.

Flores, who has long been involved in trying to improve health care to underserved populations, says language barriers are one of the biggest deterrents to people seeking health care.

"In a 1998 study we found that language barriers accounted for 26 percent of the reasons for people not to seek health care," he says.

For this study, Flores and his colleagues analyzed the results of 13 tape-recorded encounters between doctors and non-English-speaking mothers who had brought their ill children to a Massachusetts outpatient pediatric clinic. Professional hospital interpreters were there for six of the appointments and nonprofessional translators -- three nurses, three social workers and one sibling -- were used in the remaining seven.

The researchers found five categories of misinterpretation: omission of a word or phrase (52 percent of the errors); using a word that doesn't exist in the particular language (16 percent); substituting words (13 percent); editorializing about what the doctor said (10 percent); and adding a word or phrase (8 percent).

Sixty-three percent of the translation errors were found to have potential medical consequences. For instance, one interpreter told a mother to put oral amoxicillin in a child's ear to treat an ear infection. There was also confusion about follow-up visits. One of the worst, Flores says, was a nonprofessional interpreter misunderstanding an explanation of how a child had been hurt.

"He thought the child had been hit, but in fact the child had fallen off her tricycle," Flores says, and the mother temporarily lost custody of her child.

"This was an ad hoc interpreter who thought he was fluent in Spanish," Flores says.

In fact, it was the ad hoc interpreters whose mistakes were far more likely to cause medical misunderstandings, Flores says. The study found that 77 percent of the mistranslations by ad hoc interpreters had the potential for serious consequences, versus 53 percent of the errors made by professional hospital interpreters.

Camille Tumolo heads an interpreters' program for two New York City hospitals with large non-English-speaking populations. The program has exploded over the last five years as legal and ethical considerations mandate that patients have access to reliable interpreters. At Columbia Presbyterian Hospital, which serves a large, primarily Spanish population, and at New York-Weill Hospital, whose patients' languages range from Russian to Mandarin Chinese to rare African dialects, interpreters are volunteers who have gone through a 25-hour training program or employees from an agency that serves the United Nations.

The hardest thing interpreters have to learn, Tumolo says, is to be invisible.

"The interpreters have to say exactly what the doctor says, give a literal interpretation, which is difficult because the inclination is to inject an opinion," she says. "If you grab a nurse off the floor who isn't trained, she will add an opinion or change a word, and any kind of mistake can really be devastating."

Such skills do not come cheaply. Tumolo says the interpreters from the agencies cost from $35 to $100 an hour with a two-hour minimum, and that with approximately 1,000 requests monthly, this adds up.

"The cost is outrageous, and we are not reimbursed," she says.

Flores says that costs are a major factor keeping health facilities from using good interpreters.

"We really need to have third-party reimbursement," he says, adding that five states mandate this payment.

What To Do

Some recommendations for setting up interpreter programs in hospitals can be found at Universal Health Care. An article in the Arizona Republic outlines some of the problems faced by non-English speaking populations in hospitals.

SOURCES: Glenn Flores, M.D., associate professor, pediatrics, epidemiology and health policy, and director, community outcomes, Department of Pediatrics, Medical College of Wisconsin, Milwaukee; Camille Tumolo, director, volunteer services, Columbia Presbyterian Hospital, New York City; January 2003 Pediatrics
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