Using interpreters and communicating across languages

Language barriers cause more medical error than most people assume, and the common workarounds are less reliable than they appear.

Why professional interpretation matters

• Medical vocabulary is specialised.
• Precision changes meaning in ways that matter clinically.
• Professional interpreters are trained to render everything.
• They are bound by confidentiality.
• They have no emotional stake in the content.

The last point is the crucial difference from a family member, who has every reason to soften what they are conveying.

The problem with family interpreters

• They may omit or soften distressing information.
• They may lack medical vocabulary.
• They may answer on the patient's behalf.
• The patient may withhold information in front of them.
• Children should never be used in this role.

The last point is important and sometimes overlooked in practice. Asking a child to convey serious medical information places a burden on them and produces unreliable communication.

Arranging interpretation

• Request it when booking, not on arrival.
• State the language and any dialect.
• Ask whether it is provided or chargeable.
• Ask whether it will be in person or by telephone.
• Confirm before the appointment.

Requesting at booking gives the service time to arrange it; same-day requests frequently cannot be met.

In-person versus remote

• In person allows reading body language and context.
• Telephone is faster to arrange and widely available.
• Video sits between the two.
• Difficult conversations benefit from in-person presence.
• Routine exchanges work adequately by telephone.

Working with an interpreter

• Address the clinician directly, not the interpreter.
• Speak in short segments.
• Pause to allow interpretation.
• Avoid idioms and figures of speech.
• Ask the clinician to check your understanding.
• Allow extra time for the appointment.

The fourth point is practical. Idiomatic expressions translate poorly and are a common source of confusion.

Consent conversations

• Consent requires actual understanding, not a signature.
• Professional interpretation should be used.
• Documents should be available in a language you read.
• Do not sign what you cannot read.
• Ask for a written summary of what you agreed.

Signing a consent form in a language you cannot read is not informed consent, and asking for an alternative is entirely reasonable.

Translation applications

• Useful for simple, factual exchanges.
• Unreliable for medical terminology.
• Drug names translate particularly badly.
• Never adequate for consent or complex explanation.
• Useful as a supplement, not a substitute.

Where these tools help most is in everyday interactions around care rather than in the clinical conversation itself.

Preparing your own vocabulary

• Learn the words for your conditions.
• Learn the words for your allergies.
• Learn pain, bleeding and breathing difficulty.
• Carry a written list rather than relying on recall.
• Include the numbers for describing severity.

Written information

• Ask for instructions in writing.
• Ask whether translated materials exist.
• Photograph anything handwritten.
• Have it translated afterwards if necessary.
• Written information survives the appointment; spoken does not.

Written translations of key instructions

• Ask for discharge instructions in writing.
• Have them translated before you need to act on them.
• Check dosing instructions particularly carefully.
• Numbers and units are where translation errors matter most.

Dosing instructions are the place where a translation error has the most direct consequence, and checking them specifically with someone who reads both languages is worth the extra step.

Arranging interpretation for a companion too

• The companion also needs to understand what is happening.
• Instructions for care at the accommodation matter to them.
• They may be the one calling for help.
• Ask that they be included in explanations.

Interpretation is usually arranged for the patient and the companion is left to follow as best they can. Since the companion is often the person who will act on the information, including them explicitly in the conversation is worth requesting.

Cultural differences in how information is given

• Directness about serious diagnoses varies between cultures.
• In some settings families are told before patients.
• Some clinicians avoid explicit terms.
• State clearly how much you want to be told.
• An interpreter may mediate cultural as well as linguistic difference.

This is easy to misread as evasiveness when it is convention. Saying plainly that you want direct information, including bad news, usually resolves it — and it is a reasonable thing to state at the outset rather than discovering the mismatch later.

Communicating with nursing staff

• Most day-to-day contact is with nurses, not doctors.
• Interpretation is less often arranged for routine care.
• Simple written phrases help considerably.
• Pointing to a pain scale works across languages.
• Ask for a phrase card if one exists.

The bulk of hospital communication is routine and practical rather than clinical, and this is where interpretation is least available. A short written list of common needs covers most of it.

Recording what you were told

• Ask for written instructions in addition to verbal ones.
• Ask the interpreter to check your written notes.
• Repeat back the key points before the appointment ends.
• Ask for a letter summarising the consultation.

Written material can be translated later at leisure, checked by someone else, and referred back to. Spoken information in a second language is gone the moment the appointment ends.

Signs communication is failing

• Answers that do not address your question.
• Conversations between clinician and interpreter that are not relayed.
• Very short interpretation of long explanations.
• Your questions not being asked.
• Say something if you notice these.

The third is a reliable indicator. A long explanation rendered in a few words has probably lost most of its content.

Summary

Professional interpretation differs from a bilingual family member because interpreters render everything and have no stake in softening it. Request interpretation when booking rather than on arrival. Never sign a consent document you cannot read. And if a long explanation is interpreted in a few words, say so, because content has probably been lost.

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