( continued from page 21)
quality of care; professional interpreters can sometimes enhance the doctor-patient relationship and outcomes more than ad hoc interpreters. 7 Ad hoc interpreters may have a higher rate of interpretation errors and are less familiar with medical wording. Confidentiality may be compromised, interpreters may give unsolicited advice and children in this role may have limited understanding of adult issues. 8
Mustering his resolve, Mr. S. did manage to keep coming back in. However, he chose to have his teenage son interpret. But his son failed to understand certain medical terms, and Mr. S. held back sensitive personal information about his mental health, honoring what we felt was a cultural stigma, and also his desire not to burden his son. Using a family member as interpreter raises questions of exactly whose version of events is being told to us; using a professional keeps the focus on the patient only.
Many physicians prefer professional interpreters, but when rushed they might resort to these alternatives, despite a higher chance of medical misunderstanding. 6 Many clinicians are concerned that interpreters may alter the proper meanings. 9 Thus, they may request word-for-word translation, to avoid misunderstandings. 9 That too might be misleading, and direct translation is not always possible. Interpreters often change wording to be more understandable and culturally appropriate. 9 They will convert the speech of the doctor and patient into the proper meanings. 9 The messages may be better understood and will sound more empathetic, which can improve clinical understanding.
Improved relationships and health outcomes are noted with interpreters of shared cultural background. They usually minimize cultural differences and improve rapport. 10 Due to this, interpreters’ roles expand beyond simply translating languages, they serve as cultural mediators.
Once we managed to get Mr. S alone with us and the interpreter, he was reserved, uncertain if we would judge him, or fail to understand him. When I as interpreter let him know that I too was Cuban, he relaxed, and we could discuss recent events and use Cuban slang. Only then did he open up about his sadness and anxiety. His understanding of his worries and their possible solutions became clearer to all. We all felt comforted that we understood each other much better, and he expressed his relief and gratitude for our interpreter’ s ability to put him at ease.
Interpreters can improve outcomes and doctor-patient relationships, especially by making dialogue more accurate, and by adding cultural context and sensitivity. Clinicians should always individualize their speech to be patient appropriate. 9 Similarly, interpreters should be actively involved in patient care and physician relationships. The recognition of interpreters as crucial members of a medical team is pivotal to providing high quality, equitable care and transforming doctor-patient relationships.
References
1
Lee, J. S., Pérez-Stable, E. J., Gregorich, S. E., et al.( 2017). Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency. Journal of General Internal Medicine, 32( 8), 863 – 870. https:// doi. org / 10.1007 / s11606-017-3983-4. Accessed August 5, 2025.
2
Labaf, A., Shahvaraninasab, A., Baradaran, H., et al.( 2019). The Effect of Language Barrier and Non-professional Interpreters on the Accuracy of Patient-physician Communication in Emergency Department. Advanced Journal of Emergency Medicine, 3( 4), 1-5. https:// doi. org / 10.22114 / ajem. v0i0.123. Accessed August 5, 2025.
3
Karliner, L, S., Jacobs, E. A., Chen, A. H., et al.( 2007). Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature. Health Services Research, 42( 2), 727 – 754. https:// www. ncbi. nlm. nih. gov / pmc / articles / PMC1955368 /. Accessed August 5, 2025.
4
Karliner, L. S., Pérez-Stable, E. J., Gildengorin, G.( 2004). The language divide. Journal of General Internal Medicine, 19( 2), 175 – 183. https:// doi. org / 10.1111 / j. 1525- 1497.2004.30268. x. Accessed August 5, 2025.
5
Habib, T., Nair, A., Von Pressentin, K., et al.( 2023). Do not lose your patient in translation: Using interpreters effectively in primary care. South African Family Practice, 65( 1), 1-5. https:// doi. org / 10.4102 / safp. v65i1.5655. Accessed August 5, 2025.
6
Keller, M. S., Carrascoza-Bolanos, J.( 2023). Pharmacists, nurses, and physicians’ perspectives and use of formal and informal interpreters during medication management in the inpatient setting. Patient Education and Counseling, 108: 107607, 1-18. https:// doi. org / 10.1016 / j. pec. 2022.107607. Accessed August 5, 2025.
7
Pandey, M., Maina, R. G., Amoyaw, J., et al.( 2021). Impacts of English Language Proficiency on Healthcare access, use, and Outcomes among immigrants: a Qualitative Study. BMC Health Services Research, 21( 1), 1 – 13. https:// doi. org / 10.1186 / s12913-021-06750-4. Accessed August 5, 2025.
8
Juckett, G., Unger, K.( 2014). Appropriate use of medical interpreters. American Family Physician, 90( 7), 476 – 480. https:// pubmed. ncbi. nlm. nih. gov / 25369625 /. Accessed August 5, 2025.
9
Gutierrez, A. M., Statham, E. E., Robinson, J. O., et al.( 2019). Agents of Empathy: How Medical Interpreters Bridge Sociocultural Gaps in Genomic Sequencing Disclosures with Spanish-speaking Families. Patient Education and Counseling, 102( 5), 895 – 901. https:// doi. org / 10.1016 / j. pec. 2018.12.012. Accessed August 5, 2025.
10
Schwei, R. J., Guerrero, N., Small, A. L., et al.( 2019). Physician perceptions of the types of roles interpreters play in limited English proficient pediatric encounters and how they evaluate the quality of interpretation. Primary Health Care Research & Development, 20, 1-6. https:// doi. org / 10.1017 / s1463423618000890. Accessed August 5, 2025.
Adriana Mulet Miranda is a recent graduate of Bellarmine University, where she earned a Bachelor of Science in both Neuroscience and Biochemistry & Molecular Biology. She is currently applying to medical school and volunteers as a medical scribe and Spanish interpreter at the Family Community Clinic.( non-member)
Dr. Lippmann is a retired psychiatry professor from the University of Louisville School of Medicine. Subsequently, he regularly provides primary medical care practice at the Family Community Clinic, clinically mentors lots of students, residents and international medical graduate physicians and teaches scientific medical writing seminars.
22 LOUISVILLE MEDICINE