Medical Interpretation: The Complexities in Communicating Medical Care

Jessica Lan-Anh, 2/1/25

This past August, I was driving back from school to a hospital in Houston to provide my mom with translation and emotional support after an accident that occurred at home. After an eternity in the emergency unit, a social worker finally arrived to speak with her. I asked if I could assist with translation since my mom doesn’t speak English, but the worker informed me that I could only be present for support, not to translate. She wheeled in a computer screen on a stand reminiscent of Karen from SpongeBob and began pressing buttons to connect with a Vietnamese translator. A woman appeared on the screen, and I thought, “Okay, this could work.” My Vietnamese is conversational at best, and I knew I couldn’t manage the complex medical jargon. A fluent translator seemed like the best option for my mom. However, as they spoke, I noticed something troubling: the translator struggled to grasp my mom's words, losing significant details. I exchanged worried glances with my mom, realizing the translator's narrative didn’t align with what she was trying to convey. This interaction prompted me to reflect on the extent of translation services available for non-English speakers and why I could not interpret for my mom. Was my bad experience with translational services just anecdotal, or were there studies to back up the viability of these in-person and remote translators? Here is what I have learned through my research on healthcare translation services, their accuracy, and future developments. 

First, let’s examine some options for in-person translation— specifically professional and ad hoc interpretations. An ad hoc interpreter is any bilingual or multilingual individual who is not trained in medical interpretation and may be called upon to assist someone with limited English proficiency (LEP). Typically, this interpreter is a family member, such as a daughter, son, or sibling, but it can also include bilingual healthcare providers or volunteers in waiting areas. While this practice was once common, ad hoc interpreters are discouraged mainly due to serious emerging concerns. 

The primary issue is that untrained interpreters often struggle to convey the nuances and complexities of medical terminology accurately. A study found that two significant interpretation errors frequently occur with ad hoc interpreters in clinical settings: omissions and answering for patients/clinicians. Omissions happen when the interpreter removes essential words, phrases, or sentences from the original message, often due to their unfamiliarity with medical terminology. This can lead to miscommunication as they attempt to simplify complex medical concepts. Answering for patients/clinicians occurs when the interpreter responds without accurately relaying the actual questions or answers. This problem was significantly more common in ad hoc cases than those involving professional medical interpreters. 

Moreover, conflicts of interest often arise when the interpreter is a family member. This personal connection can bias the interpreter, impacting their ability to deliver impartial translations. In many cases, interpreters may omit distressing details to shield the patient, compromising the accuracy of the medical information. Additionally, younger family members often take on the interpreting role and may feel undue pressure to perform well, creating a dynamic where sensitive health discussions become even more complicated. Unfortunately, this bias can lead to dire consequences; studies indicate that the quality of care suffers significantly when ad hoc interpretation is used, sometimes as has been seen in extreme cases that have resulted in death. 

So, what alternatives exist if family members cannot be relied upon for interpretation? The most effective solution is to employ more professional medical interpreters. In-person interpretation is ideal because it allows for the nuances of non-verbal communication, such as body language, to be considered. However, there has been a long and persistent shortage of medical interpreters in healthcare settings. As of 2021, over 25.7 million people in the U.S. ages five and older reported having LEP yet only 17,526 medical interpreters were employed in the country—a stark contrast that underscores the need for more interpreters, particularly for underrepresented languages. Becoming a medical interpreter requires specialized training, including coursework, proof of language proficiency, and passing a certification exam administered by the Commission for Healthcare Interpreters or a similar organization. These barriers make it difficult for patients to access the necessary interpretation services. 

Another promising alternative is professional video-conferencing interpretation, also known as Video Remote Interpreting (VRI), which is gradually being implemented in healthcare settings. VRI allows real-time video calls with interpreters, is available nearly 24/7, and accommodates LEP patients and those requiring American Sign Language (ASL) interpretation. While VRI offers significant cost savings compared to in-person services and ensures broader availability, studies show that patients and clinicians still prefer in-person interpreting. Connection issues can hinder the quality of remote interpretation, making it less reliable during critical medical situations.

       The need for medical interpreters is a growing challenge that cannot be resolved overnight. As the immigrant population in the U.S. continues to increase, so will the demand for LEP services. One immediate step pre-medical students like you and I can take is learning a second language and that language’s relevant medical terminology. Many universities are developing programs aimed at helping health professional students acquire these skills. For example, Sam Houston State University offers a minor in Spanish Interpretation and Translation for Health Profession, and Texas A&M University has a similar minor in Spanish for the Health Professions. These initiatives can significantly enhance patient care and bridge the communication gap many face in medical settings. 

References 

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https://www.daytranslations.com/blog/ad-hoc-interpreter/ 

Detlef, P. (2023, March 1). Breaking Down Remote Interpreting: The Future of Healthcare Communication in Houston and Dallas Breaking Down Remote Interpreting: The Future of Healthcare Communication in Houston and Dallas. 

https://www.24hourtranslation.com/breaking-down-remote-interpreting-future-healthcare communication-houston-dallas.html 

Dimitriu, R. (2004). Omission in translation. Perspectives: Studies in Translatology. https://www.tandfonline.com/doi/abs/10.1080/0907676X.2004.9961499 

Francesca, G., Luciano, K., Kavitha, P., Javier, G., Lurmag, O., Chi-Hong, T., & Jyotsna, C. (2007). The impact of medical interpretation method on time and errors. Journal of General Internal Medicine, 22 Suppl 2(Suppl 2). 

https://doi.org/10.1007/s11606-007-0361-7 

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https://www.thehastingscenter.org/medical-interpretation-in-the-u-s-is-inadequate-and-ha rming-patients/ 

Glenn, F., M Barton, L., Sandra, M., Barry, Z., Milagros, A., Leonardo, M., & Eric, H. (2003). Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics, 111(1). https://doi.org/10.1542/peds.111.1.6

Haldar, S., Pillai, D., & Published, S. A. (2023, July 7). Overview of Health Coverage and Care for Individuals with Limited English Proficiency (LEP). 

https://www.kff.org/racial-equity-and-health-policy/issue-brief/overview-of-health-coverag e-and-care-for-individuals-with-limited-english-proficiency/ 

LeClair, A. M., Sweeney, M., Yoon, G. H., Leary, J. C., Weingart, S. N., & Freund, K. M. (2019). Patients’ Perspectives on Reasons for Unplanned Readmissions. The Journal for Healthcare Quality (JHQ), 41(4), 237. https://doi.org/10.1097/JHQ.0000000000000160 

Locatis, C., Williamson, D., Gould-Kabler, C., Zone-Smith, L., Detzler, I., Roberson, J., Maisiak, R., & Ackerman, M. (2010). Comparing In-Person, Video, and Telephonic Medical Interpretation. Journal of General Internal Medicine, 25(4), 345–350. 

https://doi.org/10.1007/s11606-009-1236-x 

Nápoles, A. M., Santoyo-Olsson, J., Karliner, L. S., Gregorich, S. E., & Pérez-Stable, E. J. (2015). Inaccurate Language Interpretation and its Clinical Significance in the Medical Encounters of Spanish-speaking Latinos. Medical Care, 53(11), 940. 

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Zippia The Career Expert. (2021, January 29). Medical Interpreter Demographics and Statistics [2024]: Number Of Medical Interpreters In The US. 

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