Translation: A language barrier
In previous blog entries, we have discussed some of the challenges of communication in healthcare. In this blog, we focus on translation. Translation is a language barrier for many people, especially in the ever-growing globalised societies we live. We will touch on some of the pros and cons of using family members to translate information to patients who do not speak the native language. To help bring this issue to life, I use some of my personal experiences, as a young translator for my mum to help guide this discussion.
My parents are Ghanaian immigrants who moved to Italy some years ago. They later moved to the UK, where we now live. They don’t speak Italian or English. For as long as I can remember, I have been considered the natural person to translate for my parents during their various healthcare consultations. In contrast, I speak fluent Italian and English and, they trust me to translate information to them in a way that they will understand. Interestingly, no one has ever suggested we use a translation service, instead of me.
This has for the most part been okay for me. From a young age, I have had a keen desire to become a doctor. So, science interests me. Hence, understanding illness and disease fascinate me. In many respects, my experience has been positive as I have learned about disease, and have a better understanding of medical terminology. Plus, I have mostly enjoyed translating for my mum.
Translating for my mum
She has a long term condition which has made her very unwell at times. So, she has needed many conversations with her doctors and nurses. Therefore, each time, I have translated information for her.
For example, most recently, I was sitting with my mum in the living room at home. She was watching TV, and I was working on an assignment for Uni. The phone started to ring and made us both jump. We were both engrossed in our own little worlds. Mum reached over to get the phone, but she suddenly looked uncomfortable. She frowned and leaned forwards in her chair. I could read the signs. Mum couldn’t understand what the other person was saying on the phone. Any minute I was going to be called upon to help her.
Soon enough, she handed the phone over to me. It was a nurse asking if I would interpret some information to my mum about her medication. I willingly obliged. Without hesitation, she proceeded to explain what was needed, and I translated for mum. The nurse finished the conversation by asking if she could contact me directly in future. Not for the first time; I came off the call and wondered what would have happened if I wasn’t there to take on this role?
Consequently, I started to reflect on the pros and cons of using family and friends to interpret for people. I came up with a list and I have to admit the cons list was longer. Let us look at these in turn.
Pros of translation
- It seems logical that a patient would want a family member to interpret for them if possible. This might be because they can relate to them easily1.
- In addition, the patient may have a much stronger relationship with their family member which is based on trust and honesty. My mum, for example, trusts that I will interpret and convey information on her behalf which is an honest reflection of what is being discussed.
- Using a family member to interpret is convenient for the patient and for the healthcare provider. They are readily available (think of mum’s phone call) and their presence in a face to face interaction can save time.
- Using family members does not cost the health service.
Yet, using family members to translate does seem to come with some caveats. One study conducted in Australia concluded that 54% of 37 healthcare professionals believed that it was possible to use family members to translate information to young children. However, they believed it was only appropriate to translate simple tasks, like, ‘move your arm’, or ‘stand up‘. They also believed that family should only be called upon to translate information in the event of an emergency situation.2 This study was based in a paediatric and neonatal department, and we are mostly referring to adult care, I guess in this blog, but some of these concerns raise some doubt as to whether family members should be used to break down language barriers. Which links me nicely to my list of cons.
Cons of translation
My mum has a long-term condition which has made her very ill at times. When I was younger, I didn’t fully understand what information I was translating. But I can vividly remember the times I received information which made me feel scared and overwhelmed. This resulted in me often omitting a few pieces of information offered by the doctor whilst I tried to process everything that was being said. Probably not the best approach to take! But you know, I never received any guidance or support to help me take on this role. I wanted to help my mum where I could but sometimes it was difficult for me.
I am not alone in feeling this way. Another young woman described her experience of having the unenviable task of telling her dad he had cancer. Imagine being 19 years of age and you are the one learning your dad has cancer before he even knows himself? She wanted to cry and run from the room; she was devastated. When you think about it, she had a lot of responsibility placed on her shoulders and she wasn’t prepared for this consultation or her role in it. She had no idea her dad’s illness was as serious as it was.
Moving on from this, there may be aspects of a patient’s medical or social history that are private and sensitive to them. They may not want family members knowing this information about them. In a consultation, they might not have the opportunity to consent to this information being disclosed. This might raise multiple issues for all involved in this conversation.
It is important where possible that the person translating the information remains neutral and can share information clearly and concisely without emotion. But that is an unrealistic expectation when translating for close family members. A report in the British Journal of Medicine, made a compelling argument not to use family members to translate information for this very reason3. Additionally, family members may emphasise certain points based on their own personal experience of events or illness and/or dismiss the patient’s experience altogether.
I realised that I had done this multiple times. As I interpret for my mum, my mind is often torn between expectancy to know her diagnosis and worry when considering the impact of such revelations. We know from the literature about communicating bad news that healthcare professionals often find this hard to do, and yet here I am, being expected to do just that. On top of that, there is the fact that I am thinking of how to translate something effectively, and how to break it down in a way that mum will understand. The emotional burden can be immense. On reflection, I also realise that I often fail to interpret everything my mum is asking me to tell the doctor because my mind is racing and I am trying to get all the answers from the ‘expert’ in the room.
I have touched upon some of the challenges we face as young adults, translating what is often sensitive information to our parents. Whilst we agree to do it with good intentions, we aren’t always very proficient at it. We can’t be neutral and un-emotional. You can’t expect us to be. So, if you can take anything away from my experience please consider what you are doing when asking young people to translate for their parents. Consider the type of information you expect us to translate and if it is complex, or of a very sensitive nature then use a professional translation service. I ask: Would you want your child to translate sensitive information for you?
If you have an interesting story to share along these lines, then please share your experiences with us by completing this short form: https://healthcarecommunicationmatters.co.uk/patient-and-family-experiences/
- Chase-Wesley, R. (2014) Conveying information in the interpreter-mediated medical visit: The case of epistemic brokering. Patient Education and Counselling. 97:1. pp38-46 doi: 10.1080/10410236.2019.1598740https://doi.org/10.1016/j.pec.2014.05.020C
- Pines, R., Jones, L., Sheeran, N. (2020) Using family members as medical interpreters: An explanation of healthcare practitioners normative practices in paediatric and neonatal departments in Australia. Health Communication. 35:7. pp902-909 doi: 10.1080/10410236.2019.1598740
- Rimmer.A. (2020) Can patients use family members as non-professional interpreters in consultations? British Medical Journal. https://www.bmj.com/content/bmj/368/bmj.m447.full.pdf