Communication Breakdown

September 6, 2005 12:34 AM

Communication Breakdownis a problem that often prevents doctors from treating immigrant patients effectively. Language and cultural barriers prevent patients from understanding doctors instructions, sharing their symptoms of illness, and even from being examined by the doctor in cases where religious beliefs prohibit contact with someone of the opposite gender.
posted by gregb1007 (9 comments total)

I work as a medical interpreter (Mandarin-English). I haven't had as many of these problems as some -- there are a lot of Somali interpreters here, for example, as well as Hmong -- who I'm sure have a lot more trouble.

But still I sometimes wish I was allowed to act more as a cultural interpreter as well as just a linguistic one... Mandarin speakers will not, for example, ask their doctor nearly as many questions as would Western people. Asking doctors questions is very literally "questioning authority" and a challenge to the social order, as well as a way to lose face for all parties concerned, so a lot of Chinese people feel uncomfortable asking when they don't understand. It'd be nice if I was allowed to tell doctors "I can tell she doesn't feel comfortable asking you, because you're an authority figure" or whatever.
posted by jiawen at 1:15 AM on September 6, 2005

This is one of the reasons it upsets me so much that insurance companies in the US are allowed to restrict people's choice of doctors. Many of these people, particularly those in cities, could be seeing doctors of their own culture or at least who speak their language without need of an interpreter. It's crazy that people can't just go to the doctor that best suits their needs.
posted by duck at 5:23 AM on September 6, 2005

greg, thanks for the post. jlawen, great link, "The Spirit Catches You and You Fall Down" is one of my favorite books. It's hard to grasp that good will is not enough.
posted by since1968 at 5:33 AM on September 6, 2005

A while ago, the West Midlands had the exact opposite problem. There were so many immigrant doctors and nurses that they had difficulty understanding the locals. The health authority had to publish a booklet to help the doctors with some of the odder phrases of the local dialect.
posted by salmacis at 6:14 AM on September 6, 2005

But still I sometimes wish I was allowed to act more as a cultural interpreter as well as just a linguistic one... It'd be nice if I was allowed to tell doctors "I can tell she doesn't feel comfortable asking you, because you're an authority figure" or whatever.

I don't quite understand what you mean by "not allowed." Is it forbidden (ie, if you do anything but strictly interpret you'll be fired), or is it just not done? What would happen if you said "I can tell she doesn't feel comfortable asking you, because you're an authority figure"?
posted by languagehat at 8:16 AM on September 6, 2005

As an interpreter, I'm supposed to aim for total objectivity. No gloss (either meaning), no filtering. It's not my job to advocate, or to console. Just to faithfully transmit back and forth. If the patient says "The American health system sucks, and there are too many niggers here" (yes, that actually happened once), it's my job to transmit that directly, as offensive as I may find it. If the patient says "This interpreter sucks, and I want a new one", it's my job to translate that directly, too.

More on the topic of asking questions and culture: If the patient says "I should be more filially pious to my parents" and the doctor doesn't know what "filial piety" is, it's the doctor's job to ask. If the doctor says "We'll have to check the baby's levels of alpha fetal protein" and the patient doesn't know what "alpha fetal protein" is, it's the patient's job to ask. If I don't know what it is, I ask; but if the patient doesn't know, but doesn't ask, there isn't much I can do.

Sometimes, when the doctor says "appendicitis" or whatever and the patient comes right back with "What's that?" the doctors look at me like I've translated it wrong. I hope they get the sense, eventually, that I'm just translating exactly what the patient is saying -- including their lack of knowledge. A lot of doctors get used to interpreters who blithely keep the doctors out of the conversation for minutes at a time, leaving them to think "What am I missing? What misinformation is being supplied, while I sit here helpless?"

As for what the penalties are... It's really a matter of professional ethics. That means that the biggest penalty would be that I'd feel guilty. Doctors, though, would also start to think "If she's doing this much filtering on my end, what's she doing on the patient's end?" I know there are other interpreters who don't care at all about objectivity. They seem to be pretty successful, too, because they just edit out things like "this interpreter sucks" and seemingly give patients the impression that they have no choice who their interpreter is. But I hold myself to the ethics, even if the penalties are slow and indirect at best.
posted by jiawen at 11:40 AM on September 6, 2005

But I hold myself to the ethics

I understand about the need for objectivity and accuracy, but I would think if it's clear the patient isn't understanding what's going on and it may cause a life-threatening problem, a higher ethics would come into play. But I've never been in that situation, so I don't really know what I'm talking about.
posted by languagehat at 2:31 PM on September 6, 2005

languagehat - read the book that jiawen linked to, it's pretty surprising how difficult translation can be, especially when institutional guidelines are in place. The book shows an extreme example of what can happen when both sides of the equation are unable to understand each other. I really loved the book and felt that it read very much like a novel.

Additionally, the whole subject of translation is just one of the problems faced by health care providers in general and public health practitioners in particular. We don't always realize that public heath facilities face unique challenges and need to use approaches that don't always seem intuitive.
posted by spaghetti at 9:05 PM on September 6, 2005

It's hard to say what's higher ethics: trusting the people involved (doctor and patient) to ask questions and to manage the limited time available themselves, or to take a more active role in managing the doctor-patient interface. There are numerous advantages and disadvantages to both ways of doing interpreting. It really is a difficult problem; thus why I only sometimes wish I was allowed to be more proactive.

What really needs to happen is that we get a social worker in there at all times, as well as an interpreter. Or, even better, that doctors are trained in cultural awareness and given the time to exercise it.
posted by jiawen at 12:51 AM on September 7, 2005