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Study: Medical Advice Often Gets Lost In Translation
By Robyn Suriano | Sentinel Staff Writer
January 6, 2003
The nurse gave simple instructions for treating the ear infection: The little girl should swallow a teaspoon of medicine three times a day for 10 days.
But the Spanish-speaking mother never heard that. The interpreter mistakenly told the mom that the medicine was "por los oidos" or "for the ears," rendering the instructions and the antibiotic useless.
Such botched interpretations could be a major source of medical mistakes, according to a study out today that found an alarming number of errors in translation between Spanish-speaking patients and English-speaking health-care professionals.
On average, 31 mistakes were made per visit, and most of the errors -- 63 percent -- had the potential to cause medical problems. The difficulties occurred more often when a bilingual staff member or relative was pressed into service. However, professional interpreters also made mistakes.
"We were surprised first by the sheer volume of mistakes overall and second, that professional interpreters made as many errors of clinical significance as they did," said Dr. Glenn Flores, the study's lead author and an associate professor of pediatrics, epidemiology and health policy at the Medical College of Wisconsin.
About 19 million people in the United States have limited English abilities, according to the 2000 census, which counted more than 63,000 people in Central Florida who do not speak English well or at all.
While Spanish is the second-most-common language in the country, there are more than 300 non-English languages used nationwide. Oftentimes, there simply aren't any interpreters available in hospitals or doctors offices.
Lyleany Moya, 33, of Orlando has been delaying a visit to her doctor after she was told to bring an interpreter with her who is fluent in both Spanish and English.
Moya doesn't know many people here since moving from Puerto Rico eight months ago, and she isn't comfortable taking a casual acquaintance with her to medical appointments.
"It's frustrating for me," said Moya, in Spanish. "I speak some English and I'm trying, but I don't like depending on someone else. I know I need to go to the doctor and get better."
Insurers asked to contribute
Because good medical care hinges on good communication, more must be done to address the problem, Flores said. The study calls on insurance companies to start paying for interpretation services, which would save them money in the long term, Flores said.
In one case back in 1984, Flores said, an interpretation error in Miami led to a $71 million settlement for a man paralyzed from a ruptured brain aneurysm. The man claimed he was misdiagnosed after hospital personnel took his girlfriend's use of the word "intoxicado" to mean that he was drunk. She was using the term to mean "nauseous."
"You can either spend a little bit up front or pay a lot later when you have these medical errors and even deaths that lead to lawsuits," Flores said.
Federal law requires that hospitals accommodate non-English-speaking patients by hiring professional interpreters or using volunteers from their staffs who are fluent in other languages. They can also use community volunteers or interpretation services provided via phone, for example.
But as the study shows, even professional interpreters need extra training for the medical setting, where many factors complicate the process.
Medical jargon can be difficult to interpret. Sometimes, there simply are no comparable words in the other language. Also, people can get emotional when health issues are being discussed and feel uncomfortable discussing sensitive topics. Interpreters have to keep their own biases and opinions out of the conversation.
"Being bilingual doesn't automatically make you an interpreter," said Cynthia Roat, co-chair for the National Council on Interpreting in Health Care, which promotes interpretation in health care. "You need a special set of skills to take a message in one language and cultural context and interpret it in another."
In the study, doctors analyzed audiotapes of 13 pediatric visits made to an outpatient clinic of a Massachusetts hospital from 1995 to 1997. The 13 cases were pulled out of a larger group of more than 100 that are being reviewed for a different study.
In evaluating the tapes, experts lumped the interpretation mistakes into general categories, including the omission of information, adding information, substituting words or expressing personal opinions.
In all, 396 errors were noted in just those 13 visits, including mistaken directions for using medication; failure to tell the doctor all the symptoms that were being described; and not asking the parent about drug allergies. Some of the errors also fell into the category of "false fluency," in which a word or phrase that has no meaning in the Spanish language is used.
These mistakes occurred mostly when the physician would attempt to speak with the patient directly, usually when the interpreter was out of the room for some reason.
The study was not designed to see whether any patients actually suffered from the mistakes, but Flores said, it's likely that some did. "I can't imagine that putting amoxicillin in a baby's ear has a good outcome," Flores said. "What we're seeing is that this is a new form of medical error, if you will, and we think it's a crucial one that people need to think about."
For now, hospitals deal with language differences mostly through bilingual staff members, who typically do not receive specialized training.
Chain requires training
But one local hospital chain, Orlando Regional Healthcare, does require its staff members who also serve as interpreters to go through a training program. "In many hospitals, people are pulling family members, relatives or even strangers out of the waiting room to do a quick interpretation, and that's where the risk is," said Monika Viera, co-chairwoman of Orlando Regional Medical Center's cultural-diversity committee that is addressing the problem. "We're trying to avoid that kind of incident here by registering our volunteers and training them."
The hospital also has put together a cultural guidebook that helps staff learn a little about the peculiarities of any given nationality. For example, the "OK" sign in America is offensive in Greece, and pointing is very impolite in Japan.
Roat from the National Council on Interpreting in Health Care said the cultural component is crucial, because medical problems evoke many emotions, stress and fears that are shaped by cultural differences. "The interpreter is right in there, dealing with life-and-death issues," Roat said. "There are cultural differences in the ways that people understand what makes them sick and what makes them get better, and the closer you get to major life moments -- the birth of a baby or someone's death -- the more culture defines what people believe and expect."