Speaking the Language

Translation has always been an important function in the preservation of the doctor-patient relationship. But it has always, in the past, been a background function with not much discussion about it. However, recently within the U.S. the Medicare requirements require that the physician provide translation for physician-patient communication if communication is limited by the inability to communicate in a common language. The necessity for translation in informed consent is obvious.

But, translation has many obstacles which keep from being a faultless substitute for clear native communication. A physician who learns and can casually speak a non-native language may find it satisfactory to go shopping or go on a trip but may be missing much of the subtleties in communication necessary to obtain the best clinical conversation with a patient. Using a translator doesn’t guarantee that these subtleties will be related to the patient or to the physician. The physician has no control or ability to monitor that the expressions he has put to the translator or those expressions which are being related in return from the patient are being accurately reproduced. Some translators who might be used in practice might not understand fully what the patient or physician want to say or may incorporate words or even a philosophy which is generated by the translator him/herself. Sometimes, the translator is hindered by his or her own ignorance of the technical aspects of medicine.

As I noted in a previous commentary, there are cautions to consider when using family members as translators. Family members, though eager to perform translating duties, may not perform the function in an unbiased and impartial manner. Their translation may be influenced by their own conflict of interest issues and therefore not fully represent what the physician wants to tell the patient or what the patient is actually responding.
In some cases it becomes obvious to the physician that the family translator is doing more than simply translating but also at the same time counseling the patient.

Translating, though obviously required for full patient autonomy and informed consent is not the best tool to do this. Communication by a non-native physician who has “learned” the language may also be limited. The best means for the patient to receive and transmit medical information from and to the physician is for the patient to select a physician who is a native to the language. This beneficial relationship with regard to verbal communication would also fit a concept, which has been put forth by ethicist Dr. Robert Veatch.in which better understanding of the moral and religious values of the patient by the physician could be accomplished if the patient selected a physician with these values similar to that of the patient. The practicality of attempting to make such a selection in our current system of medicine is questioned. But with the global relocation of physicians and many foreign born physicians practicing in the United States, for example, perhaps finding a doc who speaks the language may not be too difficult. ..Maurice.