Dear Medical Team: Your Words Are Gold


If your interpreter doesn’t approach your messages like gold (a.k.a. extremely valuable, precious, and of great value) each and every time, and for each and every utterance, be concerned. Before you go on an ego trip, your words are not gold each an every time you speak. You sometimes say things that are rather irrelevant or repetitious or of little consequence to the immediate or long-term outcome of the encounter. It’s fine for you to think that. It’s fine your patient to think that. It is not fine for your interpreter to think that. Your interpreter treats your words like gold every time, every utterance. Help your interpreter treat your words like gold.

Don’t get upset if the interpreter asks you for clarification. Your interpreter filters your words through any number of channels to ensure comprehension of what you said before rendering the interpretation. Any of these filters might trigger the need to ask for further clarification before barreling ahead with the interpretation. For example, you might have said something that could mean a number of different things. Think of how many words have multiple meanings. Even with context, the interpreter might need to clarify. When that happens, remember that the interpreter is treating your words like gold.

Try really hard not to speak in code. Medical interpreters can handle a lot of medical jargon, but you should still make every effort to speak like a regular person talking to another regular person. For example, avoid saying “Medical history?” when you mean to say, “Do you have any medical history that we should be aware of – like past surgeries or chronic conditions or illnesses?” Avoid saying “LMP?” when you mean to say, “When was your last menstrual period?” Using complete thoughts goes a long way to establishing effective communication. Your words are gold. Don’t hold back. Use them.

Also avoid talking like Jane and Tarzan, pointing at objects and grunting out monosyllabic words. Imagine you’re in a hospital in France, and a French-speaking nurse enters the room and points to the water closet and says “toilet” in heavily accented English. You respond by saying “yes” because she did indeed accurately name the object to which she was pointing. Unfortunately for you, the nurse thought she had clearly conveyed - through her careful enunciation of the word toilet and her emphatic pointing to the named object - this question: “Have you urinated since coming out of surgery?”  Remember how you said “yes”? Well, guess what. You have not urinated since surgery because something went wrong, and your urethra is punctured. You can’t feel anything now because of the awesome pain medications that have you flying high. Of course since everything seems to be in working order, you are discharged from the hospital. Several hours later, when the anesthesia has completely worn off, and it’s just you and the pitifully inadiquate oral pain medication, you notice extreme discomfort.  You give a call to the surgery center’s after-hours number, but since everything was supposedly in working order when you left, the on-call doctor dismisses your concern – patient just has a low pain tolerance, take more meds, follow up tomorrow. By tomorrow you’ve taken more pain meds to no avail, and you end up in the Emergency Room. At some point someone asks the question “when was the last time you urinated.” You reply, “Yesterday morning before my surgery.” Protocol dictates a peek into the pelvis, which reveals, surprise! A whole bunch of liquid that shouldn’t be there. It’s back to the operating room for you. How did we get to this point? One word coupled with one gesture.

The previous scenario was fiction based on reality. I have indeed seen a nurse point and say “bathroom” and a patient said “yes.” The extreme case described was avoided as additional communication allowed for accurate and complete conveying of information.

The following is not a fictional story, though the names and other identifying details have been changed to protect the innocent and to comply with this thing commonly referred to as HIPAA, not to mention ethical standards of practice for medical interpreters (and all interpreters regardless of specialty to the best of my knowledge).

Again, your words are gold.

The Nurse Practitioner asked the mother of the 3-year-old, “What time does your daughter usually wake up?” The mother replied in Spanish, “I usually get her up at about 7:30 or 8:00.” As the interpreter, my brain, which was converting the mother’s message while following the flow of the English conversation, initially formulated the message, “She usually gets up at about 7:30 or 8:00.” A slight change of the subject of the sentence, but the provider’s objective of establishing a time was achieved, so all is well, right? Wrong. I self-corrected before releasing my initial interpretation, and instead, accurately said, “I (referring to the mother) usually get her up at about 7:30 or 8:00.” The near error of my initial interpretation, which never was spoken and only floated in my head for a brief moment before being dismissed, was thereafter revealed as the Nurse Practitioner zeroed in on the fact that the mother was waking the child up. What’s the big deal? As the interpreter, I don’t know, and it doesn’t matter that I don’t know, but to the NP, it resulted in a thorough discussion about quality of sleep and that the child should be waking up on her own, not being coaxed to get out of bed – an indication that she wasn’t getting the kind of sleep she needed. Had my initial interpretation been the one I’d gone with, the topic of having to arouse the child in the morning would reasonably never have come to light and never been addressed. Would the child have gone on to live a healthy and fulfilling life attending an Ivy League school and becoming president of a gazillion dollar company that figures out how to establish word peace? Probably, but that’s not the point. The point is that your words are gold, and no interpreter, no interpretation, should alter their meaning, either by adding or omitting or missing the target.

Keep in mind that precision of message is not the same as precision of word. You might notice that different interpreters of the same language pair use different words to say what you’ve said. You might also have a certain degree of fluency in the patient’s language or pick up on similar sounding words and think that the interpreter is somehow changing your message or simply showing off their medical terminology prowess. It’s more likely that the interpreter is skillfully weaving the tapestry of your words into a tapestry of words that looks precisely the same for the patient as it does for you. An interpreter worth his or her weight in gold will have the ability to do this with seemingly little effort. Although I assure you, it is anything but effortless to achieve.

Medical interpreters, what other tips do you have for the medical team to help you treat their words like gold?

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