12 • Translation


As increasing numbers of UK patients speak little or no English, Dr Susan Gibson-Smith offers advice on bridging the language divide


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HE number of languages spoken across the UK is thought to be more than 300, with hotspots in cities such as London, Birmingham, Sheffield and Glasgow.


Society is more multilingual than ever, which means GPs are increasingly likely to have patients with what is known as “limited English proficiency”. Add to that potential cultural misunderstandings and effective communication and shared decision making suddenly become more challenging. Complicating the situation further is the issue of increasing practice workloads and diminishing resources. So how can we ensure we provide a high standard of care to this patient group?


Consider the following scenario: The patient, Mrs W, was booked for a routine 10-minute appointment. She had recently moved to the area and was accompanied by her husband. I asked if she minded him being in the room. He answered ‘no’, his wife did not mind as he went everywhere with her to translate because she spoke no English. I asked what the problem was and the husband explained she had been very tired and unhappy recently and had stomach pains. I asked Mrs W a few questions, all of which the husband answered, sometimes with a brief word to her in their language but usually without conferring with her at all. I was becoming increasingly frustrated that I was not able to communicate effectively with Mrs W. I asked if I could examine her abdomen. Her husband said yes and I invited her up on to the couch. She did not seem to understand what was happening and I asked him to explain what I was doing. The examination was normal apart


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from some epigastric tenderness. I then suggested some routine blood tests. The husband said that would be fine but did not translate what I had said to his wife about my management plan and what was happening. I arranged an appointment to see them with the results in 10 days. The patient and her husband both seemed pleased with the outcome and smiled as they left however I felt very unsatisfied with the consultation which had taken 25 minutes. What could I do differently the next time?


Best care Demand for GP appointments is extremely high and most practices still schedule standard 10 minute slots. This can be tricky to manage at the best of times, but particularly when treating a patient with poor English. However challenging this is, doctors cannot allow it to affect the care they provide. As RCGP chair Professor Helen Stokes-Lampard says: “GPs will always strive to deliver the best possible care to all of our patients, regardless of their nationality or ability to speak English. GP practices that serve a population where a lot


of patients might not speak English as their first language will take the need for longer appointments and translators into account when planning their services.”


Consultation tips Translators It is important to note that any translator must be reliable and appropriate. There is a clear need for one in our scenario and whilst it may not have been possible in the first appointment it would be important to book one for all future appointments, attending either in person or assisting by phone. Check arrangements with your health board/trust/CCG. Some practices place a flag on the patient records so the receptionist knows an interpreter is required when the appointment is booked. This allows a longer appointment time to be arranged and for the translator to be booked in advance. When using a professional translator, ensure


they are qualified and appropriate for the consultation. Note their details in the patient record and explain at the start that you must hear all the information offered by the patient. Maintain eye contact with the patient and speak


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