10 FYi • Advice

Overcoming communication barriers with patients can be challenging. Dr Naeem Nazem looks at the pitfalls of Google Translate and other solutions


NE of the many rewarding aspects of practising medicine is the ability to engage with people from a wide range of socio-economic and cultural backgrounds. But communication difficulties

can arise and these have the potential to negatively impact patient care. In dealing with limited English proficiency to motor speech disorders, there are a number of pitfalls to avoid.

Language barriers An obvious, and increasingly common, risk area is treating patients who speak little or no English. This can cause significant difficulties. When faced with a language barrier

between you and your patient, the ideal solution is to have a certified interpreter present. If so, be sure to record the interpreter’s details within your contemporaneous medical entry. However, logistical difficulties often mean that a professional is not readily available. In these circumstances, first check if your hospital has a policy on interpreter and translation services and be sure to follow it. If an interpreter is not readily available, consider whether it is possible to defer your interaction with the patient until one can be arranged. You

or friends who are keen to be helpful and translate for patients. This may seem like the most convenient (not to mention cost-free) solution but there are pitfalls. The first and fundamental issue to consider is your patient’s right to confidentiality and your obligation not to disclose their personal information to a third party without consent. Another relevant consideration is the lack

of any training or accreditation for such an ad hoc interpreter. Do they understand the important points you are making? Even if they do, can you be sure they are relaying the information accurately? Although this is important in all aspects of medical care, it is essential when you are seeking your patient’s informed consent. MDDUS has encountered several cases of complaints and accusations of clinical negligence in which patients have stated they were not aware of all the risks because they had not been communicated by the interpreter.

It is also important to keep in mind that

friends or relatives of a patient are not impartial and may have their own agenda which may not align with your patient’s. As a consequence, they may filter the information they communicate to the patient, or amend


may want to discuss your decision to postpone with senior colleagues to ensure they are also content it does not compromise patient care.

Help from friends or family In a busy hospital setting it is often tempting just to “make do” with whatever resources are available. Doctors often encounter relatives

responses to suit their own motivation. That said, there is no specific rule

preventing you from seeking their assistance. A patient may be adamant that they want a particular person to translate for them, or circumstances may justify seeking their assistance. In these cases it is important to make a comprehensive note explaining that a

friend/relative is acting as interpreter. Include their name and a brief record of why you believe it is appropriate or necessary, and bear in mind the pitfalls mentioned above.

Smart apps Who needs a human interpreter when you’ve got technology, right? Given the difficulties

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