Every day, the internet and other news sources offer plenty of real-life stories about situations where a breakdown in communication have costly, painful, hilarious, critical or embarrassing consequences. And that’s just between people speaking the same language. Imagine adding another language in there. Translation issues can mean life or death in medical emergencies.
The need for effective communication across languages is especially apparent in a medical setting, and in the case of a medical emergency it could literally mean the difference between life and death.
Medical emergencies and how English becomes critical
It all starts at the source. In the event of an immediate medical emergency — such as a cardiac arrest, anaphylactic shock or a stroke— any verbal or textual communication or miscommunication may have a direct and profound effect on the well-being of the patient.
Even for patients whose native language is English, medical instructions sometimes appear as a smorgasbord of hieroglyphics, Latin and medical code. The Institute of Medicine’s landmark review of medical errors more than a decade ago, found that up to 90 million adults have difficulty understanding medical instructions such as drug dosage and drug-interaction information, resulting in more than 1 million medical mishaps in the U.S. each year.
In addition, many drug labels and instructions are confusing even to the highly educated, for example:
“Take as directed” Directed by whom?
“Take one tablet twice daily” Do you cough this up or split it in half?
“Per os” This common instruction, meaning by mouth, orally, can be mistaken as “left eye” (OS-oculus sinister).
“o.d. or OD” This common instruction, meaning once daily, can be mistaken as “right eye” (OD-oculus dexter), leading to oral liquid medications administered in the eye.
And that’s just for the native English speakers. If non-English patients or patients who are Limited English Proficient (LEP) are added, the potential for miscommunication grows exponentially.
Interpreting and Document Translations
When non-English or LEP people are involved, verbal medical translations are more likely to play a critical role during medical emergencies (as opposed to textual medical translations, such as operation manuals or Instructions For Use (IFU), which are usually further removed from the emergency). The very nature of medical emergencies makes the present, live and immediate interaction between different languages (interpreting) acute and leaves little room for linguistic or cultural miscommunications.
- 18-year-old Willie Ramirez was admitted to a Florida hospital in a comatose state. His friends and family tried to describe his condition to the paramedics and doctors who treated him, but they only spoke Spanish. A medical translation was provided by a bilingual staff member who translated “intoxicado” as “intoxicated”. A professional interpreter would have known that “intoxicado” is closer to “poisoned” and doesn’t carry the same connotation with drugs or alcohol use as “intoxicated” does. Willie’s family believed he was suffering from food poisoning. He was actually suffering from an intracerebral hemorrhage, but the doctors proceeded as if he were suffering from an intentional drug overdose, which can lead to some of the symptoms he displayed. Because of the delay in treatment, Willie became quadriplegic.
- In a study conducted in the Pediatrics department of Boston Medical Center, researchers monitored thirteen encounters between physicians, non-English-speaking patients and their interpreters over the course of 7 months. In six of the cases interpreters were professionally trained; the rest were on-hand, ad-hoc interpreters including nurses, family members or social workers. The results of the study, published in January of this year in the journal Pediatrics, were startling In the thirteen audiotaped encounters, leading to 474 pages of transcribed notes, 396 interpreter errors were found, an average of 31 mistakes per encounter.
Written medical translations, on the other hand, may lack the immediate nature of interpreting, but they can be just as unforgiving or critical when they are done poorly or incorrect.
- In a hospital in Lorraine, France, an error in the medical translation of English instructions for the use of software, led to the death of 3 patients following an overdose of x-ray radiation. The errors occurred in the treatment of 23 men suffering from prostate cancer. It appeared as if there was no French translation of an English manual for an x-ray machine available, and the staff made an error by misusing the software –presumably the software that controlled the dosage. As a result, 23 patients received too much radiation, and three died. Exactly where the medical translation error took place is not clear. The deaths of three of the four patients who passed away were linked to the error. According to the official report, the other 19 patients suffered complications of varying degrees as a result of the radiation overdose.
Language Barriers within the US
If you think this only takes place outside the United States, think again.
The number of US residents who are deemed to be Limited English Proficient (LEP) has increased substantially in recent decades, consistent with the growth in the US foreign-born population. The number of LEP individuals in the United States grew by 80 percent between 1990 and 2010. In 2010, LEP individuals accounted for 25.2 million, or 9 percent, of the US population over age 5. The highest concentrations of LEP individuals were found in the six traditional immigrant-destination states: California, Texas, New York, Florida, Illinois, and New Jersey.
The top 10 languages spoken by LEP Individuals in 2010 are Spanish (or Spanish Creole), Chinese, Vietnamese, Korean, Tagalog, Russian, French Creole, Arabic, Portuguese and lastly, African languages.