Accurate communication is a cornerstone of patient safety and quality care, enabling patients to actively participate in their care. This is particularly crucial given the rise in non-native speakers in healthcare settings. For example, in 2018, 67.3 million people in the United States spoke a foreign language at home. Hospitals and doctors face challenges in addressing this multilingual patient population (such as lack of access to qualified interpreters, time constraints, and resource constraints). This results in providers having to rely on sub-optimal solutions including using family members as interpreters, providers using basic language skills to “get by”, and not addressing cultural differences that affect care delivery. Medical translation offers a solution to these challenges, leading to improved patient outcomes and compliance. For instance, translated discharge summaries help patients understand post-treatment instructions, reducing readmission risk. A study found that patients with access to professional interpreters had better glycemic control for Type 2 Diabetes. Similarly, the use of professional interpreters was associated with increased patient satisfaction and understanding of medical information. When patients can understand their healthcare providers, they are more likely to adhere to treatment plans and medication regimens, ultimately leading to better health outcomes.
Legal Requirements in Medical Translation
If improved patient care is not incentive enough, medical translation is also essential from a legal standpoint. The most important legal framework surrounding medical translation in the U.S. is Title VI of the Civil Rights Act of 1964, which prohibits discrimination on the basis of national origin, including language. This means healthcare providers receiving federal funding must provide competent interpreter services to patients with limited English proficiency (LEP). This includes oral interpretation and translation of vital documents like consent forms, discharge summaries, and patient education materials. While the use of certified medical interpreters is strongly encouraged, the lack of federal standards for certification and reimbursement poses challenges for both healthcare institutions and patients. However, some states have enacted their own legislation mandating continuing education for healthcare professionals, certification for interpreters, and even reimbursement for language services through Medicaid.
Risks of miscommunication in medical settings
The prevailing consequence of inadequate translation is miscommunication. Miscommunication in healthcare settings can lead to serious consequences, potentially causing harm to patients and increasing healthcare costs. One of the biggest dangers is the potential for misdiagnosis and incorrect treatment. If a provider misunderstands a patient’s symptoms or medical history due to a language barrier or other communication breakdown, they may provide a diagnosis or treatment plan that is not appropriate for the patient’s condition. For example, a provider who does not understand a patient’s allergies or current medications might prescribe a treatment that causes a dangerous reaction. This can lead to further complications, requiring additional treatment and potentially leading to preventable death. Additionally, unclear communication regarding medication dosage and instructions can result in patients taking medication incorrectly, leading to overdoses, underdoses, or dangerous drug interactions. Consider the following example provided by Tiwary et al. (2019) in their case report:
A 50 year old female with a new diagnosis of rheumatoid arthritis was prescribed methotrexate 15mg once weekly and folic acid 5mg twice weekly, per standard treatment. The dosing and administration instructions were miscommunicated to the patient, and she consumed 15mg of methotrexate daily for 11 days until she presented to the emergency department with oral sores, vomiting, and pancytopenia. She required an 11-day admission to the ICU for methotrexate toxicity and treatment with leucovorin, GM-CSF, and feeding via nasogastric tube.
This is an extreme example of a non-infrequent miscommunication that can, and often does, occur.
Poor communication can also lead to a breakdown in the patient-provider relationship, decreasing patient satisfaction and making patients less likely to follow medical advice. In some cases, miscommunication can also result in legal issues, including malpractice lawsuits. For example, if a patient does not fully understand the risks and benefits of a procedure due to a language barrier, they may not be able to give proper informed consent, which can lead to legal action. One study found that communication failures were responsible for over 7,000 out of 23,000 medical malpractice lawsuits, resulting in $1.7 billion in costs and almost 2,000 preventable deaths. These findings highlight the devastating impact of miscommunication and emphasize the need for effective communication practices in healthcare.
Essential Medical Translations
In order to ensure effective medical translation to optimize patient care and fulfill legal requirements, there is a robust and multi-faceted realm of essential elements in which to ensure adequate translation. Below are some examples:
- Patient-related Documentation
- Patient health records, physician’s notes, lab results, and test results need to be provided to the patient in their native language to help facilitate their communication of their health problems. This ensures ease of care with different providers, communication with consulting services, and continuity/transition of care.
- Informed consent forms in patients’ native languages are crucial for ensuring patients understand the risks and benefits of procedures they are undergoing. Lack of proper informed consent can harm patient outcomes, obstruct the provider-patient relationship, and have massive legal ramifications.
- Accurately translated discharge summaries help patients understand post-treatment instructions, reducing readmission risk.
- Pharmaceutical and Medical Devices
- Accurate translation of drug information, package inserts, and patient information leaflets ensures patients and providers understand the approved indications for use, drug administration and dosing instructions, and potential side effects. Misunderstanding of this information can expose patients to harmful drug effects.
- Medical equipment manuals and device operating instructions provide crucial information about proper function and use of medical devices, many of which are life-sustaining devices. Misunderstanding of this information by patients, providers, nursing, or representatives can have significant and potentially fatal consequences. Consider, for example, an inaccurately translated instruction manual for a respiratory ventilator for a patient with a life-threatening illness or injury. Malfunction or improper use of the ventilator could result in patient death.
- Label translations, such as those on medications or medical devices, are essential for proper administration. Consider one kind of medication at a pharmacy that is mid-labeled as a different medication that is then unknowingly dispensed to a patient. Not only is proper treatment for their condition not being given, but improper medication use could expose the patient to dangerous drug interactions or side effects.
- Digital Health Care Solutions
- Electronic health record (EHR) systems and healthcare mobile apps must be accurately translated. The benefits of these platforms are enormous in that they give patients access to their own healthcare right at their fingertips. Having platforms, such as Epic’s MyChart, available to patients in their native language allows even LEP patients to be bigger advocates in their own care.
- Telemedicine platforms and interfaces are an avenue to ensure effective medical translation even when certified medical interpreters are not available in person. Having these platforms available in patients’ native languages, facilitates ease of use and patient access to adequate care.
- Accurate translation within medical imaging software and other medical software applications facilitates widespread use, expanding reach across cultures on a global scale.
- Real-Time Medical Communication
- Accurate medical translation during patient-doctor consultations and emergency medical encounters is crucial to ensure the provider’s understanding of the patient’s present illness and medical history as well as the patient’s understanding of the treatment plan. The use of certified medical interpreters facilitates this communication despite language barriers.
- Medical translation at healthcare conferences and medical seminars ensures knowledge and new discoveries are accurately shared with providers from across the globe.
- Administrative and Legal Documents
- Health insurance documents and policy terms and conditions provide information to patients about their healthcare benefits and available resources. Without this knowledge, patients will not be able to access quality care and may be led into situations where care is obtained out-of-network leading to unnecessary medical costs and financial burden.
- Inaccurately translated claims forms may put patients in a position where they are unable to obtain coverage for the necessary care they received leading to dire financial consequences.
- Legal medical documentation provides information to patients on their healthcare rights. Lack of access to these documents in their native language can lead patients to misunderstanding their rights, not recognizing when harm has been done, missing opportunities to pursue legal action when harm is done, and decreasing their access to adequate legal representation.
Best Practices for Hospitals and Doctors When Leveraging Medical Translation
To ensure patient safety and quality care for diverse populations, hospitals and doctors should prioritize using certified medical translators with expertise in both language and medical terminology in order to prevent miscommunications. These professionals should be involved from the beginning of the patient’s journey, participating in discussions between healthcare providers and patients to enhance shared decision-making. Hospitals can create a standardized process to schedule interpreters, ensuring consistent coverage for patient interactions, even small ones. Beyond interpretation, providing dual-language materials, like the ones discussed above, ensures patients understand their treatment and rights. Cultural awareness training for staff is equally important, as cultural beliefs and traditions can influence care delivery.
The requirements for effective medical translation are comprehensive and multi-faceted. Implementation is often best achieved on a systems level. Healthcare systems should consider taking advantage of professional translation services, such as organizations like Ulatus, to facilitate and support effective implementation. By fostering a supportive and inclusive environment that recognizes and respects diversity, hospitals and doctors can overcome communication challenges and provide equitable care to all patients.
