Why You Should Not Rely on Ad Hoc Interpreters

By David Fetterolf, Stratus Video President

Imagine that you are in front of a patient who is asking for help, but that the patient doesn't speak English. It is clear that an interpreter is needed, but at the same time, the patient's daughter is sitting right next to her, and she speaks English. What do you do? We all know that the correct answer is to call an interpreter anyway, but if we are really honest with ourselves, it is easy to understand why someone might just turn to the bilingual family member out of convenience and perceived efficiency.

An Ad Hoc interpreter is anyone who has not trained as a professional interpreter. It might be a patient's family member, a bilingual healthcare provider, or even someone in the waiting room who volunteers to facilitate communication. In extreme cases, it may even be a patient's child. It is easy to understand why someone may choose to communicate through an ad hoc interpreter rather than through a professional interpreter. Often, the ad hoc interpreter is there at the moment an interpreter is needed, and sometimes the necessary communication is emergent, brief, or seemingly simple. But while it is easy to understand why ad hoc interpreters are appealing, it is important to understand why a professional interpreter is always necessary.

Studies have found that interpretation errors with clinical consequences are far more likely when an ad hoc interpreter is used, and that clinicians report higher satisfaction when they are able to communicate with their patients through a professional interpreter. Studies have even associated longer length of hospital stays with a lack of professional interpretation.

Let's take a look at an example. In the famous case of Willie Ramirez, the 18-year old patient (Willie), was brought to the ER with a headache so bad that he had lost consciousness. His family told the ER staff that he was intoxicado”, which in Spanish simply means that he ingested something that made him ill. Without consulting with a medically qualified interpreter, the medical staff took that to mean that he was intoxicated and diagnosed him with an overdose. In reality, Ramirez was suffering from an intracerebellar hemorrhage (a brain bleed). The bleed went untreated for more than two days and resulted in him becoming a quadriplegic. Tragically, if a neurosurgeon had been called in earlier, Ramirez could have walked out of the hospital without serious side effects, but instead, the medical staff relied on themselves as ad hoc interpreters, and the patient suffered significantly.

Diversity is a fact of life in American hospitals. Dozens of languages are encountered every day, and a comprehensive language access program is necessary to suit patient needs. Healthcare staff must be able to reach a qualified medical interpreter in the language they need without delay.

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