There are more than 25 million people with limited English proficiency (LEP) in the U.S., and more than 60 million people speak more than one language at home. For clinicians serving LEP patients, it is tempting to accept help from an eager family member willing to translate for their parents. Who better to help communicate than someone in the room who knows the parents well and is accustomed to translating for them?
The truth is that asking children to serve as ad hoc interpreters for patients with LEP is both harmful to the patient’s clinical course and unfair to the child.
Compared to certified medical interpreters, ad hoc interpreters commit twice as many errors. Even children proficient in both languages may not understand medical vocabulary, just as many native English speakers don’t. Certified interpreters are not just bilingual; they have completed medical interpreter training and passed certification exams. Their services facilitate a more accurate conversation and reduce the risk for clinically significant medical errors.
Asking children to serve as interpreters poses a burden. Children with LEP parents carry a near daily responsibility to serve as a language broker. This ranges from answering home telephone calls to discussing the family’s finances with banks. While it can feel like just another setting, hospitals can carry additional emotional weight.
Translating also forces children to step outside of their parent-child dynamic. It may inadvertently lead them to disclose difficult news or explore sensitive topics that can extend beyond their understanding.
While many have become accustomed to this role, the stress of serving as the constant translator accumulates and puts these children at greater risk for anxiety and depression in adolescence and young adulthood. Medical interpretation is emotionally taxing even for third-party professionals who do not know the patient.
It is not groundbreaking to say proper use of interpreters for patients with LEP improves patient care. Implementation is harder. Time and effort are finite resources. Wait times to connect to interpreters remain a barrier. COVID-19 has also reduced the number of in-person interpreters available. In a health care system where efficiency is gold, connecting to interpreters demands intrinsic motivation over response to external efficiency rewards.
These decisions come with social costs as well. Telling a bilingual family member that a phone or video interpreter is preferred to their abilities can be uncomfortable. It can challenge the rapport building between clinician, patient and family from the onset.
Phone interpreters are far from perfect. The extra minutes it takes to connect to an interpreter feel like hours when a willing ad hoc interpreter is right there in the room.
Even so, using a certified interpreter is ultimately the correct decision for patients, clinicians and families. The patients’ clinical outcomes improve. Clinicians guide care with consistently effective communication. And instead of being translators, children get to be children.
The original version of this article was published by Doximity.
