Family interpreters can cause harm

They might purposely misinterpret

When hospitals rely on a patient's family members to interpret medical news, they might be placing the patient at risk, an expert says.

Family members sometimes purposely misinterpret information because of their own biases or agenda, says Elizabeth Jacobs, MD, MPP, an associate professor of medicine in the collaborative research unit at the Stroger Hospital of Cook County and Rush University Medical Center in Chicago, IL. Jacobs recently studied the impact of having an enhanced interpretation service on Spanish-speaking patients' satisfaction and on hospital costs.

"When I ran the study, one of the things our interpreters did was introduce themselves to each Spanish-speaking patient, saying, 'My name is so and so. Here's my card, and you can keep it at the bedside and show to your doctor and family members,'" Jacobs says.

In one case, a family member told the interpreter, "No thank-you, we won't need your services," Jacobs recalls.

The interpreter told the family that the service was free, but the family still declined.

With a little investigation, the interpreter found that the family did not want the patient to know about her diagnosis, so the interpreter called Jacobs with this information.

"I told her I was glad she called me, and I called the attending and said, 'I want to make you aware of this situation,'" Jacobs says.

Jacobs advised the attending physician to be culturally sensitive, but to give the patient the option of refusing the interpreter services and relying on family members.

"I told him, 'You can get an interpreter to go in there and ask what the patient would like, saying the family would like to be the ones to give you all of the information, or we could have an interpreter in here to talk with you directly about your health,'" Jacobs recalls.

The doctor handled the case as Jacobs' recommended, and the patient chose to have a medical interpreter present, Jacobs says.

"In 80% to 90% of cases the patient does want the information from an interpreter," she adds. "And that's an example of what happens if you use an ad hoc interpreter."

Family members often will change the conversation or distort the doctor's words, often out of love and a misguided feeling that it's in the patient's best interest, Jacobs explains.

"So the doctor could be treating a patient with chemotherapy and not know that the patient doesn't even know her diagnosis," Jacobs adds.