Checklist: These tips may help reduce your liability

These tips on improving your translation services are offered by Glenn Flores, MD, director of community outcomes in the department of pediatrics at the Medical College of Wisconsin in Milwaukee, and Grena Porto, RN, ARM, DFASHRM, senior director of clinical operations at VHA Inc. in Berwyn, PA, and past president of the American Society for Healthcare Risk Management:

Omissions are by far the most common error, accounting for about half, so translators should be trained to focus principally on faithfully translating every word the doctor says. Emphasize that the translator is not there to explain the doctor’s words, necessarily, but to accurately translate them. A well-intentioned translator may try to help the patient understand the words beyond just accurately translating them, but that is a slippery slope, Flores says. It is better for the translator to strictly translate and let the patient indicate to the doctor whether he or she understands or needs clarification.

All translators, even those who already work in the medical field, should be trained on medical terminology. An English-speaking doctor who speaks Spanish fluently still may not know the equivalent medical terms in Spanish. Errors can result when the translator tries to compensate by using words he or she does know instead of the proper terms.

Flores’ research indicates that many translation errors occurred when the interpreter was distracted or out of the room — the doctor continues to speak and thinks the patient understands because the information is simple or the patient is nodding. Policy should require that the interaction stop when the interpreter is distracted or out of the room.

Teach clinicians to plan the interaction with the translator and patient. People tend to just go ahead and start talking once the translator is present, but Porto says you will get better results if you brief the translator on the situation, generally what you need to convey to the patient, and allow the translator to ask questions about specific facts or terminology. But be careful not to let this preparation veer off course so that the translator thinks you want that information conveyed to the patient in the translator’s own words. The preparation is only to help the translator understand the situation; you still want the translator to wait and convey the doctor’s words precisely as the doctor speaks them.

Identify which languages for which you may have adequate resources, and which represent more of a challenge. For instance, you may find that you have plenty of Spanish-speaking health care workers who have demonstrated that they truly are fluent. After providing specific training in medical translation, you can consider Spanish to be a low-risk translation situation, Porto says.

"Then you can decide that you don’t have the resources for others, like Russian, and that makes them a high-risk situation," she says. "Decide how you will handle these high-risk translation situations and it can’t be the same way you handle the low risk. Organizations must have radar these are high-risk situations, outside the norm, and pay more attention to them. I don’t think we do enough of that now."