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    Thursday, January 09, 2003

    On Language: Here's a revelation about translating the language of medicine:

    Trained translators provided by the hospital, involved in six of the encounters, made almost as many errors as the nurses, social workers, strangers or siblings who translated in the other cases. The errors by the trained translators were less likely to be important; still, half were rated as medically significant.

    Over all, about half of the errors were omissions - neglecting to tell the doctor important facts or failing to ask about allergies. Other errors were categorized as substitutions, editorialization and addition. One interpreter told a woman not to answer some of the doctor's questions because they were "personal"; another told a mother to put antibiotics for her child's ear infection in the baby's ears.

    I've often wondered what interpreters were really telling my patients. Sometimes a long sentence by me will come out as three words from the interpreter. And sometimes the patient will tell a big long story to the interpreter that becomes just one sentence in the interpretation.

    Then, there's the matter of thinking we're all on the same page when we aren't:

    Not all the mistakes were by the interpreters. The study found that physicians made a large number of what they called errors of false fluency - assuming that they or the patients understood something correctly when they did not. This kind of error was most common when a trained interpreter was involved in the encounter but was distracted or briefly called away.

    This kind of error is also common between two people who supposedly speak the same language. I once had a patient who was treated by a surgeon and oncologist for an inoperable abdominal tumor. She had even been referred by the oncologist for an experimental trial of chemotherapy. When the disease had metastasized to her liver, she enrolled in hospice. When the hospice nurse went to visit her and mentioned her cancer, she freaked out. She always thought of her disease as a tumor, not a cancer. When I tried to remember my conversations with her, I realized I always said things like, "How's your chemotherapy going?" I never said "How's your cancer?"

    Then, there's the matter of cultural differences. The first time someone told me they had piles, I had no idea what they meant. And when an elderly black man says he's having trouble with his nature, he doesn't mean his personality. What he wants is Viagra.

    posted by Sydney on 1/09/2003 12:52:00 AM 0 comments


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