In our journey of developing No Barrier, we engaged with numerous medical providers to gain insights into language barriers in healthcare. One recurring topic that emerged was the utilization of family members as interpreters in medical settings. As we delved into their experiences, we uncovered a diverse array of stories that shed light on the challenges and nuances of this practice. It appears that there is often a tension between the necessity of having a formal medical interpreter for LEP patients and the practical realities faced by providers.

Here are some key points we gathered from our interviews:

Patient Preference: Many patients express a preference for having a family member as their interpreter, feeling more comfortable and at ease. One provider shared, "Lots of time the patient DON'T want a translator and feel, naturally, more comfortable with his/her family member." Another recounted a specific case of a Dominican Republican patient who didn’t feel comfortable with other Spanish that an interpreter may bring. We heard similar sentiments with other cultures; for instance, a Chinese patient may be unsure about which type of Chinese dialect the online interpreter may have. Another topic that was raised are the community volunteer interpreters - sometimes the patients may be familiar with community volunteer interpreters or their families, leading to discomfort during intimate medical encounters.

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Lack of Accuracy: Family interpreters often are not professionally trained to explain complex medical terms. One doctor shared: “I often hear mistakes when well-meaning family members try to translate or explain certain concepts in Spanish, which I’m fluent in as well. This can often lead to funny mistranslations, eg ‘Constipado’ means ‘congested nose’ and not ‘Constipated.’ Imagine the patient’s surprise when receiving a prescription for laxatives for a runny nose because their family mistranslated! However, this can also lead to serious medical errors.”

Child Involvement: Providers highlighted instances where children accompany their parents to medical appointments but may be exposed to inappropriate or intimate topics during interpretation, posing a delicate balance between family involvement and safeguarding a child's innocence. One healthcare provider shared, "A child escorted his mom but shouldn't hear intimate topics."

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Family Member Agenda: The risk of family members unintentionally guiding conversations or influencing responses was noted by healthcare professionals, emphasizing the need for precision and objectivity in interpretation. "Sometimes the family member can 'lead' the questions asked to a certain direction," explained a healthcare professional. They provided an example: "A provider asked the patient, 'Do you have any pain now?' and the family member asked the patient, 'Does your leg hurt?'" In another instance, a provider recounted, "A family member once told me, 'I will tell everything to dad at home,'" leaving the provider unsure of how to navigate the dynamics.

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Culture Influence: Cultural beliefs and practices may influence communication, impacting medical decisions and potentially compromising patient autonomy. Providers shared examples of family members who may "screen out" specific medicines if there is an emphasis on natural remedies, for example in Asian cultures.

Ethical Dilemma: Providers are aware of the ethical challenges posed by using family members as ad-hoc interpreters. "Many doctors do know that they shouldn’t assist family members as interpreters, due to lack of formal training and potential breach of patient confidentiality," noted one provider.

Senior Patients: There is a tendency to rely on the son or daughter of LEP senior patients as interpreters, driven by tradition and familiarity. "In the case of older patients, physicians would even prefer to use family members," shared a provider. Some doctors mentioned that they “would ask the family member if they're comfortable to be an interpreter, due to hearing issues, and just to get the settings more known to the patient.”

Consent-Required Situations: Providers emphasize the necessity of adhering to protocol, especially in critical moments requiring formal consent or during surgical procedures, where official interpreters are mandated to ensure precision and legality. "When there is a surgical procedure or required consent, doctors would go by the protocol and have an official interpreter on board," shared another healthcare professional.

In summary, while ethical guidelines discourage the use of family members as medical interpreters, the practical realities often necessitate their involvement. Providers navigate this complex landscape with empathy and expertise to deliver the best care for LEP patients, recognizing the challenges inherent in communication across language barriers.

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In these cases, No Barrier could supplement the expertise and familiarity of family translators, if preferred by the patient, and provide an unbiased, accurate, professional medical translation.

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