Does someone involved in an ethics consultation or family meeting have limited English proficiency? “For patients, family members, caregivers, or legally authorized representatives with limited English language proficiency, it is critical to engage a translator,” says Lewis J. Kaplan, MD, FACS, FCCM, PCCP, professor of surgery at the Perelman School of Medicine at the University of Pennsylvania.
The primary clinical team likely is aware of the need for translator services, and the fact family members are not sufficient for medical translation. However, ethicists providing consult services can request a translator if one has not already been engaged. “Ethicists should do so if there is any lack of fluency with English language discourse,” Kaplan suggests.
If there is any question, ethicists can ask the patient or other decision-makers whether they would want a translator to help. Clinicians likely have ample experience with translators in person, by phone, or video platforms. Despite this, many clinicians have not been trained on how to work with a translator.
“Optimizing working with a translator is one way to help improve patient- and family-centered care,” says Kaplan, who offers these practices ethicists can share with clinicians working with translators:
• Break up sentences and allow each one to be translated and received prior to the next one. “Clinicians often bundle more than one concept into a single sentence,” Kaplan notes.
For the medical translator, this creates a convoluted sentence they must keep in mind, determine how to translate, and then share with listeners. Instead, clinicians should stop frequently to ask if the listeners understand what has been translated.
“This is preferable rather than asking at the end of a long discourse whether there are any questions,” Kaplan says.
A good rule of thumb is to stop and check for comprehension after a key point is shared, especially when that point will influence decision-making or may change an individual’s perspective on the situation at hand.
For example, an ethicist might say to the family, “As you know, your mother has not been well for the last six months, most recently recovering from her prior stroke and pneumonia in a rehab center. Now, she has returned to the hospital with a new infection in her bloodstream that is resistant to our usual antibiotics.”
“This sentence is straightforward for an individual with English proficiency,” Kaplan says.
But for those who need medical translation, it could be broken up this way, with a pause after each sentence to allow for translation: “As you know, your mother has not been well for the last six months. She most recently recovered from her prior stroke and pneumonia in a rehab center. Now, she has returned to the hospital with a new infection in her bloodstream. That infection is resistant to our usual antibiotics.”
• Meet with the translator before meeting with everyone else to review complex medical terms. “Ensure that the medical translator understands what those terms mean,” Kaplan says.
Uncommon terms may include procedures (“transjugular intrahepatic portosystemic shunt”), imaging (“diffusion-weighted magnetic resonance imaging”), or therapeutics (“specific chemotherapy regimens or immune-modulating therapies”).
“It is a wise time investment to ensure that those terms can be effectively and clearly communicated,” Kaplan says.
• Talk directly to the patient or family member, not to the medical translator.
“It is quite common for the patient or family member to reply directly to the medical translator; therefore, that flow should be anticipated,” Kaplan says.
Using a medical translator may require consults to be scheduled in advance, rather than pursuing them in an impromptu fashion. This is particularly common for unique services, such as sign language interpreters. “It helps ensure information transfer fidelity and respects the needs of the patient and their support system,” Kaplan says.
A good rule of thumb is to stop and check for comprehension after sharing a key point, especially when that point will influence decision-making or may change an individual’s perspective on the situation.
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