Medical Interpreting: A Review of the Literature

Developed by J. Moore and L. Swabey
CATIE, College of St. Catherine/NCIEC
DRAFT ~ 2007

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Introduction | Deaf Patient Perspectives | Non-deaf Patient Perspectives | Settings and Types | Challenges and Issues | Interpreting Role | Preparing to Interpret | Summary and Implications | References | Bibliography | Download PDF

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Second-Language Patient Perspectives on Health Care            

Non-deaf patient perceptions.

Sign language interpreters and Deaf people themselves commonly see the Deaf community experience as unique. However, research indicates a number of parallels between the experiences of Deaf patients and those of other non-English speakers. There is a body of research reporting on issues that arise in interpreted encounters between non-deaf second-language users and health care providers. Many of these studies relate to the quality of interpreting. For example, Prince (1986) analyzed questions in interpreted doctor-patient conversations and found distortions in three categories: interpreters answering questions for the patient; incomplete translations of multi-part questions; and incorrect translations, primarily due to mishearing, misunderstanding of technical terms, and failure to check the accuracy of information before relaying it. 

Flores et al. (2003) reviewed interpreted outpatient pediatric visits facilitated by Spanish-speaking interpreters. Interpreters included both professional interpreters and ad hoc interpreters, that is, nurses, social workers, or family members, and averaged 31 errors per encounter. Most common were errors of omission, 63% of which had possible medical consequences. Errors in word or phrase choice were most often (73%) related to medical terminology. These included incorrect dosage, frequency or mode of administering medications, and omitting relevant information on drug allergies or medical history. The most serious errors were in interpretations by ad hoc interpreters. Other researchers, however, have questioned Flores’ categorization of some utterances or omissions as errors, arguing that they may represent a meaning-based rather than a literal, conduit model of interpreting (Hsieh, 2006, p. 4).

Rivadeneyra (2000) suggested that both health care providers and non-English-speaking patients may alter their behavior in ways that stand in the way of developing a trusting relationship, perhaps resulting in doctors’ misunderstanding of patients’ symptoms, and decreasing the likelihood of patients following doctors’ recommendations (as cited in Angelelli, 2004, p. 21).

Although issues arising from encounters between non-deaf health care providers and Deaf patients and between health care providers and non-English-speaking patients are very similar, Iezzoni (2004) pointed to one important difference: Deaf people are more concerned than non-deaf second-language users when doctors question their intelligence. This is likely due to the long history of oppression and discrimination, and an education system that has historically linked deafness with low intelligence (p. 361). Writing about health care providers’ expectations that Deaf patients will communicate easily by writing or speech reading, Harmer (1999) quoted Lotke (1995), “No other subset of Americans who use English as their second language are expected to do this, nor are they presumed to be retarded (sic) when they fail at these efforts. Deaf people are expected to do both” (p. 96).

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