Lost in Translation

[zcanova]

Last week I had a patient with neck and shoulder pain that I was required to use an interpreter for. Rather than reflecting on the evaluation, I wanted to reflect specifically on the challenges I faced with communicating through the translator. Performing an examination with a translator introduces several challenges that can impact the quality and accuracy of the assessment. Subjective examinations often involve gathering information about a person’s thoughts, feelings, and experiences, and the presence of a translator can complicate the process. It was very difficult to build rapport and communicate both verbally and non-verbally with this patient due to the lag of translation through the interpreter. I quickly realized that a lot of time was being spent waiting for translations and my questioning was not as efficient as I would have liked it to be. Reflecting on this aspect of the interaction, I realized the importance of asking open-ended questions and being very specific in my questioning. There was a lot of time wasted asking closed-ended questions that did not help guide my thought process. There were also questions that I asked that were open-ended that did not help guide my decision making which led to even more wasted time.

The difficulty of communicating continued into my objective examination. In the objective examination, we have to be very specific without questioning to elicit the desired response. I noticed that it was hard to keep track of symptoms when everything was delayed. There were a lot of movements and positions that were symptom-provoking for this patient and I was having difficulty getting the specifics about where the symptoms were. After reflecting, I should have made a clear statement before starting and instructed the patient on what I would be doing and what I wanted them to do as well. I could have saved a lot of time if I had just told the patient “I am going to take you through a few movements and I would like you to tell me when and where you have any symptoms”. Instead, I went the route of asking after each test or measure.

I think that this experience has a lot of carry-over to evaluations that do not require a translator. I am glad that I had this experience because it helped me understand the importance of asking questions clearly and utilizing open-ended questions to gain more information. This is something that is used whether there is a translator or not and I will continue to work on improving the efficiency and clarity of my questioning with this experience in mind.

I am interested in hearing about other individuals’ experiences utilizing a translator and the difficulties faced during the experience. I am also interested in discussing ways to combat the language barrier and improve efficiency with questioning.

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