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Using interpreters in medical consultations: What is said and what is translated—A descriptive analysis using RIAS

https://doi.org/10.1016/j.pec.2017.03.023Get rights and content

Highlights

  • Analysing interpreted consultations using RIAS is feasible.

  • The concordance of utterances with the corresponding translations is not given.

  • All participants of an interpreted consultation should be cautioned against the loss of information.

Abstract

Objective

To analyse the concordance of original utterances by healthcare providers (HCP) and patients with the corresponding translations by interpreters using the Roter Interaction Analysis System (RIAS).

Methods

Video recordings of interpreted consultations were transcribed. Transcription was performed by professional interpreters, who first transcribed consultations in both languages, then provided a translation of what was said in the foreign language. Based on the translations, the videos were coded and analysed using RIAS.

Results

Overall, 19 consultations with a total recording time of 865 min were analysed. The main finding is the large difference in the number of utterances in the original language compared to the number of utterances in the target language: about one third of the HCPs’ and the patients’ utterances were not translated. In no instance were omissions explained to HCP or patient.

Conclusion

Interpreters in this sample did not always translate what had been said precisely; they omitted utterances by both HCPs and patients.

Practice implications

All participants of an interpreted consultation must be made aware of potential omissions in the process of translation. Further understanding of the causes and consequences of omissions is needed.

Introduction

With four national languages, 26 federal independent cantons and 42% non-Swiss inhabitants, Switzerland is marked by diversity. For Swiss healthcare institutions this poses a challenge because they face an increasing number of patients who do not speak one of the three major languages: German, French, and Italian [1]. Accurate comprehension of what is being said plays a crucial role in communication between healthcare providers (HCP) and patients. The use of interpreters has become a common procedure in most western countries [2], [3], [4], [5], [6], [7], [8] to support healthcare provider-patient communication. Interpreting has been shown to improve patient outcomes [8], [9], [10].

However, while the presence of an interpreter in a medical session has the potential to improve HCP-patient communication, it also bears the risk of causing misunderstandings or even treatment failure if content is not translated correctly. Several studies analysing the quality of interpreting in medical encounters have demonstrated a considerable rate of deviations or errors [2], [3], [11], [12], [13], [14], [15], [16], [17].

We therefore aimed to assess the quality of interpreters’ proficiency in the correct translation of content from one language into another. Medical professionals and patients alike favour a translation close to what is said, a “word for word” or “literal” translation [18], [19], [20]. In the current paper, we analyse the concordance of original utterances by HCPs and patients with the corresponding translations by interpreters using the Roter Interaction Analysis System (RIAS) that allows for a precise utterance by utterance analysis of interactions in healthcare [21]. We chose to use RIAS because it aims to identify communication units, called utterances that “are the smallest discriminable speech segment to which a classification may be assigned. The unit may vary in length from a single word to a lengthy sentence. A sentence is considered one unit if it conveys only one thought or relates to one item of interest” [22]. RIAS thereby circumvents the problem that different languages need different numbers of words to convey a certain meaning; it is not the correspondence of words in language A versus language B that we analysed but the ‘one thought’ or ‘item of interest’. We provide a complete and quantified description of single utterances in 19 interpreted consultations which were completely transcribed and translated.

Section snippets

Methods

This paper is part of a larger national study conducted in Switzerland that examined the roles of medical interpreters [11].

Results

Professional utterances made up a total of 32.0% of all utterances. Patient utterances comprised 26% of the utterances. The remaining utterances were provided by interpreters. Almost half of the HCPs’ utterances were not translated into the patients’ language. Furthermore, about one third of patient utterances did not reach the HCP.

Discussion and conclusion

We analysed the concordance of utterances in the original language (either German or Albanian or Turkish) with utterances in the target language (German translated into Albanian or Turkish; Albanian/Turkish translated into German) in 19 medical consultations. The translations were provided by professional interpreters.

Conflict of interest

The authors declare that they have no competing interest. The study received funding by the Commission for Technology and Innovation, CTI N 11424.1 PFES-ES.

Acknowledgments

We would like to thank all patients, healthcare providers, interpreters, transcriptors and CTI for their trust and support.

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