Dear Sir
First, we would like to thank Dr Bond and his colleagues for their valuable suggestions on working with informal interpreters in medical practice, an issue that we have not elaborated on in our paper. Indeed, it is well known that doctors often turn to family members as interpreters.
Students need to learn how to manage the tension between the ‘ideal’ way to overcome a language barrier (which is generally seen as working with a formal interpreter), and the everyday reality in which family members often take on the role of ad hoc interpreters.
All types of interpreters have their pros and cons, depending on the nature of the problem, the patient's background, or the availability of formal interpreters. Students should become aware of these and learn what is preferred and what is acceptable in each new situation (e.g., only in highly exceptional cases can children be used as interpreters).
In order for students to learn specific skills in communicating through an interpreter, we would suggest to start with a workshop using a formal interpreter. In this way students can learn the basic skills. At the same time, this may lower the barrier for working with formal interpreters that many health care professionals experience.
Working with informal, family interpreters asks for extra competencies. Students should learn about the specific pitfalls, such as the ones mentioned by Bond and colleagues, and be able to recognize and avoid them. This can be achieved, for example, by instructing family members to translate as exactly as possible, and by paying extra attention to the nonverbal communication of the patient. Students would likewise benefit of exercises in respectfully dismissing a family member who is willing to translate and to call in a formal interpreter instead, if that is what is needed in a specific situation.
All in all, education in communicating through interpreters is essential. The importance of true understanding between care provider and patient cannot be overemphasized and overcoming a language barrier is the first condition to reach this.
Conny Seeleman, Marie-Louise Essink-Bot, Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. E-mail: [email protected]
Veronica Selleger, Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands
Benno Bonke, Department of Medical Psychology, Erasmus University Medical Centre, Rotterdam, The Netherlands