Every doctor has faced this scenario: A patient with limited English arrives for an appointment. The schedule is already running late. A "solution" materializes – an adult or child who "speaks enough," a bilingual receptionist pulled from the front desk, or a smartphone with Google Translate propped between clinician and patient.
The visit proceeds. Everyone nods. But often, things go quietly wrong leaving you with the false confidence that you've communicated clearly when you haven't.
Language barriers transform routine care into a high-stakes exercise in patient safety. The issue extends far beyond taking a medical history; it affects informed consent, complex decisions and whether patients can articulate their deepest concerns.
The human cost: a case study
Dr. Dominic Mudiayi, an internal medicine specialist leading a quality improvement (QI) project on interpreter utilization, notes that skipping professional interpretation doesn't just cause confusion – it causes harm.
He recalls a French-speaking patient who presented to the ER four times over three months. During each visit, without a formal interpreter, her complex symptoms were missed. By the time she was referred to Dr. Mudiayi (who speaks French and could communicate directly) she was diagnosed with mononeuritis multiplex and lupus.
"Had an interpreter been used during her initial presentations," Dr. Mudiayi notes, "it could have led to a quicker diagnosis and fewer complications." Instead, the delay resulted in debilitating comorbidities.
Family members: the default option
Using relatives as interpreters is often the default option, but evidence consistently shows that informal interpretation produces omissions, substitutions and editorial filtering.
Family dynamics can suppress sensitive information – sexual health, substance use, domestic violence, or coercion. Furthermore, relying on family does not offer the legal protection that comes with using a certified interpreter. If a poor outcome occurs due to miscommunication with a family member translating, the clinician is left vulnerable.
Google Translate: a shaky foundation
Studies of written medical translation suggest Google Translate achieves reasonable accuracy for some languages, but with a clinically significant error rate.
- A JAMA study found Google Translate’s algorithm produced 92% accuracy in Spanish and 81% in Chinese.
- However, a minority of sentences carried potential for clinically significant harm (2% for Spanish; 8% for Chinese).
Translation apps can be a bridge for low-stakes communication (scheduling, wayfinding), but they are a shaky foundation for clinical decision-making.
What Alberta offers (AHS facilities)
Alberta Health Services (AHS) runs a province-wide interpretation program designed for clinical use (LanguageLine), available 24/7 in roughly 240 languages, including ASL and 23 Indigenous languages.
Dr. Mudiayi’s tip for AHS clinicians
You do not need to hunt for an iPad on the ward.
Dr. Mudiayi’s QI project highlights the LanguageLine InSight App:
- Download: Available on Apple or Android.
- Access: AHS staff can use their own devices to connect to a video or audio interpreter in ~15 seconds.
- Benefit: It removes the barrier of finding hardware, making it easier to do the right thing for the patient.
Access for community (Non-AHS) clinics
Primary Care Networks (PCNs), independent clinics and community specialists can (and should) sign up for their own professional interpretation accounts. While the vendor (LanguageLine) is the same, AHS funding is strictly for AHS facilities. You must register for your own unique community access code.
How to sign up:
- Cost: There is no cost to sign up or maintain an account. Clinics are only billed per minute when they actually use the service.
- Registration: Email [email protected]
- Use: Once set up, you receive a dedicated toll-free number and access code for your clinic.
Bottom Line
- Offers qualified language assistance.It improves patient satisfaction, outcomes, and provides legal protection for the physician.
- Avoid using family and untrained interpreters for major clinical decisions.
- AHS Staff: Download the app to your phone to reduce barriers.
Editor’s note: The views, perspectives and opinions in this article are solely the author’s and do not necessarily represent those of the AMA.
Banner image credit: Gino Crescoli, Pixabay.com