Elderkin-Thompson V, Silver R C, Waitzkin H
Institute for Brain Aging & Dementia, University of California, Irvine, USA.
Soc Sci Med. 2001 May;52(9):1343-58. doi: 10.1016/s0277-9536(00)00234-3.
The United States is experiencing one of its largest migratory waves, so health providers are caring for many patients who do not speak English. Bilingual nurses who have not been trained as medical interpreters frequently translate for these patients. To examine the accuracy of medical interpretations provided by nurses untrained in medical interpreting, we conducted a qualitative, cross-sectional study at a multi-ethnic, university-affiliated primary care clinic in southern California. Medical encounters of 21 Spanish-speaking patients who required a nurse-interpreter to communicate with their physicians were videorecorded. Encounters were transcribed by blinded research assistants. Transcriptions were translated and analyzed for types of interpretive errors and processes that promoted the occurrence of errors. In successful interpretations where misunderstandings did not develop, nurse-interpreters translated the patient's comments as completely as could be remembered and allowed the physician to extract the clinically-relevant information. In such cases, the physician periodically summarized his/her perception of the problem for back-translation and verification or correction by the patient. On the other hand, approximately one-half of the encounters had serious miscommunication problems that affected either the physician's understanding of the symptoms or the credibility of the patient's concerns. Interpretations that contained errors that led to misunderstandings occurred in the presence of one or more of the following processes: (1) physicians resisted reconceptualizing the problem when contradictory information was mentioned; (2) nurses provided information congruent with clinical expectations but not congruent with patients' comments; (3) nurses slanted the interpretations, reflecting unfavorably on patients and undermining patients' credibility; and (4) patients explained the symptoms using a cultural metaphor that was not compatible with Western clinical nosology. We conclude that errors occur frequently in interpretations provided by untrained nurse-interpreters during cross-language encounters, so complaints of many non-English-speaking patients may be misunderstood by their physicians.
美国正在经历其最大规模的移民潮之一，因此医疗服务提供者正在照顾许多不会说英语的患者。未经医学口译培训的双语护士经常为这些患者进行翻译。为了检验未经医学口译培训的护士所提供的医学翻译的准确性，我们在南加州一家多民族、大学附属的初级保健诊所进行了一项定性横断面研究。对21名需要护士口译员与医生沟通的讲西班牙语的患者的医疗会诊进行了录像。会诊由不知情的研究助理进行转录。转录内容被翻译并分析了口译错误的类型以及导致错误发生的过程。在成功的口译中，即未产生误解的情况下，护士口译员尽可能完整地翻译患者的评论，并让医生提取临床相关信息。在这种情况下，医生会定期总结他/她对问题的理解，以便患者进行回译并核实或纠正。另一方面，大约一半的会诊存在严重的沟通问题，影响了医生对症状的理解或患者担忧的可信度。包含导致误解的错误的口译出现在以下一个或多个过程中：(1)当提到矛盾信息时，医生拒绝重新构思问题；(2)护士提供的信息与临床预期一致，但与患者的评论不一致；(3)护士歪曲口译内容，对患者产生不利影响并损害患者的可信度；(4)患者用与西方临床疾病分类学不兼容的文化隐喻来解释症状。我们得出结论，在跨语言会诊中，未经培训的护士口译员提供的口译经常出现错误，因此许多非英语患者的投诉可能会被他们的医生误解。
