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Posted on October 3, 2019 at 2:22 PM Comments comments (2)
Conference interpreter Barry Slaughter Olsen explains what it's really like to be a professional interpreter. Barry goes behind the scenes of his vocation, breaking down the many real-life scenarios he faces on a day-to-day basis. From simultaneous and consecutive interpretation to chuchotage and décalage, take a peek behind what it really takes to be a professional interpreter. 

Barry Slaughter Olsen is the Professor of Translation and Interpretation at Middlebury Institute of International Studies. 

NOTE: The techniques employed in this video are not all applicable to interpreting in a courtroom setting, where expectations regarding accuracy and completeness can be quite different. In this sense, legal interpreting is unique. More information on standards for interpreting in the U.S. courts can be found here:

Footage of Muammar Gaddafi at the 64th General Assembly provided by the United Nations. (The views in the film are not those of the United Nations).

Conference Earpiece courtesy of Conference Rental.

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Interpreter Breaks Down How Real-Time Translation Works | WIRED
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Why English is so weirdly different from other languages

Posted on December 19, 2015 at 6:40 PM Comments comments (6)
No, English isn’t uniquely vibrant or mighty or adaptable. But it really is weirder than pretty much every other language
Death and the word; William conquers Harold and the English language. From Cotton Vitellius A. XIII.(1) f.3v. Photo courtesy British Library
John McWhorteris a professor of linguistics and American studies at Columbia University. His latest book is The Language Hoax (2014).3,400 wordsEdited byEd LakeSend to KindleShare:ShareTweetDoes English have any special merits that set it apart from other languages?148Join the conversation →Popular nowEssayHow masks explain the psychology behind online harassmentOpinionPerspective is a lesson in how science collaborates with artEssayThe humanities are booming, only the professors can’t see itEnglish speakers know that their language is odd. So do people saddled with learning it non-natively. The oddity that we all perceive most readily is its spelling, which is indeed a nightmare. In countries where English isn’t spoken, there is no such thing as a ‘spelling bee’ competition. For a normal language, spelling at least pretends a basic correspondence to the way people pronounce the words. But English is not normal.Spelling is a matter of writing, of course, whereas language is fundamentally about speaking. Speaking came long before writing, we speak much more, and all but a couple of hundred of the world’s thousands of languages are rarely or never written. Yet even in its spoken form, English is weird. It’s weird in ways that are easy to miss, especially since Anglophones in the United States and Britain are not exactly rabid to learn other languages. But our monolingual tendency leaves us like the proverbial fish not knowing that it is wet. Our language feels ‘normal’ only until you get a sense of what normal really is.

There is no other language, for example, that is close enough to English that we can get about half of what people are saying without training and the rest with only modest effort. German and Dutch are like that, as are Spanish and Portuguese, or Thai and Lao. The closest an Anglophone can get is with the obscure Northern European language called Frisian: if you know that tsiis is cheese and Frysk is Frisian, then it isn’t hard to figure out what this means: Brea, bûter, en griene tsiis is goed Ingelsk en goed Frysk. But that sentence is a cooked one, and overall, we tend to find that Frisian seems more like German, which it is.We think it’s a nuisance that so many European languages assign gender to nouns for no reason, with French having female moons and male boats and such. But actually, it’s us who are odd: almost all European languages belong to one family – Indo-European – and of all of them, English is the only one that doesn’t assign genders that way.More weirdness? OK. There is exactly one language on Earth whose present tense requires a special ending only in the third‑person singular. I’m writing in it. I talk, you talk, he/she talk-s – why just that? The present‑tense verbs of a normal language have either no endings or a bunch of different ones (Spanish: hablo, hablas, habla). And try naming another language where you have to slip do into sentences to negate or question something. Do you find that difficult? Unless you happen to be from Wales, Ireland or the north of France, probably.Why is our language so eccentric? Just what is this thing we’re speaking, and what happened to make it this way?
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English started out as, essentially, a kind of German. Old English is so unlike the modern version that it feels like a stretch to think of them as the same language at all. Hwæt, we gardena in geardagum þeodcyninga þrym gefrunon – does that really mean ‘So, we Spear-Danes have heard of the tribe-kings’ glory in days of yore’? Icelanders can still read similar stories written in the Old Norse ancestor of their language 1,000 years ago, and yet, to the untrained eye, Beowulf might as well be in Turkish.The first thing that got us from there to here was the fact that, when the Angles, Saxons and Jutes (and also Frisians) brought their language to England, the island was already inhabited by people who spoke very different tongues. Their languages were Celtic ones, today represented by Welsh, Irish and Breton across the Channel in France. The Celts were subjugated but survived, and since there were only about 250,000 Germanic invaders – roughly the population of a modest burg such as Jersey City – very quickly most of the people speaking Old English were Celts.
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Crucially, their languages were quite unlike English. For one thing, the verb came first (came first the verb). But also, they had an odd construction with the verb do: they used it to form a question, to make a sentence negative, and even just as a kind of seasoning before any verb. Do you walk?I do not walk. I do walk. That looks familiar now because the Celts started doing it in their rendition of English. But before that, such sentences would have seemed bizarre to an English speaker – as they would today in just about any language other than our own and the surviving Celtic ones. Notice how even to dwell upon this queer usage of do is to realise something odd in oneself, like being made aware that there is always a tongue in your mouth.At this date there is no documented language on earth beyond Celtic and English that uses do in just this way. Thus English’s weirdness began with its transformation in the mouths of people more at home with vastly different tongues. We’re still talking like them, and in ways we’d never think of. When saying ‘eeny, meeny, miny, moe’, have you ever felt like you were kind of counting? Well, you are – in Celtic numbers, chewed up over time but recognisably descended from the ones rural Britishers used when counting animals and playing games. ‘Hickory, dickory, dock’ – what in the world do those words mean? Well, here’s a clue: hovera, dovera, dick were eight, nine and ten in that same Celtic counting list.pretty soon their bad Old English was real English, and here we are today: the Scandies made English easier The second thing that happened was that yet more Germanic-speakers came across the sea meaning business. This wave began in the ninth century, and this time the invaders were speaking another Germanic offshoot, Old Norse. But they didn’t impose their language. Instead, they married local women and switched to English. However, they were adults and, as a rule, adults don’t pick up new languages easily, especially not in oral societies. There was no such thing as school, and no media. Learning a new language meant listening hard and trying your best. We can only imagine what kind of German most of us would speak if this was how we had to learn it, never seeing it written down, and with a great deal more on our plates (butchering animals, people and so on) than just working on our accents.As long as the invaders got their meaning across, that was fine. But you can do that with a highly approximate rendition of a language – the legibility of the Frisian sentence you just read proves as much. So the Scandinavians did pretty much what we would expect: they spoke bad Old English. Their kids heard as much of that as they did real Old English. Life went on, and pretty soon their bad Old English was real English, and here we are today: the Scandies made English easier.I should make a qualification here. In linguistics circles it’s risky to call one language ‘easier’ than another one, for there is no single metric by which we can determine objective rankings. But even if there is no bright line between day and night, we’d never pretend there’s no difference between life at 10am and life at 10pm. Likewise, some languages plainly jangle with more bells and whistles than others. If someone were told he had a year to get as good at either Russian or Hebrew as possible, and would lose a fingernail for every mistake he made during a three-minute test of his competence, only the masochist would choose Russian – unless he already happened to speak a language related to it. In that sense, English is ‘easier’ than other Germanic languages, and it’s because of those Vikings.Old English had the crazy genders we would expect of a good European language – but the Scandies didn’t bother with those, and so now we have none. Chalk up one of English’s weirdnesses. What’s more, the Vikings mastered only that one shred of a once-lovely conjugation system: hence the lonely third‑person singular –s, hanging on like a dead bug on a windshield. Here and in other ways, they smoothed out the hard stuff.They also followed the lead of the Celts, rendering the language in whatever way seemed most natural to them. It is amply documented that they left English with thousands of new words, including ones that seem very intimately ‘us’: sing the old song ‘Get Happy’ and the words in that title are from Norse. Sometimes they seemed to want to stake the language with ‘We’re here, too’ signs, matching our native words with the equivalent ones from Norse, leaving doublets such as dike (them) and ditch (us), scatter (them) and shatter (us), and ship (us) vs skipper (Norse for ship was skip, and so skipper is ‘shipper’).But the words were just the beginning. They also left their mark on English grammar. Blissfully, it is becoming rare to be taught that it is wrong to say Which town do you come from?, ending with the preposition instead of laboriously squeezing it before the wh-word to make From which town do you come? In English, sentences with ‘dangling prepositions’ are perfectly natural and clear and harm no one. Yet there is a wet-fish issue with them, too: normal languages don’t dangle prepositions in this way. Spanish speakers: note that El hombre quien yo llegué con (‘The man whom I came with’) feels about as natural as wearing your pants inside out. Every now and then a language turns out to allow this: one indigenous one in Mexico, another one in Liberia. But that’s it. Overall, it’s an oddity. Yet, wouldn’t you know, it’s one that Old Norse also happened to permit (and which Danish retains).as if all this wasn’t enough, English got hit by a firehose spray of words from yet more languages We can display all these bizarre Norse influences in a single sentence. Say That’s the man you walk in with, and it’s odd because 1) the has no specifically masculine form to match man, 2) there’s no ending on walk, and 3) you don’t say ‘in with whom you walk’. All that strangeness is because of what Scandinavian Vikings did to good old English back in the day.Finally, as if all this wasn’t enough, English got hit by a firehose spray of words from yet more languages. After the Norse came the French. The Normans – descended from the same Vikings, as it happens – conquered England, ruled for several centuries and, before long, English had picked up 10,000 new words. Then, starting in the 16th century, educated Anglophones developed a sense of English as a vehicle of sophisticated writing, and so it became fashionable to cherry-pick words from Latin to lend the language a more elevated tone.It was thanks to this influx from French and Latin (it’s often hard to tell which was the original source of a given word) that English acquired the likes of crucified, fundamental, definition and conclusion. These words feel sufficiently English to us today, but when they were new, many persons of letters in the 1500s (and beyond) considered them irritatingly pretentious and intrusive, as indeed they would have found the phrase ‘irritatingly pretentious and intrusive’. (Think of how French pedants today turn up their noses at the flood of English words into their language.) There were even writerly sorts who proposed native English replacements for those lofty Latinates, and it’s hard not to yearn for some of these: in place of crucified, fundamental, definition and conclusion, how about crossed, groundwrought, saywhat, and endsay?But language tends not to do what we want it to. The die was cast: English had thousands of new words competing with native English words for the same things. One result was triplets allowing us to express ideas with varying degrees of formality. Help is English, aid is French, assist is Latin. Or, kingly is English, royal is French, regal is Latin – note how one imagines posture improving with each level: kingly sounds almost mocking, regal is straight-backed like a throne, royal is somewhere in the middle, a worthy but fallible monarch.Then there are doublets, less dramatic than triplets but fun nevertheless, such as the English/French pairs begin and commence, or want and desire. Especially noteworthy here are the culinary transformations: we kill a cow or a pig (English) to yield beef or pork (French). Why? Well, generally in Norman England, English-speaking labourers did the slaughtering for moneyed French speakers at table. The different ways of referring to meat depended on one’s place in the scheme of things, and those class distinctions have carried down to us in discreet form today.Caveat lector, though: traditional accounts of English tend to oversell what these imported levels of formality in our vocabulary really mean. It is sometimes said that they alone make the vocabulary of English uniquely rich, which is what Robert McCrum, William Cran and Robert MacNeil claim in the classic The Story of English (1986): that the first load of Latin words actually lent Old English speakers the ability to express abstract thought. But no one has ever quantified richness or abstractness in that sense (who are the people of any level of development who evidence no abstract thought, or even no ability to express it?), and there is no documented language that has only one word for each concept. Languages, like human cognition, are too nuanced, even messy, to be so elementary. Even unwritten languages have formal registers. What’s more, one way to connote formality is with substitute expressions: English has life as an ordinary word and existence as the fancy one, but in the Native American language Zuni, the fancy way to say life is ‘a breathing into’.Even in English, native roots do more than we always recognise. We will only ever know so much about the richness of even Old English’s vocabulary because the amount of writing that has survived is very limited. It’s easy to say that comprehend in French gave us a new formal way to say understand – but then, in Old English itself, there were words that, when rendered in Modern English, would look something like ‘forstand’, ‘underget’, and ‘undergrasp’. They all appear to mean ‘understand’, but surely they had different connotations, and it is likely that those distinctions involved different degrees of formality.Nevertheless, the Latinate invasion did leave genuine peculiarities in our language. For instance, it was here that the idea that ‘big words’ are more sophisticated got started. In most languages of the world, there is less of a sense that longer words are ‘higher’ or more specific. In Swahili, Tumtazame mbwa atakavyofanya simply means ‘Let’s see what the dog will do.’ If formal concepts required even longer words, then speaking Swahili would require superhuman feats of breath control. The English notion that big words are fancier is due to the fact that French and especially Latin words tend to be longer than Old English ones – end versus conclusion, walk versus ambulate.The multiple influxes of foreign vocabulary also partly explain the striking fact that English words can trace to so many different sources – often several within the same sentence. The very idea of etymology being a polyglot smorgasbord, each word a fascinating story of migration and exchange, seems everyday to us. But the roots of a great many languages are much duller. The typical word comes from, well, an earlier version of that same word and there it is. The study of etymology holds little interest for, say, Arabic speakers.this muttly vocabulary is a big part of why there’s no language so close to English that learning it is easy To be fair, mongrel vocabularies are hardly uncommon worldwide, but English’s hybridity is high on the scale compared with most European languages. The previous sentence, for example, is a riot of words from Old English, Old Norse, French and Latin. Greek is another element: in an alternate universe, we would call photographs ‘lightwriting’. According to a fashion that reached its zenith in the 19th century, scientific things had to be given Greek names. Hence our undecipherable words for chemicals: why can’t we call monosodium glutamate ‘one-salt gluten acid’? It’s too late to ask. But this muttly vocabulary is one of the things that puts such a distance between English and its nearest linguistic neighbours.And finally, because of this firehose spray, we English speakers also have to contend with two different ways of accenting words. Clip on a suffix to the word wonder, and you get wonderful. But – clip on an ending to the word modern and the ending pulls the accent ahead with it: MO-dern, but mo-DERN-ity, not MO-dern-ity. That doesn’t happen with WON-der and WON-der-ful, or CHEER-y and CHEER-i-ly. But it does happen with PER-sonal, person-AL-ity.What’s the difference? It’s that -ful and -ly are Germanic endings, while -ity came in with French. French and Latin endings pull the accent closer – TEM-pest, tem-PEST-uous – while Germanic ones leave the accent alone. One never notices such a thing, but it’s one way this ‘simple’ language is actually not so.Thus the story of English, from when it hit British shores 1,600 years ago to today, is that of a language becoming delightfully odd. Much more has happened to it in that time than to any of its relatives, or to most languages on Earth. Here is Old Norse from the 900s CE, the first lines of a tale in the Poetic Edda called The Lay of Thrym. The lines mean ‘Angry was Ving-Thor/he woke up,’ as in: he was mad when he woke up. In Old Norse it was:
Vreiðr vas Ving-Þórr / es vaknaði.
The same two lines in Old Norse as spoken in modern Icelandic today are:
Reiður var þá Vingþórr / er hann vaknaði.
You don’t need to know Icelandic to see that the language hasn’t changed much. ‘Angry’ was once vreiðr; today’s reiður is the same word with the initial v worn off and a slightly different way of spelling the end. In Old Norse you said vas for was; today you say var – small potatoes.In Old English, however, ‘Ving-Thor was mad when he woke up’ would have been Wraþmod wæs Ving-Þórr/he áwæcnede. We can just about wrap our heads around this as ‘English’, but we’re clearly a lot further from Beowulf than today’s Reykjavikers are from Ving-Thor.
Thus English is indeed an odd language, and its spelling is only the beginning of it. In the widely read Globish (2010), McCrum celebrates English as uniquely ‘vigorous’, ‘too sturdy to be obliterated’ by the Norman Conquest. He also treats English as laudably ‘flexible’ and ‘adaptable’, impressed by its mongrel vocabulary. McCrum is merely following in a long tradition of sunny, muscular boasts, which resemble the Russians’ idea that their language is ‘great and mighty’, as the 19th-century novelist Ivan Turgenev called it, or the French idea that their language is uniquely ‘clear’ (Ce qui n’est pas clair n’est pas français).However, we might be reluctant to identify just which languages are not ‘mighty’, especially since obscure languages spoken by small numbers of people are typically majestically complex. The common idea that English dominates the world because it is ‘flexible’ implies that there have been languages that failed to catch on beyond their tribe because they were mysteriously rigid. I am not aware of any such languages.What English does have on other tongues is that it is deeply peculiar in the structural sense. And it became peculiar because of the slings and arrows – as well as caprices – of outrageous history
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HMOs Confront Language Struggles

Posted on April 8, 2013 at 11:57 AM Comments comments (8)
HMOs Confront Language StrugglesLimited English Enrollees Have Tough Time With DoctorsBy Payers & Providers Staff Mar 7, 2013 California Region Forward/E-MailA new study by UCLA researchers has discovered a link between low levels of English proficiency among health plan enrollees and difficulty in accessing healthcare.According to the study, which was undertaken by the UCLA Center for Health Policy Research, as many as 1.3 million Californians with limited proficiency in the English language are enrolled in health maintenance organizations. Most are enrolled in plans that are designed to serve low-income enrollees, although nearly 10% are enrolled in commercial plans.About 12% of those enrollees – most of whom spoke Spanish as their primary language – said they had trouble communicating with their physicians.Despite state laws and regulations regarding provisions for interpretative services for these enrollees, about half of those surveyed said they did not receive them.“One of the problems with planning for and providing effective interpreter services for our LEP population in California is the lack of consistent training of interpreters,” said Dylan Roby, lead investigator on the study and director of the Center's Health Economics and Evaluation Research Program. “Although health plans are required to assess the language needs of their members and develop a plan to address them, there is quite a bit of variation in how they do so and who is expected to provide interpretation to patients at the bedside or during a visit.”The study also suggested that there was a “disconnect” between the expectations of health plans in dealing with language barrier issues and the actual reality confronted by their enrollees.The study showed significant gender and ethnic divisions when it came to language issues: About two-thirds of females said they had a hard time understanding their physicians, versus about one-third of males.Enrollees in commercial health plans were more likely to have communication issues than those in public plans, while Asians and Pacific Islanders had communication issues less than 20% of the time.Income divisions ran across similar lines: About two-thirds of those with incomes below 200% of the federal poverty level said they had trouble communicating. Only about one-third of respondents with incomes above that threshold said they had trouble communicating with their doctors.Given that as much as 36% of those Californians who receive healthcare coverage next year as a result of the Affordable Care Act, the study's authors suggested that health plans exercise more rigor in training bilingual staff and contracting for language interpretation services.
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Posted on February 15, 2013 at 12:01 PM Comments comments (4)
Language, Culture, And Medical Tragedy: The Case Of Willie Ramirez

byGail Price-Wise Gail Price-WiseView Biographical InfoView posts from Gail Price-WiseStart Social Shares Bar End Social Shares Bar Editor’s Note: The November-December issue of Health Affairs contains essays by a physician and a medical interpreter on the challenges and perils of navigating language gaps between medical providers and patients in the absence of a trained medical interpreter. The essays appear in the journal’s “Narrative Matters” section, which is supported by the W.K. Kellogg Foundation. The post below by Gail Price-Wise explores the same themes as these “Narrative Matters” essays. Price-Wise sheds new light on the case of Willie Ramirez, one of the most well-known and tragic instances in which interpreting difficulties and cultural misunderstandings resulted in medical error.On the evening of January 22nd, 1980, eighteen year old Willie Ramirez was out with a friend when he experienced a headache. He attributed it to the smell of gasoline in his friend’s car:
I tried to ignore it because I wanted to be with my friend, and it went away for a while. All of a sudden, I had a sharp pain. I grabbed the back of my head. I sat on the floor. It felt like someone was sticking a needle through my head. My friend helped me to my car. I knew I was going to my girlfriend’s house – it was closer than my house. I couldn’t see right. Everything looked like things were moving around. I tried to find back streets to find the shortest route. I passed her house, slammed on the brakes and turned around and parked. I stumbled out of the car. I fell against the fence. Then her mom came out of the house and helped me in. I think I went in and out of consciousness. I remember a white coat. I think they were slapping my face. They were yelling, “What did you take?! What did you take?!” When I woke up, I didn’t know where I was. I already had the surgery, but I didn’t know anything. I didn’t know I was in a hospital. I didn’t know I was quadriplegic.
Willie Ramirez was taken by ambulance to a South Florida hospital in a comatose state. He became quadriplegic as a result of a misdiagnosed intracerebellar hemorrhage that continued to bleed for more than two days as he lay unconscious in the hospital. In the course of the law suit, it was asserted that Willie could have walked out of the hospital had the neurosurgeon been called in earlier. No neuro consult was ordered for two days because the Emergency Room physician and the doctor covering Willie in the ICU erroneously believed that Willie had suffered an intentional drug overdose and had treated him accordingly. The misdiagnosis was based on the physical exam which initially pointed to a drug overdose, and on complete confusion regarding the medical history. At the heart of this confusion, was the Spanish word “intoxicado” which is NOT equivalent to the English word “intoxicated.”
‘Intoxicado’ And ‘Intoxicated’: Similar In Sound, Very Different In MeaningAmong Cubans, “intoxicado” is kind of an all encompassing word that means there’s something wrong with you because of something you ate or drank. I ate something and now I have hives or an allergic reaction to the food or I’m nauseous. On the day Willie’s intracerebellar bleed began, he had lunch at a fast food restaurant, the newly opened Wendy’s. His mother and his girlfriend’s mother assumed that the severe headache he experienced that night was related to eating a bad hamburger at Wendy’s – that Willie was “intoxicado.” There are various accounts as to when and with whom the word “intoxicado” was used. Four people came into contact with the paramedics and the emergency room doctor: Willie’s mother, Iberia; his 13 year old sister; his 15 year old girlfriend; and his girlfriend’s mother, Concha. Distress clouds Iberia’s face when she denies she used the word, “intoxicado.” I feel like grabbing her by the shoulders and saying, “If it was you, it’s ok. It wasn’t your fault. It was the responsibility of the hospital to ensure their doctors can communicate with patients.”Only Concha admits to using the word, but she adds an important caveat. She insists she clarified to the ER doctor that there was no alcohol or drugs involved. Concha’s English is very difficult to understand. Her accent is thick. She pauses frequently to search for an appropriate English word. She often places the accent on the wrong syllable, distorting the word. But Concha is bold and outgoing and unafraid to speak in a foreign tongue. She’s worked hard to assimilate into America, desperately wishes to speak English like a native and is overconfident in her ability to do so. She informed me that since Iberia didn’t speak English, she spoke to the doctor – in English. She wanted to tell the doctor that the hamburger Willie ate made him sick: “I say him, doctor the amburger intoxiCAted him. I asplain him no alcol, no droogs.”In spite of the emphasis on the wrong syllable, the clearly pronounced “intoxiCAted” is clearly distinguishable, one of the few words that stands out as she relays the story. As Concha speaks, I wondered why she would have added the part about “no drugs, no alcohol,” since 28 years ago she didn’t know what “intoxicated” means in English and would not have recognized the potential for confusion. In recounting the story, she may have added this caveat to calm her conscious. There’s no way of knowing since the depositions have long since been destroyed. But if she truly said “no alcol, no droogs”, her accent may have rendered the words incomprehensible to an English speaker.Differing Memories And Cultural Confusion The ER doctor recalls:
The paramedics brought in an 18 year old comatose male, with no apparent trauma. In those days, we didn’t have a CT scanner in our hospital. All I had was my experience to draw from. His respirations were labored and I thought he might have a respiratory arrest. I intubated him and got his breathing stabilized. He had pinpoint pupils, which can be caused by opioid intoxication. He had no focal neurological sign, no palsy, no blown pupil, nothing to suggest a space occupying lesion. Healthy, strapping kids don’t come into the ER comatose unless they’ve been in a car accident or had an overdose. I thought my conversation with the family confirmed the diagnosis – that he had taken an overdose of drugs. I remember coming into lobby. His mother was there and I spoke to her through an interpreter that accompanied the family. I had some trouble understanding them, but the “gist” of the conversation was that he was upset about a fight with his girlfriend and had taken drugs.
Willie’s sister remembers the conversation with the ER doctor differently:
I remember him very clearly. He was tall and thin and light colored. We Cubans think a lot of Americans look light colored, but he was particularly light. The ER doc said to my mom that he thought it was drugs – that Willie’s condition looked like a drug overdose. My Mom was really upset that they said it was drugs. My mom and I spoke to each other in Spanish. My brother was an all-star baseball player, an athlete. He was really concerned about taking care of his body. We couldn’t imagine that he would use drugs. But a doctor said it – and you tend to believe what a doctor says. So we didn’t protest. We didn’t tell him this was impossible – that Willie never took drugs. In front of the doctor, we just said to each other in Spanish, “This just cannot be true.”
Cultural differences complicated the language issue. The ER doctor did not consider that in certain cultures, people never contradict what an authority figure, like a doctor, has said. The doctor needed to engage the family in a deeper discussion to understand the family’s persepective – that Willie was strongly opposed to drugs and could therefore never suffer an intentional overdose. In my interview with Willie, he said, “I rarely even drank a beer. I was totally against drugs. In fact, I was afraid of them.” The family would have told this to the doctor if they had been put at ease to speak freely. This would certainly have required a professional interpreter.In my interview with the ER doctor, he continues his version of the story, “If I had a Mom who said, “My son would NEVER use drugs,” I may have thought differently.”The ER doctor believed Willie had a fight with his girlfriend that upset him to the point of taking drugs. In my interviews with them, Willie and his girlfriend each told me that they frequently argued. Like many adolescent romances, they would break up one day and get back together the next day. His girlfriend, who was 15 at the time, likely found this to be endlessly fascinating and may have relayed it to the ER doctor. Willie’s mother would have known that her son never took the spats seriously and that this discussion was simply a distraction from the relevant medical history. But she didn’t speak English and was therefore relegated to silence. Most of us would shudder to think that an adolescent girl chattering about her boyfriend could influence life and death decisions in a hospital. This is the power given to bilingual children whose parents don’t speak English.Neither the ER doctor nor the family requested a professional medical interpreter because each side believed they were communicating adequately.According to the 2006 American Community Survey of the US Census Bureau, nearly one in five Americans speak a language other than English at home. At least one in 11 people older than the age of five report that they speak English less than “very well.” In the absence of readily available professional medical interpreters, health care providers turn to people without adequate skills to interpret. Ad hoc interpreters defined as family members, friends, untrained staff, or strangers from the waiting room are significantly more likely to make mistakes and to omit valuable information when interpreting than are professional interpreters.The Power Of Personal ExperienceI’ve spent most of my professional career trying to improve health care services for cultural and linguistic minorities. Privately, I never understood what was so wrong with using a bilingual friend or family member to interpret, especially if the topic wasn’t of a personal nature – meaning sex, or bladder and bowel functions. I changed my mind when my stepmother suffered a vertebral fracture after being thrown from a horse while on vacation in French-speaking Guadeloupe. Unhappily, I was the only person who could interpret in the hospital. My French isn’t fluent, but I would guess that it’s better than the English spoken by many family members who are asked to interpret in US hospitals. The fear of a spinal cord injury added urgency to my attempts to accurately interpret a foreign language. “Does she have neurological damage or not?” I struggled to pronounce “neurological” in French and hoped they would understand me. The response: “There doesn’t appear to be any neurological damage.” I didn’t understand the French phrase for “there doesn’t appear to be” and asked the doctors several times to repeat it, as family members waited wide-eyed for me to interpret what was being said.It’s easy to make serious errors when interpreting. If you don’t understand a word or two, it’s natural to skip that part and just interpret what you understand. You just convince yourself that the few missing words probably weren’t important anyway. Like the ER doctor in the Willie Ramirez case said, you can still get the “gist” of the conversation. As I interpreted for my step-mother is Guadeloupe, I was only missing the French words “there doesn’t appear to be” – followed by the words that were clear to me, “neurological damage.” In getting the “gist” I had a 50:50 chance of interpreting correctly, that there either was or wasn’t neurological damage.Then there was the task of relaying her medical history. Like Willie, my stepmother had suffered a brain aneurysm as a young woman. I assumed this to be an important part of her history, but unfortunately, the word “aneurysm” had never come up in my high school French class. I struggled to explain and believed they understood what I was saying, but I didn’t know if they did. In the end, she recovered fully – in spite of the limitations of her ad hoc interpreter.‘Embarazada’ Versus “Embarrassed” And Other Translation Pitfalls There are lots of pitfalls to avoid when interpreting. Particularly dangerous are false cognates, which are words like “intoxicado” that sound the same in both languages, but mean something different. “Embarazada” in Spanish does not mean embarrassed. It means pregnant. Imagine the woman in her first trimester struggling to explain her condition to the ER staff in her rudimentary English, “I am embaras.” Because of this word, a fetus might be exposed to harmful x-rays or drugs.It’s also easy to simply be offensive. “Excitado” in Spanish is only used to denote sexual arousal. One would not be “excitado” about seeing an old friend – except if that friend is a real or imagined sexual partner. In English, “he is a character,” is different from “he has character.” “I am boring” is easily confused with “I am bored.” These expressions cannot be translated word for word because they won’t make any sense in other languages. “Caliente” means, “hot” in Spanish, but, like “excitado” is often used to refer to sexual arousal, or to food at a high temperature. It would be inappropriate to call yourself “caliente” in a doctor’s office, but you could say that your feverish child feels “caliente” to the touch.One 2-year-old girl with a clavicular fracture was mistakenly placed in child protective custody for suspected abuse as a result of such a mistake. In the absence of an interpreter, a medical resident who may have spoken some Spanish misunderstood “se pegó” to mean the girl was “hit by someone else” instead of the girl “hit herself” when she fell off her tricycle. To a non-Spanish speaker, such an error would seem highly unlikely, but in fact, both translations for “se pegó” – “she hit herself” and “she was hit” are correct. In this situation, a medical resident who spoke some Spanish was worse than a provider who spoke no Spanish. A professional interpreter was needed to glean the correct meaning from the context. Errors in interpretation occur frequently, because it takes years to learn the nuances of a language.Willie Ramirez: Conclusion And AftermathAs a result of the miscommunication, Willie Ramirez was admitted to the intensive care unit with a diagnosis of “probable intentional drug overdose.” The attending physician did not question the diagnosis. Willie’s mother recalls that he had to be restrained because he was pulling out tubes with arms that still worked. After nearly two days, the attending physician recognized that Willie was no longer moving his arms and called in a neurologist who found a serious loss of eye function, indicating brain damage. The left lateral rectus muscle, which normally causes the eye to look to the side, was no longer working, leaving the medial rectus muscle unbalanced. The result was that Willie appeared to be looking at his nose, at least with his left eye.During the exam, Willie experienced a respiratory arrest. He was put on a respirator and whisked away to one of the few hospitals in South Florida that had a CT scanner in 1980. The scan revealed a left intracerebellar hematoma with brain-stem compression, and an acute subdural hematoma. Emergency surgery was performed but it was too late to prevent the brain damage that left Willie quadriplegic. The law suit resulted in a settlement over Willie’s lifetime of approximately $71 million, assuming he lives to age 74.There are other casualties in this story. Willie’s family and friends who tried to explain what was wrong with him and the doctors who tried to diagnose and treat him carry enormous sorrow, not only for Willie’s tragic loss of function, but for the painful thought that it didn’t have to be. In the words of the attending physician 28 years after the event, “You don’t know the agony of being blamed for something like this.
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Clearing up the Top 10 Myths About Translation

Posted on June 15, 2012 at 1:45 PM Comments comments (18)
Nataly Kelly
Co-Author, Found in Translation and Chief Research Officer, Common Sense Advisory
Translation has an impact on virtually every aspect of society, politics, and economics, but how much of what you know about translation is really true? You might be surprised to learn that translation is a highly diverse and complex market -- and one that's bigger than you might think. Here are ten of the most widely held myths about translation:
1. Translation is a small, niche market. The global market for outsourced language services is worth more than US$33 billion in 2012. The largest segment of the market is written translation, followed by on-site interpreting and software localization. The vast majority of these translation services are provided by small agencies -- there are more than 26,000 of them throughout the world. These companies coordinate translation projects in multiple languages simultaneously, often involving many different file types, processes, and technology tools. The words themselves are translated and interpreted by the hundreds of thousands of language professionals scattered all across the globe. Many translators and interpreters also have direct clients, but most are freelancers whose work comes from agencies.
2. The need for translation is fading away. The U.S. Bureau of Labor Statistics estimates that there will be 83,000 jobs for interpreters and translators by 2020 in the United States alone. This job market is expected to grow by 42 percent from 2010 to 2020, significantly higher than the average of 14 percent for all professions. Data from Common Sense Advisory shows that globally, the market has a compound annual growth rate of 12.17 percent.
3. Most translators translate books; most interpreters work at the United Nations. Literary translation and conference interpreting are two of the most visible specializations, but they actually represent very tiny segments of the market at large. Who are the biggest translation spenders? Military and defense agencies spend the most on translation, with the United States routinely spending billions on language services for defense and intelligence initiatives. On the commercial side, some of the largest segments of the translation market are manufacturing, software, health care, legal, and financial services. As a result, freelancers often work in these specialty areas -- as financial translators, medical interpreters, legal translators, and court interpreters.
4. Any bilingual can be a translator or an interpreter. The ability to write in English does not make a person a professional writer. The ability to speak English does not make a person a professional speaker. Likewise, the ability to write or speak two languages does not mean that a person can translate or interpret. Plenty of people who are perfectly fluent in two languages fail professional exams for translation and interpreting. Why? Being bilingual does not guarantee that a person will be able to transport meaning from one language and culture to another without inflicting harm in the process. Most translators and interpreters are highly educated, with advanced degrees and training in either translation, linguistics, or a specialty field. Also, while not mandatory, professional certifications are widely recognized and strongly encouraged. In the U.S., translators are certified by the American Translators Association, and a variety of certifications exist for interpreters.
5. Interpreters and translators do the same thing. The all-encompassing term that the general public uses to refer to language professionals is "translators," but the reality is that translators and interpreters have very different job skills. Translation refers to written language, while interpreting refers to spoken language. Translators must have great writing skills and training in translation, but they must also be adept at using computer-assisted translation tools and terminology databases. Interpreters, on the other hand, have to develop their short-term memory retention and note-taking skills as well as memorizing specialized terminology for instant recall.
6. Translators and interpreters work in more than two languages. One of the most common questions translators and interpreters are asked is, "How many languages do you speak?" In reality, many translators work in only one direction -- from one language into another, but not in the reverse. For translators and interpreters, it is better to have in-depth knowledge of just two languages than to have surface-level knowledge of several. Why? Of approximately one million words in English, the average person uses only 4,000 to 5,000 words on a regular basis. People who are "educated" know between 8,000 and 10,000 words. The professions with the widest vocabulary, such as doctors and lawyers, use about 23,000 words. Interpreters and translators who work for these specialized professions often use this kind of advanced technical vocabulary in two languages. Some translators and interpreters do work in more than one language combination -- for example, conference interpreters often have several "passive" languages that they can understand. However, translators and interpreters are not usually hyperpolyglots.
7. Translation only matters to "language people." The need for translation crosses both the public and private sectors. In the business world, executives at companies of all sizes are beginning to recognize that translation is a pathway to enabling more revenue and entering new markets. A recent study found that Fortune 500 companies that augmented their translation budget were 1.5 times more likely than their Fortune 500 peers to report an increase in total revenue. Also, government bodies are increasingly taking an interest in translation. Indeed, even those involved in development and non-profit work need to pay attention to translation. A report on translation in Africa conducted for Translators without Borders in May 2012 showed that greater access to translated information would improve political inclusion, health care, human rights, and even save lives of citizens of African countries.
8. Crowdsourcing puts professional translators out of work. As online communities have become more popular, so has something called "crowdsourced translation." This phenomenon typically emerges when online community members get excited about a product and want to use it in their native languages. Sometimes, these customers and fans even begin creating their own translations and posting them in user forums. Instead of leaving their customers to pontificate on the best translations amongst themselves, smart companies are giving these communities the ability to easily suggest their translations. Are companies harnessing the work of these volunteers to obtain free labor? Actually, as the research shows, saving money is not a primary motivation -- setting up these kinds of platforms can cost companies more time and money than just paying for traditional human translation. They typically pay human translators and translation companies to edit the group-translated content anyway, but they believe the collective approach gives power directly to customers and users, enabling them to have a say in which translations they like best.

9. Machine translation is crushing the demand for human translation.
The opposite is true. Machine translation is actually expanding the demand for human translation and fueling the market at large. How? Machine translation -- especially the free online kind -- serves as an awareness campaign, putting translation squarely in front of the average person. Translating large volumes of information is never free -- it comes at a cost, even with machine translation. Machine translation technology and related services make up a tiny percentage of the total translation market. Of course, machine translation can achieve some feats that humans cannot, such as quickly scanning large bodies of text and provide summaries of the information contained within them. However, as with most technologies, humans are needed to use machine translation intelligently. As Ray Kurzweil points out, technologies typically don't replace whole fields -- rather, they more often help fields to evolve.
10. All translation will someday be free. The translation and interpreting industry adds tens of thousands of new jobs to the global economy each year and there is no slowdown in sight. Translators and interpreters are extremely important members of this industry -- in fact, they are the very heart of it. However, much like other professional service industries, the translation industry also relies on countless other professionals: project managers, account managers, vendor managers, production managers, schedulers, trainers, quality assurance teams, proofreaders, desktop publishing professionals, engineers, product managers, salespeople, marketers, technicians, and even people who work in procurement, human resources, billing, and IT. Research from Common Sense Advisory shows that demand for translation is outpacing supply -- so if anything, human translators are becoming even more important. However, they are part of a much larger ecosystem, one that keeps global business churning and international communication flowing.
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Hospitals struggle to provide interpreters for patients who don't speak English.

Posted on May 22, 2012 at 11:11 AM Comments comments (41)
Hospitals struggle to provide translators for patients who don’t speak English
Hospitals and other medical providers are in a tough spot, say experts. The law prohibits them from asking patients to pay for translation services, and they may not receive adequate or in some cases any other reimbursement. “It’s a civil rights law, not a funding law,” says Mara Youdelman, managing attorney in the Washington office of the National Health Law Program.A dozen states and the District reimburse hospitals, doctors and other providers for giving language services to enrollees in Medicaid, the joint federal-state program for low income people, and in CHIP, a federal-state health program for children, according to Youdelman. Virginia and Maryland do not. /article_body Personal Post INLINE_BB AD BEGIN INLINE_BB AD END/article-side-rail A 2008 survey by America’s Health Insurance Plans, an industry trade group, found that 98 percent of health insurers provide access to interpreter services, but providers and policy experts question that figure. According to a survey by the Health Research and Educational Trust, in partnership with the American Hospital Association,
3 percent of hospitals received direct reimbursement for interpreter services, most of that from the Medicaid program. “Most hospitals that make this a priority make it a budget item,” Youdelman says. Lost in translation Hospitals and other providers realize that offering competent interpreter services can help ensure that they don’t miss or misdiagnose a condition that results in serious injury or death, experts say. Trained interpreters can also help providers save money by avoiding unnecessary tests and procedures. Youdelman cites the example of a Russian-speaking patient in Upstate New York who arrived at an emergency department saying a word that sounded like “angina.” The emergency staff ran thousands of dollars’ worth of tests, thinking he might be having a heart attack. The real reason for his visit: a bad sore throat. Like many hospitals, Children’s Medical Center of Dallas provides interpreter services around the clock via varying modes of communication — face-to-face, telephone and video — delivered by a mix of trained staff interpreters and outside contractors.When Nadia Compean, 23, was six months pregnant, her doctor in Odessa, Tex., told her that her baby had spina bifida, a condition in which the spinal cord doesn’t close properly, leading to permanent nerve and other damage.The local hospital wasn’t equipped to handle the birth and subsequent surgery that her daughter would require, so Nadia and the child’s father traveled to Dallas, about 350 miles away.Neither speaks much English, but at Children’s Medical Center of Dallas, interpreters helped them understand what to expect, Nadia said (through an interpreter).Nadia says she learned that her daughter, Eva, would be born with a lump on her back and would require immediate surgery. She also learned about problems that Eva may experience walking and using the toilet, she says.Eva was born March 6. Because of her medical needs and the lack of adequate interpreter services in Odessa, the couple is considering relocating to Dallas, where the father hopes he can find construction work.This column is produced through a collaboration between The Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente.
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Interpreters ratify contract with 99% "yes" vote!

Posted on July 15, 2011 at 8:04 AM Comments comments (17)
Federation-represented medical interpreters today ratified their first-ever – and groundbreaking – contract with the state with a 99 percent yes vote.

The vote was 256 to accept and 3 to reject, with 30 ballots voided. This first two-year collective bargaining agreement takes effect July 1.

It’s the first-ever such agreement in the nation for independent contract interpreters.

We’ll have much more in the coming weeks and months on the personal impact of this victory.

But in the big picture, it stands as a moral victory for some 2,000 medical interpreters under contract with the state – many of whom are first-generation Americans seeking the American dream of freedom and fairness.

The pact covers about 2,000 independent interpreters under contract with the state. These “language access providers” help doctors and others communicate to patients and clients for whom English is a second language.

The program came about because of a civil rights lawsuit settlement. Federal law requires that health care providers ensure their Medicaid patients can communicate with doctors. Without the state program, doctors and hospitals would shoulder the costs of hiring interpreters proficient in dozens of languages. And those costs could be passed along to consumers, driving up already high medical costs.

One of the goals of the unionized interpreters is to streamline the program and keep overall health costs low.

In combination with 2011 legislation, the interpreters’ contract reforms an archaic and costly brokerage system where middlemen sap up millions of state and federal dollars before they ever get to interpreters providing the services required by federal law. Ending the costly brokerage system will free up necessary funds; more savings will come from a new online system and resulting scheduling efficiencies. This comes even with a 24 percent budget cut. That current system ends Jan. 1 when a new delivery system for medical interpreter services will start.

The new agreement also aims to retain qualified and quality interpreters. Under their first-ever contract, the state medical interpreters achieved improved work rights and minimum hourly pay of $30. The contract provides an agreement to return to the table to discuss economic compensation after the brokerage system ends in January.

The interpreters began their grassroots campaign to win a contract nearly two years ago. They objected to more taxpayer dollars going to middlemen – an estimated 44 percent of the budget – plus bureaucracy and poor treatment by brokers and agencies. They won union rights from the Legislature in 2010, voted to make WFSE/AFSCME their union and began the groundbreaking contract talks.

The interpreters will use their new contract to continue their fight to maintain quality services in the face of budget cuts.

The interpreters’ comprehensive campaign that included winning the new contract has lowered administrative costs from 44 percent to 28 percent. The union provided data showing the state’s assumptions – based on the number of medical appointments and inflation -- were unnecessarily high. The union will continue to push for administrative costs closer to those for Medicaid of about 4 percent.
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Program teaches interpreters how to translate medical jargon with sensitivity

Posted on June 2, 2011 at 7:46 AM Comments comments (55)
Years ago, when Rodney Ramos came to the U.S. from Puerto Rico he was the first one in his family to learn English. So when he was 11 years old and his grandmother became ill, it fell to him to try interpret the doctor's diagnosis that his grandmother had a detached uterus and possibly cancer.
It was an experience he never forgot.
"A child can't be asked to do that," he said, adding that he often served as his family's interpreter.
Out of his experience as a child and then as an adult interpreter at a hospital in Racine, Ramos said he continued to be dissatisfied with the training and outcomes of interpreters trying to communicate between Spanish-speaking patients and doctors.
So after doing a lot of research and consultation, he developed a yearlong medical interpreter technician program that he has taught for the last seven years at Milwaukee Area Technical College.
Earlier this month, 18 students completed the two-semester program that teaches not just language fluency, but also medical terminology, cultural sensitivity, dialectical differences among various Spanish-speaking countries, ethics, values and nonverbal communication skills.
With the growth of the Latino community and changing demographics, health care providers are challenged by the demand to provide professional health care interpreters, said Ramos, 45, who has a bachelor's degree in Spanish with concentrations in English and philosophy.
"There's an incredible need for medical interpreters," he said.
Kristin Neitzel, the patient amenities and family services manager at Children's Hospital of Wisconsin, agrees.
"The need has been around for a long time," she said. "We want to provide interpreters because civil rights law dictates that we do. But more than that, there's a lot of research that shows that service and outcomes are better when an interpreter is used."
Skilled medical interpreters are sometimes also good for a medical facility's bottom line, because if a health issue is well understood and identified early, it can keep the number and cost of diagnostic tests down, she said.
Cultural comfort
It's also important that patients and families feel comfortable culturally, so that they can accurately communicate with doctors and nurses, she said.
"A lot of times families will nod or say 'yes' and that's not what they mean. Or they don't understand and don't want you to know that they don't understand," Neitzel said.
Years ago, people used to say that if you live in this country you should speak English, she said. "But imagine if you were in another country with a sick child or family member and didn't speak the language and couldn't communicate."
In 2000, the U. S. Census Bureau estimated that more than 21 million are of limited English proficiency, she added.
Children's Hospital has five full-time and four part-time interpreters and 29 other interpreters that it brings in through a local company, Neitzel said. All but two of the interpreters speak Spanish; one speaks Hmong and one is a sign language interpreter.
"We don't have the ability to hire all the interpreters we need because it's a cost to the organization and there's no reimbursement for it," she said.
Neitzel, who is a member of the advisory board of health care professionals that Ramos has assembled to provide feedback on the curriculum, said some of the interpreters who work at Children's have gone through the MATC program.
"Rodney has really taken his program to a new level," she said.
Before a student begins the program, Ramos gives a Spanish proficiency assessment, both written and oral, to test comprehension, fluency and limitations. He also conducts a conversation in Spanish and English with the student for additional input.
Ramos then develops an individual educational language plan for each student to elevate a person's language skills. Together the students work in classes in medical terms, culture, ethics and techniques of interpretation.
"The size of the class is kept at 18 because beyond that it's not manageable to produce the level of quality we want," he said. "I think the success of the curriculum is the individualized plan."
He claims a 100% graduation rate from his program.
Most of the students in his classes are Latino but "culturally broader," he said. "They're not polarized, like I'm Puerto Rican. They need to understand the wonderful variations, regionalisms, and that there's no one right way. He who knows the most ways of saying something can cater to the most patients."
Interpreter's role
The role and importance of an interpreter, he said, is to be "a conduit, clarifier and cultural broker."
His goal at MATC is "to lead the state and the Midwest in the quality of medical interpretation."
Every hospital administers its own interpreter test, even if the person has completed the MATC program, he said.
Only in the last year have efforts begun for a national certification program for medical interpreters, and that's still evolving, said Ramos and Neitzel. She said she would like to see Wisconsin have a licensure program for interpreters, but there is none now.
Medical interpreters can earn from $16 to $25 an hour, said Ramos.
"Mr. Ramos is a great teacher who tells you how it is with patients," said Rigoberto Valle, 25, who said he had firsthand experience with interpreters when his mom suffered a stroke. "There were misinterpretations and what I call 'false fluency,'" he said.
Yvette Martinez, 25, who was born in Mexico and is a native Spanish speaker, said she walked into the class thinking she knew what she was doing but soon learned differently.
"I went through a one-week interpreter training course, but I quickly found out I needed more training," she said after completing the MATC program.
"It's so important to be accurate and complete and to convey what the patient is feeling and saying to the doctor," said Manal Rivera, 32. "You see what your family and others go through. That's why I want to do this professionally."
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Transfusing a Jehovah’s Witness during surgery

Posted on May 14, 2011 at 9:34 AM Comments comments (21)
I was in practice about five years and was about to do a radical nephrectomy on a patient.
I met with the patient and his son in my office and the son informed me that he and his father were Jehovah’s Witnesses and that he didn’t want his father to receive any blood or blood products before, during, or after surgery. I asked the father if that was his wish and he sheepishly agreed that it was his decision as well. I had him sign a consent form, with the appropriate documentation, that would absolve me of any negligence if he should require a blood transfusion and didn’t receive it.
The night before surgery, I met with the patient alone in his room. He confided in me that he was not as “religious” as his son — if he needed blood, he wanted to receive it. However, he requested that I shouldn’t tell him or his son if he received a transfusion.
I thought that was a prudent plan of action, and I documented our discussion in the patient’s chart. I then made calls to the laboratory and the blood bank, to type and hold several units of packed cells.
The surgery was a little more difficult than I anticipated and the patient lost several units of blood — he had signs of hypovolemia in the immediate post-operative period. At the end of the procedure I ordered that the blood be given to the patient in the recovery room. I told the nurses not to allow any family members into the recovery room while the transfusions were being given. I also had the nurses change the IV tubing after the transfusions were given so that there would be no tell-tale signs of blood in the IV tubing that could be seen by the family. I thought I had covered all of my bases.
I then walked out to meet with the family in the family lounge. The son asked me about the surgery and I told him about the difficulty of the operation but that his father was stable and doing well in the recovery room. The son then asked me, “Did my father receive any transfusions or any blood products?” Pow! I know I had the look of a deer stunned by the headlights. There were so many thoughts that raced through my mind in the interval between his questions and my response.
I responded, “Why do you ask?” as I was hoping to have just a few more seconds to gather my thoughts. The son said that someone from the blood bank had come into the family lounge during the surgery and asked if anyone in the family would consider donating blood, as their father was going to receive blood. I thought I had taken care of everything but I didn’t give the blood bank a heads up on my agreement with the patient. I thought, do I tell the truth and risk rupturing rapport between the father and the son and/or between the patient and myself? To give an adult patient blood against their will or wishes could be considered an assault with battery. I was truly scared about the legal ramifications the truth would subject me to. Or do I lie and protect the patient? I decided that my responsibility was to the patient and that the patient deserved that I protect his wishes and preserve his relationship with his son.
I said, “There must have been a mistake as your father did not receive any blood.” The son gave a sigh of relief and I know that inside I, too, was also relieved that the rapport was not blown between the patient and me, or between the patient and his son.
I ask, if you were the doctor in this situation, what would you have done? Would you be perfectly honest and tell the son about your discussion with the father the night before? Or would you do as I did, and lie to the son in order to protect your patient, his father?
We have all taken the Hippocratic Oath, which admonishes us “To do no harm.” I believe this dictum refers to more than just clinical harm to the patient, but also to psychological harm. I believe that had I been forthright about the transfusions, I would have harmed the patient — the lie protected the patient.
A certain moral goodness is expected in physicians, and if goodness is not present, education probably will not create it. Superior moral reasoning can enhance moral behavior, and we only have to look at the lessons of the great physicians who preceded us for the answers and the advice that can guide us in the practice of our profession.
This was one of the scariest days in my professional life and I believe, to this day, that I behaved in the best interest of my patient.
Addendum: I have researched this issue and the legal implications associated with blood transfusions in Jehovah’s Witness patients. The advice is that “medical providers should take care that each patient presenting as one of Jehovah’s Witnesses has ample opportunity to express their personal preferences of treatment outside the presence of any other member of the faith, including close family members.” And that is exactly what I did.
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Helping Patients Understand Their Medical Treatment

Posted on April 14, 2011 at 10:06 AM Comments comments (21)
Helping Patients Understand Their Medical Treatment googleoff: all googleon: all
Topics: Delivery of Care, Quality, Public HealthBy Sandra G. Boodman Mar 01, 2011
This story was produced in collaboration with (Illustration for Kaiser Health News by Jack Black)An elderly woman sent home from the hospital develops a life-threatening infection because she doesn't understand the warning signs listed in the discharge instructions. A man flummoxed by an intake form in a doctor's office reflexively writes "no" to every question because he doesn't understand what is being asked. A young mother pours a drug that is supposed to be taken by mouth into her baby's ear, perforating the eardrum. And a man in his 70s preparing for his first colonoscopy uses a suppository as directed, but without first removing it from the foil packet.Each of these examples provided by health-care workers or patient advocates illustrates one of the most pervasive and under-recognized problems in medicine: Americans' alarmingly low levels of health literacy — the ability to obtain, understand and use health information.Translating Medical JargonSome technical terms and what they mean in plain English:
  • "myocardial infarction" (heart attack)
  • "hyperlipidemia" (high cholesterol)
  • "febrile" (feverish)
A 2006 study by the U.S. Department of Education found that 36 percent of adults have only basic or below-basic skills for dealing with health material. This means that 90 million Americans can understand discharge instructions written only at a fifth-grade level or lower. About 52 percent had intermediate skills: They could figure out what time a medication should be taken if the label says "take two hours after eating," while the remaining 12 percent were deemed proficient because they could search a complex document and find the information necessary to define a medical term.Regardless of their literacy skills, patients are expected to manage multiple chronic diseases, to comply with drug regimens that have grown increasingly complicated and to operate sophisticated medical devices such as at-home chemotherapy equipment largely on their own.Health literacy "affects every single thing we do," said Susan Pisano, a member of the Institute of Medicine's health literacy roundtable and vice president of communications for America's Health Insurance Plans, the industry trade association. "The implications are mind-boggling."As recently as a decade ago, the problem of health literacy was largely the province of academic researchers who published study after study documenting the glaring mismatch between the dense, technical and jargon-heavy materials routinely given to patients, some written at the graduate school level, and their ability to understand them.These days, health literacy is the focus of unprecedented attention from government officials, hospitals and insurers who regard it as inextricably linked to implementing the health-care overhaul law and controlling medical costs. The new law, which contains explicit references to health literacy, requires that information about medications and providers be made accessible to those with limited skills. In October, President Barack Obama signed the Plain Writing Act, which will boost that effort by directing federal agencies to use plain language in their materials.Adding urgency to those endeavors is the projected influx into the health care system of 32 million currently uninsured Americans who will begin to get coverage in 2014 under the new law.See DetailsSee details of the National Action Plan To Improve Health Literacy "Health literacy is needed to make health reform a reality," Health and Human Services Secretary Kathleen Sebelius said last year as she launched the National Action Plan to Improve Health Literacy, an effort designed to eliminate medical jargon and the complex, often convoluted explanations that pervade handouts, forms and Web sites."A whole bunch of new people are going to be entering the health-care market and making decisions that involve not just cost and 'Is my doctor in the plan?'" but also complicated trade-offs about risks and benefits, said Cindy Brach, a senior policy analyst at the Agency for Healthcare Research and Quality, which has made improving health literacy a priority.Keeping It Simple Studies have linked poor health literacy, which disproportionately affects the elderly, the poor and recent immigrants, to higher rates of hospital readmission, expensive and unnecessary complications, and even death. A 2007 study estimated the problem cost the U.S. economy as much as $238 billion annually.Starting this year, the Joint Commission, the group that accredits hospitals, is requiring them to use plain-language materials and to "communicate in a manner that meets the patient's oral and written communication needs" in providing care.Hospitals and health plans increasingly are turning to computer software that analyzes materials given to patients and flags overly technical language such as "myocardial infarction" (heart attack), "hyperlipidemia" (high cholesterol) and "febrile" (feverish). One program, developed by Bethesda-based Health Literacy Innovations, is being used by the National Institutes of Health, CVS and Howard University Hospital. It analyzes texts for complexity and suggests ways to simplify them.Employers are pushing insurers to demonstrate that the materials they give patients are simple and intelligible, said Aileen Kantor, founder of Health Literary Innovations.Instead of handing a patient pages of instructions, some hospitals and clinics are using videos or handouts with lots of pictures.Doctors at Boston Medical Center have pioneered an innovative program called Project RED, short for Re-Engineered Discharge, an effort that between 2006 and 2007 reduced readmission rates for the first month after discharge by 30 percent and costs by 33 percent. Instead of standard instructions, RED patients received a personalized discharge booklet, along with help making follow-up appointments and a call from a pharmacist a few days after they arrived home.

A Positive TestJaved Butler, a heart surgeon at Emory University Hospital in Atlanta, said one obstacle to improving health literacy is the language that doctors typically use. "When we say 'diet,' we mean 'food,' but patients think we mean going on a diet. And when we say 'exercise,' we may mean 'walking,' but patients think we mean 'going to the gym.' At every step there's a potential for misunderstanding," said Butler, who added that he tries not to lapse into "medicalese" with patients.It's not a problem only for those with basic skills. Paula Robinson, a patient education manager at the Lehigh Valley Health Network, which includes three hospitals in eastern Pennsylvania, said that even highly educated patients are affected, particularly if they're stressed or sick.She cites the
initial reaction of former New York Mayor Rudolph Giuliani, who thought he was cancer-free when his doctor told him several years ago that his prostate biopsy was "positive." Actually, a positive biopsy indicates the presence of cancer.Many patients, Robinson said, won't ask questions or say they don't understand, either because they are intimidated or worried about looking stupid. Some simply tune out or shut down, she said, and "a lot of people take things literally because of anxiety."Robinson recounts one such case: A patient who had been prescribed daily insulin shots to control his diabetes diligently practiced injecting the drug into an orange while in the hospital. It was only after he was readmitted with dangerously high blood sugar readings that doctors discovered he was injecting the insulin into an orange, then eating it.AHRQ's Brach said that some time-strapped doctors have complained that their schedules are too packed to add literacy concerns to the list.But she said simple measures that are not unduly time-consuming can be integrated into the visit. They include a method called "teach back," which asks patients to repeat in their own words what they have just been told.Illinois geriatrician Cheryl Woodson said she avoids making assumptions about her patients' health literacy. "You can't tell by looking," said Woodson, a solo practitioner in Chicago Heights."I never ask, 'Do you understand?'" she added, "because they say, 'Uh-huh,' and you don't know what they understand. So instead I'll say, 'I know your daughter is going to want to know about this, so what are you going to tell her?'"No Literacy Sometimes the problem is not health literacy, but the ability to read or write at all. It is estimated that 14 percent of adults are illiterate, but many find ingenious ways of compensating and take great pains to hide the problem.Archie Willard said he avoided going to the doctor for years before he learned to read at age 54. Even today Willard, now 80, said he struggles with reading — he is severely dyslexic — and identifies his medication by the shape and color of the pill, not by reading the label.Willard, who divides his time between Iowa and Arizona, said that before he learned to read he employed a strategy in medical settings common among those who cannot read or write. "I would say I couldn't fill out the paperwork because I forgot my glasses. And I didn't even wear glasses."Many experts predict that efforts to boost health literacy may benefit even the minority who are proficient. "People worry about dumbing things down," Brach said, "but in the research, no one has ever complained that things were too simple. Everybody wants clear communication."
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