Prescripción de los muertos

by Translation Guy on May 25, 2010
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I wonder how many patients with limited English proficiency (LEP) in the US health care system die each year due to the lack of care in their native language. I’ll bet it’s a lot given the health profession’s general penchant for planting so many of their patients six feet under.  After so many years in the business, I am no longer surprised by the carelessness of so many caregivers in making sure that LEP patients get the treatment that justice and compassion demand. Thank goodness for the efforts of many dedicated health care professionals to correct the problem of crossed languages in healthcare.

So it’s no surprise that the miscommunication so prevalent in hospitals and clinics extends to the pharmacy as well. Pharmacies that print prescription labels translated into Spanish often issue inaccurate or confusing instructions that could potentially be hazardous to a patient’s health, according to a report in the May issue of Pediatrics.

In a survey of Bronx pharmacies, researchers Iman Sharif and Julia Tse found that 73% of them provided medicine labels in Spanish.

“Independent pharmacies were significantly more likely to provide Spanish labels than were hospital or chain pharmacies (88% vs 57% vs 32%). Pharmacies that provided Spanish labels most commonly (86%) used computer programs to do so; 11% used lay staff members, and 3% used a professional interpreter. We identified 14 different computer programs used to generate Spanish labels, with 70% of pharmacies using 1 of 3 major programs. We evaluated 76 medicine labels generated by 13 different computer programs. Overall, 32 Spanish labels (43%) included incomplete translations (a mixture of English and Spanish), and 6 additional labels contained misspellings or grammar errors, which resulted in an overall error rate of 50%.”

This in a state where the law requires pharmacists to provide patients with spoken and written information about the dosage, purpose and side effects of prescription drugs. The law also prohibits pharmacies from discriminating against non-English speakers.

It’s worth noting that more people die in New York State from medication mishaps than from automobile accidents.

And this problem is not confined to the Empire State alone. A team of researchers led by Stacey Cooper Bailey surveyed pharmacies in four states with large Spanish-speaking populations. Their conclusion: “The majority of pharmacies surveyed offered limited or no translation services. Lack of translation services is not isolated to rural areas or locations with a marginal Latino population. Spanish-speaking patients encounter barriers to acquiring instructions that support the safe and effective use of medications.”

And if Spanish speakers are having this kind of trouble, you can bet that it’s even worse for all those other non-English speakers.

So, a dire diagnosis. What’s the treatment? Telephone interpreters? The New York State Attorney’s General Office reached an agreement with the five biggest pharmacy chains to provide access to telephone interpreters on demand so that pharmacists could talk to their LEP customers about treatment options. My professional assessment? Not worth the press release it’s written on. Telephone Interpreting doesn’t work for retail. Sure, they offer the service, and they may even put up a sign, but they do no staff training.  Meanwhile, the store manager is watching the checkout line grow, so the last thing pharmacists are going to want to do is have a leisurely conversation with one of our interpreters repeating everything back and forth. Telephone interpreters are everyone’s last resort.

The reported problem with machine translation is the lack of standardized language in the English-language instructions. That’s because these programs are being used out of the box. I am unfamiliar with a dedicated system, but I would think that, with such a narrow domain, it would be relatively inexpensive to construct a concept glossary that would regularize all the expressions in English to a few thousand text strings (to the additional benefit of those of us English speakers who actually read the label before we start popping our pills). Depending on the size of the database, a hybrid machine translation and translation memory system would make short work of it.

Take two aspirins and call me in the morning…

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  2. Nancy Grey says:

    Scary considering that 20 percent of Californians and 47 percent of Miami residents have limited English proficiency.

  3. Deb says:

    It’s ugly. Many patients who need medical interpreters have no access to them. According to one study (can’t remember the source, sorry), no interpreter was used in 46 percent of emergency department cases involving patients with limited English proficiency!

  4. Wow. It’s alarming that 86% would use software to translate something as vital as labels…

    Your suggestion of a standardised translation memory makes a lot of sense (certainly, it’s light years ahead of telephone interpreters) but I still don’t see why pharamacies can’t just use the services of a reliable professional translator.

    What would doctors and pharmacists think if we told them “Thanks Doc, but I’ll just go to an alchemist friend of mine, or check my symptoms on wiki”? 😉

  5. Sushi says:

    Ad hoc interpreters, including family members, friends, untrained members of the support staff, and strangers found in waiting rooms or on the street, are commonly used in clinical encounters. But such interpreters are considerably more likely than professional interpreters to commit errors that may have adverse clinical consequences. Ad hoc interpreters are also unlikely to have had training in medical terminology and confidentiality; their priorities sometimes conflict with those of patients; and their presence may inhibit discussions regarding sensitive issues such as domestic violence, substance abuse, psychiatric illness, and sexually transmitted diseases. It is especially risky to have children interpret, since they are unlikely to have a full command of two languages or of medical terminology; they frequently make errors of clinical consequence; and they are particularly likely to avoid sensitive issues.

  6. Doug says:

    I’m a doctor and I know this issue far too well. Inadequate communication can have tragic consequences: in one case at my hospital, the misinterpretation of a single word led to a patient’s delayed care and preventable quadriplegia…imagine that…

  7. Cid the kid says:

    “The U.S. Office of Management and Budget estimates the cost of providing adequate language services to everyone who needs them to be around $4 more for each doctor visit during emergency department, inpatient, outpatient, and dental visits.” – seems like a small price to pay, no?

  8. Mark Demanno says:

    Lack of health care kills 68 people in the US per day when it works well – image with this…ugh…sad

  9. Having a bilingual nurse, ad-hoc staff or family member review pharmacy and doctor instructions with the patient before leaving a doctor’s office should be on every persons list, if your 2nd language is Enslish. Bottom line.

  10. Chloe J. says:

    What about terminology though? Even for people with a strong understanding of the English language. I think Ken touched on this in a previous post – ensuring written materials are compatible with the very low educational level of some limited English proficient groups is needed desperately

    • Ken says:

      Chloe, its like doing the Limbo. How low can you go? And no matter how low you go, some folks just don’t get it, either. Professionally, I draw the line at hand puppets.

  11. Jasmine says:

    What about using video interpretation pools so that the state’s relatively few professional health care interpreters can help patients with limited English skills who live in remote locations?

  12. Flexwheel says:

    Good ideas everyone. Ken, do you know if some of these have been/are being utilized?

  13. Marshal says:

    It’s my understanding that the law prevents any state run agency from turning away patients due to their lack of health care. If that’s the case, are these people dying because they don’t realize that they can go to the hospital? If so, then I think the article should read “Lack of intelligence kills an additional 68 a day”. How did this survey determine whether or not somebody died from lack of health care?

  14. Qasim11876 says:

    I’ll bet it’s a lot given the health profession’s general penchant for planting so many of their patients six feet under.

  15. Qasim11876 says:

    In a survey of Bronx pharmacies, researchers Iman Sharif and Julia Tse found that 73% of them provided medicine labels in Spanish.

  16. ejaz14357 says:

    I’ll bet it’s a lot given the health general penchant for planting so many of their patients six feet under.

  17. My professional assessment? Not worth the press release it’s written on. Telephone Interpreting doesn’t work for retail. Sure, they offer the service, and they may even put up a sign, but they do no staff training. Meanwhile, the store manager is watching the checkout line grow, so the last thing pharmacists are going to want to do is have a leisurely conversation with one of our interpreters repeating everything back and forth. Telephone interpreters are everyone’s last resort.

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