Lost In Translation

Shin remembers a disturbingly easy employment process. After expressing interest in the position on Handshake, Shin received tests to take: He listened to people speaking and recorded his interpretations. Shin says he felt he did badly on them, as the speech needing interpretation was fast. Certain passages listed 20 medications at once, he says. He got the impression that the company wanted nothing more than a basic assurance that Shin could speak Korean, and did not care much about the quality of his interpretation.  

Shin passed the test. “Oh, you could speak Korean, so you could learn how to interpret,” he remembers thinking.

Shin’s own parents used medical interpreters by phone when he was in middle school and high school. They deemed him too young to interpret for them at the time. Still, Shin recalls needing to correct interpreters on “pretty obvious things” when accompanying his parents. “Their Korean was pretty bad. Grammar wise, the words they were using, and their vocabulary, was pretty limited,” he says.

Now Shin told his parents he was nervous to take calls for his new job, as he was scared to make mistakes. They said the fact that he was nervous meant he, at least, cared. 

From their experience, most medical interpreters didn’t.

Catherine Zhang lives in Los Angeles near her elderly parents, neither of whom speak English. As her parents have gotten older, she has often accompanied them to doctors’ visits, ranging across specialties. She’s also made several visits of her own.  Zhang has encountered only iPad interpreters at any of these hospital appointments. 

Because Zhang speaks basic English, she has understood many of the exchanges between the interpreters and providers. Roughly a third of the time, she says, she’s noticed interpreters misinterpreting symptoms  or omitting details. One time she let her mother’s doctor know of her mother’s recent cellulitis diagnosis. She’d written the English term on a piece of paper and showed it directly to the doctor. There is only one possible translation in Mandarin for cellulitis, Zhang says. However, the interpreter, speaking on behalf of the doctor, used an entirely different word in Mandarin when talking to Zhang and her mother.

Shin says Propio does not teach its interpreters any medical terminology in their non-English language. After Shin passed the recording tests, his recruiter gave him two online courses: one on interpreter ethics and one on understanding English medical terms. The course on medical terminology focused only on common suffixes or prefix meanings in English. Shin was asked to translate literally as best he could, or find the actual Korean medical terms on his own time. Since Propio gave him no additional resources, Shin resorted to using Google translate or dictionaries. 

Both courses took him about a week and a half to complete. The medical terminology course consisted of 20 to 30 hours of instruction, and the interpreter ethics course took about 10 to 15 hours. Shin needed to score at least 75 percent on the courses’ final exams to start interpreting for pay. The tests were online, so consulting outside sources rather than actually learning the content of the courses was easy to do. Knowing that the content would be  integral to his job, Shin made sure to take the tests  “clean,” but he says “there are definitely ways to cheat, and the compromise is in the services that you offer.” Shin felt that if “you’re not really learning terminologies, you’re not really qualified for the job.”

In light of her past experiences with inaccurate interpretation, Zhang says she always listens attentively to the exchanges between her interpreter and doctor. Prior to each medical appointment, she searches up key terms in English, and writes down her own questions. She shows her provider the notes she’s written in English during the appointment, in an effort to prevent misinterpretation. 

“I fear the interpreters’ mistakes will lead to wrongly prescribed medicine, and I will use and take the wrong medicine,” Zhang says to me in Mandarin. 

But Zhang says she doesn’t blame these interpreters. She recalls once asking an interpreter if they did only medical interpreting, and the interpreter had told her “we interpret everything. If you call a phone company, we translate that. If you call a utility company, we translate that as well.” Though Shin is primarily trained in medical interpreting, he says he’s  interpreted for a variety of other purposes: conversations with banks, business pitches, and even once calling a police station in England. 

The Patient Protection and Affordable Care Act prohibits discrimination in health care on the basis of sex, race, color, national origin, age or disability. This includes those with limited English proficiency. It states that qualified interpreters must be provided, which means they have demonstrated proficiency in speaking and understanding both languages. They must also interpret effectively and accurately between the two languages, and follow “generally accepted interpreter ethics principles.”

 But with lax enforcement of this law, there’s enormous leeway for companies like Propio to determine interpreter standards. “Certified” interpreters are a step above qualified interpreters. “Certified” interpreters, as defined by the National Council on Interpreting in Health Care, are “certified as competent by a professional organization or government entity through rigorous testing based on appropriate and consistent criteria. Interpreters who have had limited training or have taken a screening test administered by an employing health, interpreter or referral agency are not considered certified.” 

But who is “certified” and who “qualified” has been left up to interpreter service companies. Shin was advised by Propio to say, when asked, that he is a certified interpreter due to the online coursework he completed. 

Whether interpreter companies get penalized for not properly screening or training medical interpreters remains to be seen. Propio Language Services, in its instructions to Shin, explicitly forbids him to divulge his connection to Propio. If asked by a provider what company he works for, Shin is instructed to say he is self-employed. Shin recalls once being asked by a nurse what interpreting company he worked for; he told her he was not allowed to say. 

The Affordable Care Act requires that patients—like nine year-old Alex, like Shin’s parents, and like Zhang—receive the same level of care from their doctors as any other U.S. resident receives, regardless of their English proficiency. 

For Alex, this means the ability to express his emotions and connect with his doctor. For Shin’s parents, this means feeling that their interpreters care enough to get the words right.  For Zhang, this means lifting the burden of constantly being on guard.

Zhang loves the speed with which an interpreter can be called on-screen. She just wishes interpreters were more accurate. Especially in medicine, Zhang says, accuracy is crucial. “Is this too difficult for an interpreter? They’re not interpreting ordinary terms,” Zhang ponders. She ruefully laughs. “Maybe my request is too high of an ask,” she says. 

Is it?