Seale is right to observe that this is the first published empirical study of interpreter-mediated consultations in UK primary care; in the past 10 years, with several colleagues I was unsuccessful in getting funding for such a study.1 The paper is shocking to the extent that it shows in one UK setting — but there is no reason to suppose this was atypical — a flagrant disregard for well-evidenced guidelines2–4 on the need for proper interpreters in consultations between health professionals and people with limited English proficiency.
One of their most glaring findings is that in interpreted consultations professionals used mostly third-person pronouns (she, his) while in non-interpreted ones almost entirely second-person forms (you, your); in other words the health professionals were saying to the interpreters ‘does he take sugar?’ They note ‘Thus a concordance analysis showed that “does he” is the most common two-word phrase associated with providers’ usage of “he” in these consultations (33 times), and the most common verbs occurring before “him” in provider talk in these consultations are “see”, “ask”, “give”, “tell”, and “help”.’
All guidance points to the importance of addressing the patient directly, ‘do you take sugar?’, allowing the interpreter simply to relay the same words.
The various qualitative findings point to serious shortcomings in consultations interpreted by ‘informal’ (usually family members) interpreters, and highlight the need for proper provision.
The implication of this study, as noted by Joe Kai in his editorial, is surely that the cost of paid interpreters (whether face-to-face or a telephone service) is likely to outweigh the loss of effectiveness in diagnosis and management by health professionals hindered by a ‘language barrier’.5
- © British Journal of General Practice 2013