For patients who speak a different language, the gold standard is to use a professional interpreter. Our hospital is based in a multi-ethnic area where a substantial proportion of the patients do not speak any English. Professional interpreters are booked for clinic appointments and ‘language line’ is used in the acute setting. 

An elderly lady presented to the Emergency Department with urinary tract obstruction secondary to uterine prolapse. Language line was used to obtain the history and explain and gain consent for an internal examination and pessary replacement. However, when the patient struggled to tolerate the examination it became near impossible to guide her through it, due to the language barrier.

Reflection on a clinical case.

Rather than asking the patient to re-dress and call back language line; the patient’s grand-daughter attended with her and was eager to help. She held her grand-mother’s hand and translated feedback on the progress of the examination and pessary replacement. 

The patient’s face transformed from a picture of discomfort and fear to a relaxed smile as she nodded to her grand-daughter’s words. On completion, language line was again used to explain the findings and the management plan.

In this case, the presence of a relative as a second interpreter significantly aided the assessment. Instead of prolonging an uncomfortable assessment by asking the patient to re-dress and wait for another telephone interpreter to answer, the examination was completed promptly. 

Due to the patient’s presenting complaint, she was already in discomfort and self-conscious. To combine this with the confusion she developed during the examination, quickly escalated to fear. As doctors we strive to ‘do no harm’ with patient welfare being at the core of our practice. In this scenario, the words of assistance and reassurance from a loved one enabled us to maintain patient wellbeing and dignity.

Patient autonomy is a core value in Western Medicine. There was a temporary loss of autonomy when the patient became fearful which was recovered because of the aid of the grand-daughter. To give informed consent, a patient requires adequate understanding which this relative provided throughout the examination.
 
It could be argued that we did not ensure justice for this patient, as a similar patient may have been provided with a professional interpreter for the entirety of the assessment. However in this case, the reassuring guidance provided by the grand-daughter gave immeasurable relief to the patient.  

The core principles of beneficence and non-maleficence were key in opting for the utilisation of the grand-daughter as an interpreter in that precise moment. Cultural elements were also in favour of this as the patient was comfortable with this situation.

In summary, using a family member as a translator is often inappropriate due the risk of breeching confidentiality. However, in this scenario the relative was able to dispel the fear and anxiety that an unfamiliar, professional interpreter would be unable to.  This enabled us to care for the patient whilst upholding the core ethical principles, integral to our practice.